Evolution of the digital tendon locking mechanism in bats and dermopterans: A phylogenetic perspective

A tendon locking mechanism (TLM) in the digits of the feet has been described previously only in bats and birds. In bats, this mechanism typically consists of a patch of tuberculated fibrocartilage cells on the plantar surface of the proximal flexor tendons, and a corresponding plicated portion of the adjacent flexor tendon sheath. The two components mesh together like parts of a ratchet, locking the digit in a flexed position until the mechanism is disengaged. This system apparently allows bats to hang for long periods of time with reduced muscular activity. In this study, we document for the first time the presence of a similar tendon lock in dermopterans, an occurrence that provides additional support for the hypothesis that dermopterans and bats are sister taxa. The present work also includes observations on the morphology of the digital tendon system in chiropteran species not previously examined, including members of the Craseonycteridae, Mystacinidae and Kerivoulinae. Unlike other bats that have a TLM,Craseonycteris andKerivoula have a plicated proximal tendon sheath but lack distinct tubercles on the flexor tendon. This condition may be related to small body size or may represent an evolutionary intermediate between the presence of a well-developed TLM and the complete absence of this structure. Phyllostomids apparently lack the ratchet-like TLM typical of other bats, instead exhibiting modifications of the tendon sheath that may contribute to its function as a friction lock. Consideration of the distribution of TLM structures in the context of previous phylogenetic hypotheses suggests that a ratchet-type tendon lock was lost and reexpressed at least once and perhaps several times within Microchiroptera. The friction lock is an autapomorphy of Phyllostomidae.     

A tendon-locking mechanism in two climbing rodents,Muscardinus avellanarius and Micromys minutus (Mammalia,Rodentia)

Having compared the microanatomy of the toes of a terrestrial to two climbing species, adaptations were found in the flexor tendons and in the integument. In contrast to Crocidura russula, both Muscardinus avellanarius and Micromys minutus have a tendon-locking mechanism (TLM) that is engaged when the middle phalanx is bent. A ventral thickening of the flexor tendon is situated deep to a thickened portion of the ventral tendon sheath. When twigs or stalks are grasped, the TLM allows less muscular energy to be expended. In C. russula glands are restricted to the terminal pads, but in the climbing species they occur in the sole of the toes as well. In the reed-living M. minutus knob-shaped integumental thickenings, together with the digital pads, stabilize the grip. In contrast the arboreal M. avellanarius often climbs thick branches and shows adaptations for pressing the sole of the feet against the surface. Thereby the tendon attached to the plantar integument of the toes transfers the muscle force directly to the bark. Unlike the other digits on the forefeet of both climbing species, no TLM is present in the anterior digit. In M. minutus this short digit is twisted towards the palm and, with the carpal pads, provides an abutment against the grasping fingers. In M. avellanarius the anterior digit has very thin tendons and is that much reduced in length that it is completely integrated into the digital pad where it acts, at best, as a lateral support of the pad. © 1996 Wiley-Liss, Inc.     

Chiropteran tendon locking mechanism

Rather than the usual mammalian scheme in which tendon and sheath surfaces provide as little friction as possible, the tendons and sheaths of many bats have a locking segment on the manual and pedal flexor tendon complex. This tendon locking mechanism (TLM) exists opposite the proximal phalanges of each toe and pollex of many bats. Its structure, similar to a ratchet mechanism, assists bats in hanging with little muscular effort. The third digit of the pelvic limb and the pollex of species representing 15 chiropteran families were studied to determine the presence or absence, morphology, and function of the TLM. Most of the species studied have a TLM consisting of a patch of tubercles on the ventral surface of the flexor tendon associated with the proximal phalanx of each pollex or toe. The sheath adjacent to this portion of the flexor tendon has a series of transverse folds or ridges, which, when engaged with the tubercles on the tendon, lock the tendon in place. The TLM is similar in megachiropterans and microchiropterans possessing it. The TLM is absent, however, in some of the microchiropterans studied, most notably in the phyllostomids. Since many birds have a TLM similar to that of bats, it is an excellent example of the convergent evolution of a feature brought about by similar functional pressures on birds and bats. © 1993 Wiley-Liss, Inc.     

Structural modifications involved in the fore- and hind limb grip of some flying foxes (Chiroptera: Pteropodidae)

A mechanism which enables flying foxes to lock their hind limb digits and thumbs in flexion is described. The deep digital tendons of the hind limbs have roughened fibrocartilage surfaces. The adjacent flexor tendon sheath supports ridges which interact with the rough tendon surface, temporarily 'locking' the two structures together. This tendon locking mechanism is of importance as it enables bats to reduce the energetic cost of hanging from branches. It does this by reducing, or eliminating, the need for digital flexor muscle activity.     

Estimation of finger muscle tendon tensions and pulley forces during specific sport-climbing grip techniques

The present work displayed the first quantitative data of forces acting on tendons and pulleys during specific sport-climbing grip techniques. A three-dimensional static biomechanical model was used to estimate finger muscle tendon and pulley forces during the "slope" and the "crimp" grip. In the slope grip the finger joints are flexed, and in the crimp grip the distal interphalangeal (DIP) joint is hyperextended while the other joints are flexed. The tendons of the flexor digitorum profundus and superficialis (FDP and FDS), the extensor digitorum communis (EDC), the ulnar and radial interosseus (UI and RI), the lumbrical muscle (LU) and two annular pulleys (A2 and A4) were considered in the model. For the crimp grip in equilibrium conditions, a passive moment for the DIP joint was taken into account in the biomechanical model. This moment was quantified by relating the FDP intramuscular electromyogram (EMG) to the DIP joint external moment. Its intensity was estimated at a quarter of the external moment. The involvement of this parameter in the moment equilibrium equation for the DIP joint is thus essential. The FDP-to-FDS tendon-force ratio was 1.75:1 in the crimp grip and 0.88:1 in the slope grip. This result showed that the FDP was the prime finger flexor in the crimp grip, whereas the tendon tensions were equally distributed between the FDP and FDS tendons in the slope grip. The forces acting on the pulleys were 36 times lower for A2 in the slope grip than in the crimp grip, while the forces acting on A4 were 4 times lower. This current work provides both an experimental procedure and a biomechanical model that allows estimation of tendon tensions and pulley forces crucial for the knowledge about finger injuries in sport climbing.     

Moment arms of the human digital flexors

For the extrinsic hand flexors (flexor digitorum profundus, FDP; flexor digitorum superficialis, FDS; flexor pollicis longus, FPL), moment arm corresponds to the tendon's distance from the center of the metacarpalphalangeal (MP), proximal interphalangeal (PIP), or distal interphalangeal (DIP) joint. The clinical value of establishing accurate moment arms has been highlighted for biomechanical modeling, the development of robotic hands, designing rehabilitation protocols, and repairing flexor tendon pulleys (Brand et al., 1975; An et al., 1983; Thompson and Giurintano, 1989; Deshpande et al., 2010; Wu et al., 2010). In this study, we define the moment arms for all of the extrinsic flexor tendons of the hand across all digital joints for all digits in cadaveric hands.     

Connective tissue reinforcing structures of the digital tendon sheaths of the human hand

At a greater number of humid preparated human hands, all the ligamentous supports of the digital tendon sheath were exposed and their dimensions were determined. The osteofibrous channels, which contain the long flexor tendons of the digits, were bounded on the one hand by transversely concave shaft areas of the phalanges and the palmar ligaments and on the other side by the fibrous parts of the tendon sheath. From the second to the 5th finger, it has a regular extension of length, which begins proximal at the heads of the metacarpal bones and runs distal to the base of the nail phalanx. In some cases, there is a continuous communication between the digital tendon sheath of the little finger and the carpal synovial sheath. The tendon sheath of the flexor pollicis longus muscle in comparison with it is always in an open communication with the radial synovial sac of the wrist. At the fibrous supports of the digital tendon sheath, one can find constant and inconstant ligamentous structures. Regular shaped ligaments consist of annular fibers (A1 to A5). The proximal complex of fiber supports is a formation of the A1 and A2 ligaments. The band A1 can be divided into 2 ligaments both of roughly equal length, which lay between the head of the metacarpal bone and the base of the proximal phalanx. The strongest fibrous support of the whole digital tendon sheath represents the band A2. It is attached to the midth of the proximal phalanx and increases in strength from proximal to distal. The middle length varies between 6.7 mm at the thumb and 18.7 mm at the middle finger. The distal margin is strengthened by fibrocartilage tissue to be in accordance with the important function as a pulley. The annular band A4 forms the distal supporting complex height above the shaft of the middle phalanx. At the 2nd to the 5th finger it is, with a middle length of 6 to 7 mm, very much shorter than A2 and restrains first of all the tendon of the flexor digitorum profundus muscle. In the area of the interphalangeal joints, we can find the annular bands A3 and A5, which fiber texture is formed variable. Both ligaments are attached on either both sides with the joint capsule and the palmar plate. The other inconstant supports of the digital sheaths are systematically recorded indeed (C1 to C3), but only in exceptional cases they exist of cruciform fibers (Lig. cruciatum).(ABSTRACT TRUNCATED AT 400 WORDS)     

A combined regimen of controlled motion following flexor tendon repair in "no man's land"

A program of controlled motion following repair of flexor tendons in the hand is presented. This regimen incorporates the features of active extension against rubber band passive flexion, as well as those of controlled passive extension and passive flexion. In this prospective study, 44 digits with complete lacerations of the flexor digitorum profundus and flexor digitorum superficialis in zone 2 were treated. Using the Strickland formula of total active motion of the interphalangeal joints, 36 fingers (82 percent) were rated "excellent"; 7 fingers (16 percent) were rated "good"; 1 finger (2 percent) was rated "fair"; none was rated "poor". There was no statistical difference between the results of delayed primary repair and immediate primary repair.     

A kinematic model of the flexor tendons of the hand

The multi-joint model is a kinematic simulation of the long flexor tendons of the fingers. The tendons modeled are the flexor pollicis longus, the flexor digitorum profundus, and the flexor digitorum superficialis. The simulated tendons are displayed on an Evans and Sutherland PS330 color graphics terminal attached to a display of articulated bones of the hand. As a user changes the position of the joints of the simulated hand, the simulation displays the new tendon path and the excursion of the tendon for the new position of the hand. The multi-joint model is one component of a comprehensive model for use in a hand biomechanics computer workstation.     

Telemetered electromyography of flexor digitorum profundus and flexor digitorum superficialis in Pan troglodytes and implications for interpretation of the O. H. 7 hand.

The importance of knuckle-walking in the locomotor repertoire of African apes raises the possibility that the long digital flexors may be specially adapted more to meet the demands of ground quadrupedalism than those of suspension. To investigate this possibiltiy, the activities of the flexor digitorum superficialis and flexor digitorum profundus were studied by means of telemetered electromyography in three chimpanzees. Results clearly indicate that the fasciculi of the muscles to digits bearing weight in knuckle-walking are not called upon to contract in quadrupedal postures or in slow and moderately fast quadrupedal locomotion except to help clear the fingers from the ground as the forelimb begins its recovery stroke. At the most rapid speeds, a slight to moderate level of activity sometimes occurs in the latter half of stance phase. The long digital flexors display maximum and sustained activity during suspension. It is concluded that any role for these muscles in maintenance of stability at the metacarpophalangeal joints during knuckle-walking must be predominantly passive. Prominent markings for insertions of these muscles in a fossil hand (such as O.H. 7) suggest use of the forelimb in suspensory climbing behaviors.     

Friction between human finger flexor tendons and pulleys at high loads

A method was developed to indirectly measure friction between the flexor tendons and pulleys of the middle and ring finger in vivo. An isokinetic movement device to determine maximum force of wrist flexion, interphalangeal joint flexion (rolling in and out) and isolated proximal interphalangeal (PIP) joint flexion was built. Eccentric and concentric maximum force of these three different movements where gliding of the flexor tendon sheath was involved differently (least in wrist flexion) was measured and compared. Fifty-one hands in 26 male subjects were evaluated. The greatest difference between eccentric and concentric maximum force (29.9%) was found in flexion of the PIP joint. Differences in the rolling in and out movement (26.8%) and in wrist flexion (14.5%) were significantly smaller. The force of friction between flexor tendons and pulleys can be determined by the greater difference between eccentric and concentric maximum force provided by the same muscles in overcoming an external force during flexion of the interphalangeal joints and suggests the presence of a non-muscular force, such as friction. It constitutes of 9% of the eccentric flexion force in the PIP joint and therefore questions the low friction hypothesis at high loads.     

Wrist and digital joint motion produce unique flexor tendon force and excursion in the canine forelimb

The force and excursion within the canine digital flexor tendons were measured during passive joint manipulations that simulate those used during rehabilitation after flexor tendon repair and during active muscle contraction, simulating the active rehabilitation protocol. Tendon force was measured using a small buckle placed upon the tendon while excursion was measured using a suture marker and video analysis method. Passive finger motion imposed with the wrist flexed resulted in dramatically lower tendon force (approximately 5 N) compared to passive motion imposed with the wrist extended (approximately 17 N). Lower excursions were seen at the level of the proximal interphalangeal joint with the wrist flexed (approximately 1.5 mm) while high excursion was observed when the wrist was extended or when synergistic finger and wrist motion were imposed (approximately 3.5 mm). Bivariate discriminant analysis of both force and excursion data revealed a natural clustering of the data into three general mechanical paradigms. With the wrist extended and with either one finger or four fingers manipulated, tendons experienced high loads of approximately 1500 g and high excursions of approximately 3.5 mm. In contrast, the same manipulations performed with the wrist flexed resulted in low tendon forces (4-8 N) and low tendon excursions of approximately 1.5 mm. Synergistic wrist and finger manipulation provided the third paradigm where tendon force was relatively low (approximately 4 N) but excursion was as high as those seen in the groups which were manipulated with the wrist extended. Active muscle contraction produced a modest tendon excursion (approximately 1 mm) and high or low tendon force with the wrist extended or flexed, respectively. These data provide the basis for experimentally testable hypotheses with regard to the factors that most significantly affect functional recovery after digital flexor tendon injury and define the normal mechanical operating characteristics of these tendons.     

Roping injuries in the hand: mechanism of injury and functional results

Twenty-two patients with roping injuries to 38 digits, including 19 patients injured while team roping, are discussed. Ten digits in nine patients were successfully revascularized or replanted. Seven digits in three patients failed after initial success. One patient is included in both categories. The failure rate is 41 percent for all 17 digits. Average follow-up is 18 months. The dominant hand was injured in 83 percent of team roping injuries; the thumb is the most commonly injured digit. Average interphalangeal motion for thumb replants is zero; for revascularizations, it is 47 degrees. There was 43 percent return of pinch strength for thumb replants compared to 83 percent return for a single thumb revascularization. The most common mechanism of injury was catching the roping thumb in the "thumb up" position during dallying. There are good motion and pinch strength with thumb revascularizations provided tendons and the interphalangeal joint are intact. Reconstruction of the flexor pollicis longus in the replanted thumb gave poor results. Primary tenodesis or arthrodesis is recommended.     

Changes in bones of the foot and development of inserting tendons of the lower leg musculature in tibial aplasia

Skeleton, muscles and tendons were investigated in 3 lower legs with aplasia of the tibia. The tibiofibular joint appears to be rather a syndesmosis than a diarthrosis. In all 3 cases, talus and calcaneus are connected by a synostosis. Also in the other parts of the skeleton of the feet, synarthroses with different extensions are found. The muscles, normally originating from the tibia, have shifted their origin to the fibula. The proximal part of the inserting tendons under the retinacula is quite normal. Also, their distal part in the region of the metatarsalia and of the digits exhibits no alterations. In the region of the tarsus in which already alterations in bone formation are found, the tendons of the flexor muscles of the toes exhibit some variations. Often the muscles show a new, strong insertion into the bones of the tarsus. The normal connection between the proximal and distal parts of the tendons is sometimes still indicated by a thin bundle of collagenous fibers. In all 3 cases, the tibialis anterior muscle inserts into the distal part of the tendons of the flexor muscles of the toes, indicating that there are also connections between tendons of muscles from different blastemas.     

Estimation of the effective static moment arms of the tendons in the index finger extensor mechanism

A novel technique to estimate the contribution of finger extensor tendons to joint moment generation was proposed. Effective static moment arms (ESMAs), which represent the net effects of the tendon force on joint moments in static finger postures, were estimated for the 4 degrees of freedom (DOFs) in the index finger. Specifically, the ESMAs for the five tendons contributing to the finger extensor apparatus were estimated by directly correlating the applied tendon force to the measured resultant joint moments in cadaveric hand specimens. Repeated measures analysis of variance revealed that the finger posture, specifically interphalangeal joint angles, had significant effects on the measured ESMA values in 7 out of 20 conditions (four DOFs for each of the five muscles). Extensor digitorum communis and extensor indicis proprius tendons were found to have greater MCP ESMA values when IP joints are flexed, whereas abduction ESMAs of all muscles except extensor digitorum profundus were mainly affected by MCP flexion. The ESMAs were generally smaller than the moment arms estimated in previous studies that employed kinematic measurement techniques. Tendon force distribution within the extensor hood and dissipation into adjacent structures are believed to contribute to the joint moment reductions, which result in smaller ESMA values.     

Differential expression of transforming growth factor-beta receptors in a rabbit zone II flexor tendon wound healing model

Flexor tendon repair in zone II is complicated by adhesions that impair normal postoperative gliding. Transforming growth factor-beta (TGF-beta) is a family of growth factors that has been implicated in scar formation. The TGF-beta family of proteins binds to three distinct classes of membrane receptors, termed RI, RII, and RIII. In this study, we analyzed the temporal and spatial distribution of TGF-beta receptor isoforms (RI, RII, and RIII) in a rabbit zone II flexor tendon wound healing model.Twenty-eight adult New Zealand White rabbit forepaws underwent isolation of the middle digit flexor digitorum profundus tendon in zone II. The tendons underwent transection in zone II and immediate repair. The tendons were harvested at increasing time points: 1, 3, 7, 14, 28, and 56 days postoperatively (n = 4 at each time point). The control flexor tendons were harvested without transection and repair (n = 4). Immunohistochemical analysis was used to detect the expression patterns for TGF-beta receptors RI, RII, and RIII.Immunohistochemical staining of the transected and repaired tendons demonstrated up-regulation of TGF-beta RI, RII, and RIII protein levels. TGF-beta receptor production in the experimental group (transection and repair) was concentrated in the epitenon and along the repair site. Furthermore, the TGF-beta receptor expression levels peaked at day 14 and decreased by day 56 postoperatively. In contrast, minimal receptor expression was observed in the untransected and unrepaired control tendons.These data provide evidence that (1) TGF-beta receptors are up-regulated after injury and repair; (2) peak levels of TGF-beta receptor expression occurred at day 14 and decreased by day 56 after wounding and repair; and (3) both the tendon sheath and epitenon have the highest receptor expression, and both may play critical roles in flexor tendon wound healing. Understanding the up-regulation of TGF-beta isoforms and the up-regulation of their corresponding receptors during flexor tendon wound healing provides new targets for biomolecular modulation of postoperative scar formation.     

Finger joint coordination during tapping

We investigated finger joint coordination during tapping by characterizing joint kinematics and torques in terms of muscle activation patterns and energy profiles. Six subjects tapped with their index finger on a computer keyswitch as if they were typing on the middle row of a keyboard. Fingertip force, keyswitch position, kinematics of the metacarpophalangeal (MCP) and the proximal and distal interphalangeal (IP) joints, and intramuscular electromyography of intrinsic and extrinsic finger muscles were measured simultaneously. Finger joint torques were calculated based on a closed-form Newton–Euler inverse dynamic model of the finger. During the keystroke, the MCP joint flexed and the IP joints extended before and throughout the loading phase of the contact period, creating a closing reciprocal motion of the finger joints. As the finger lifted, the MCP joint extended and the interphalangeal (IP) joints flexed, creating an opening reciprocal motion. Intrinsic finger muscle and extrinsic flexor activities both began after the initiation of the downward finger movement. The intrinsic finger muscle activity preceded both the IP joint extension and the onset of extrinsic muscle activity. Only extrinsic extensor activity was present as the finger was lifted. While both potential energy and kinetic energy are present and large enough to overcome the work necessary to press the keyswitch, the motor control strategies utilize the muscle forces and joint torques to ensure a successful keystroke.     

Identification of surgically-induced longitudinal lesions of the equine deep digital flexor tendon in the digital flexor tendon sheath using contrast-enhanced ultrasonography: an <Emphasis Type="Italic">ex-vivo</Emphasis> pilot study

Background

Longitudinal tears in the lateral aspect of the deep digital flexor tendon are the most common causes of pain localised to the equine digital flexor tendon sheath. However conventional ultrasonographic techniques provide limited information about acute lesions. Ultrasonographic contrast agents are newly developed materials that have contributed to advancement in human diagnostic imaging. They are currently approved for intravenous use in human and animal models. In this study we described intrathecal use in the horse. This study was undertaken to evaluate the reliability of standard and angle contrast-enhanced ultrasonography to detect and characterize surgically-induced longitudinal lesions in the deep digital flexor tendons.In this pilot study surgically-induced lesions were created in the lateral aspect of the deep digital flexor tendon within the digital flexor tendon sheath in 10 isolated equine limbs to generate a replicable model for naturally occurring lesions. Another 10 specimens were sham operated. All the limbs were examined ultrasonographically before and shortly after the intrasynovial injection of an ultrasound contrast agent containing stabilised microbubbles. The images were blindly evaluated to detect the ability to identify surgically-created lesions. The deep digital flexor tendons were dissected and a series of slices were obtained. The depth of longitudinal defects identified with contrast-enhanced ultrasound scans was compared to the real extent of the lesions measured in the corresponding gross tendon sections.

Results

Contrast-enhanced ultrasonography with both angle and standard approach provided a significant higher proportion of correct diagnoses compared to standard and angle contrast ultrasonography (p < 0.01). Contrast-enhanced ultrasonography reliably estimated the depth of surgically-induced longitudinal lesions in the deep digital flexor tendons.

Conclusion

Contrast-enhanced ultrasound of the digital flexor tendon sheath could be an effective tool to detect intrasynovial longitudinal tears of the deep digital flexor tendon, although an in vivo study is required to confirm these results for naturally occurring lesions.

     

Hind limb myology of the common hippopotamus,Hippopotamus amphibius (Artiodactyla: Hippopotamidae)

Based on morphological traits, hippos have traditionally been classified with pigs and peccaries in the suborder Suiformes. However, molecular data indicate that hippos and cetaceans are sister taxa. This study analyses muscle characters of the common hippo hind limb in order to clarify the phylogenetic relationships and functional anatomy of hippos. Several muscles responsible for propelling the body through water are robust and display extensive fusions, including mm. semimembranosus, semitendinosus, biceps femoris and gluteus superficialis. In addition, common hippos retain long flexor and extensor tendons for each digit, reflecting the fact that all four toes are weight‐bearing. These flexor tendons, together with the well‐developed intrinsic muscles of the pes, serve to adduct the digits, preventing splaying of the toes when walking on soft terrain. Lastly, common hippos retain a number of primitive features, including the presence of m. articularis coxae, a well‐developed m. obturator internus, superficialis and profundus tendons to all digits, mm. flexor digitorum brevis, abductor digiti V, lumbricalis IV, adductores digitorum II and V, and two mm. interossei per digit. Pygmy hippos share these features. Thus, hippopotamids retain muscles that have been lost in the majority of artiodactyls, including other suiforms. These and previously reported findings for the forelimb support the molecular data in indicating an early divergence of the Hippopotamidae from the rest of the Artiodactyla. © 2010 The Linnean Society of London, Zoological Journal of the Linnean Society, 2010, 158 , 661–682.     

Apparent transverse compressive material properties of the digital flexor tendons and the median nerve in the carpal tunnel

Carpal tunnel syndrome is a frequently encountered peripheral nerve disorder caused by mechanical insult to the median nerve, which may in part be a result of impingement by the adjacent digital flexor tendons. Realistic finite element (FE) analysis to determine contact stresses between the flexor tendons and median nerve depends upon the use of physiologically accurate material properties. To assess the transverse compressive properties of the digital flexor tendons and median nerve, these tissues from ten cadaveric forearm specimens were compressed transversely while under axial load. The experimental compression data were used in conjunction with an FE-based optimization routine to determine apparent hyperelastic coefficients (μ and α) for a first-order Ogden material property definition. The mean coefficient pairs were μ=35.3 kPa, α=8.5 for the superficial tendons, μ=39.4 kPa, α=9.2 for the deep tendons, μ=24.9 kPa, α=10.9 for the flexor pollicis longus (FPL) tendon, and μ=12.9 kPa, α=6.5 for the median nerve. These mean Ogden coefficients indicate that the FPL tendon was more compliant at low strains than either the deep or superficial flexor tendons, and that there was no significant difference between superficial and deep flexor tendon compressive behavior. The median nerve was significantly more compliant than any of the flexor tendons. The material properties determined in this study can be used to better understand the functional mechanics of the carpal tunnel soft tissues and possible mechanisms of median nerve compressive insult, which may lead to the onset of carpal tunnel syndrome.