MR imaging of the carpal tunnel: normal anatomy and preliminary findings in the carpal tunnel syndrome

MR imaging was performed through the carpal tunnel in 18 wrists of nine normal volunteers and compared with cryomicrotome sections from cadaver wrists. MR reliably imaged the flexor retinaculum and carpal bones and thus defined the borders of the carpal tunnel. In all cases the median nerve was seen as an ovoid structure of moderate signal intensity and was easily distinguished from the flexor tendons of the hands running in the carpal tunnel. The tendons were separated from each other by their tendon sheaths, and this allowed for identification of the various tendons. Anatomic variations encountered in the normal volunteers included anomalous positioning of the origin of the lumbrical muscles within the carpal tunnel in two, persistent median arteries in two, and interposition of the median nerve between the flexor pollicis longus and the superficial flexor tendon to the index finger in one. Preliminary observations in 10 wrists of patients with carpal tunnel syndrome include segmental and diffuse swelling of the median nerve in six, distortion of the nerve in one, and thickening of the tendon sheaths in one. We conclude that MR imaging accurately and reliably displays the normal anatomy of the carpal tunnel and can detect morphologic changes in patients with carpal tunnel syndrome.