Relative displacement of the tendon and subsynovial connective tissue using ultrasound captures different phenomena than mechanical tendon shear.

The most common finding in carpal tunnel syndrome is fibrosis and thickening of the subsynovial connective tissue (SSCT). While the SSCT mediates tendon gliding in the carpal tunnel, this histopathology suggests excessive shear forces are involved in injury development. Ultrasound is often used to quantify relative motion between the finger flexor tendons and SSCT as an indirect measure of "shear-strain"; however, the underlying mechanical implications of using ultrasound are not well understood. The middle flexor digitorum superficialis (FDS) tendon of 8 cadavers was moved in a combination of 2 wrist postures (neutral, flexed), 3 velocities (5, 10, 15cm/s), and 3 forces (10, 20, 30N) to assess ultrasound-based FDS-SSCT relative displacement while simultaneously quantifying tendon frictional work in the carpal tunnel. We found independent velocity effects for both constructs (relative displacement, ηp 2 =0.862, p<0.05; frictional work, ηp 2 =0.937, p<0.05), indicating ultrasound captured viscous gliding resistance owing to the gel-like inter-fibrillar matrix of the SSCT. FDS-SSCT relative displacement also increased independently in a flexed wrist posture (p=0.010) and with greater tendon force (p=0.036), likely representing strain dependant changes with tendon position. Alternatively, we found a significant posture×force interaction on tendon frictional work (p<0.01), due to, in part, greater surface friction against the transverse carpal ligament with a flexed wrist and high force. While ultrasound provided a different interpretation compared to direct measurement of mechanical shear, FDS-SSCT relative displacement successfully localized viscoelastic shear-strain, which may help elucidate the role of hand motion in SSCT pathology and CTS.