Changes in the functional structure of the tenosynovium in idiopathic carpal tunnel syndrome: A scanning electron microscope study

Anke M. Ettema, Peter C Amadio, Chunfeng D Zhao, Lester E. Wold, Megan M. O'Byrne, Steven Lawrence Moran, Kai Nan An

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

BACKGROUND: The subsynovial connective tissue lies between the flexor tendons and visceral synovium in the carpal tunnel. Although tenosynovial fibrosis is nearly universally noted in patients with carpal tunnel syndrome, the relationship, if any, between the fibrosis and nerve abnormalities is unknown. The authors used light and scanning electron microscope imaging of the subsynovial connective tissue to gather information about its organization. METHODS: Human subsynovial connective tissue was studied to determine its ultrastructural morphology. Biopsy specimens of 11 patients (12 hands) with idiopathic carpal tunnel syndrome, 14 cadaver controls, and two cadavers with a history of carpal tunnel syndrome were obtained for scanning electron microscopic imaging and histopathologic examination. RESULTS: The visceral synovial layer is an uninterrupted membrane that defines the bursa dorsally. The subsynovial connective tissue consists of fibrous bundles that run parallel to the tendon, interconnected by smaller fibrous fibers. It connects to the synovial membrane and the flexor tendons. During tendon motion, the loose fibers between adjacent layers are stretched. The control tissue showed interconnections between all the parallel layers, whereas in patients with idiopathic carpal tunnel syndrome, these interconnections were absent, replaced with thicker parallel fibrous bundles. Similar changes were found in the cadaver carpal tunnel syndrome specimens. Pathologic changes in the patient and cadaver carpal tunnel syndrome specimens were most apparent close to the tendon and became progressively less severe in more superficial layers. CONCLUSIONS: The authors' observation that the most severe changes in the subsynovial connective tissue were found close to the tendon suggests that these changes may be the result of a shearing injury.

Original languageEnglish (US)
Pages (from-to)1413-1422
Number of pages10
JournalPlastic and Reconstructive Surgery
Volume118
Issue number6
DOIs
StatePublished - Nov 2006

Fingerprint

Carpal Tunnel Syndrome
Tendons
Connective Tissue
Electrons
Cadaver
Synovial Membrane
Fibrosis
Wrist
Hand
Biopsy
Light
Membranes
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

Cite this

Changes in the functional structure of the tenosynovium in idiopathic carpal tunnel syndrome : A scanning electron microscope study. / Ettema, Anke M.; Amadio, Peter C; Zhao, Chunfeng D; Wold, Lester E.; O'Byrne, Megan M.; Moran, Steven Lawrence; An, Kai Nan.

In: Plastic and Reconstructive Surgery, Vol. 118, No. 6, 11.2006, p. 1413-1422.

Research output: Contribution to journalArticle

@article{197d6b841f104203ada3da8c9ef77529,
title = "Changes in the functional structure of the tenosynovium in idiopathic carpal tunnel syndrome: A scanning electron microscope study",
abstract = "BACKGROUND: The subsynovial connective tissue lies between the flexor tendons and visceral synovium in the carpal tunnel. Although tenosynovial fibrosis is nearly universally noted in patients with carpal tunnel syndrome, the relationship, if any, between the fibrosis and nerve abnormalities is unknown. The authors used light and scanning electron microscope imaging of the subsynovial connective tissue to gather information about its organization. METHODS: Human subsynovial connective tissue was studied to determine its ultrastructural morphology. Biopsy specimens of 11 patients (12 hands) with idiopathic carpal tunnel syndrome, 14 cadaver controls, and two cadavers with a history of carpal tunnel syndrome were obtained for scanning electron microscopic imaging and histopathologic examination. RESULTS: The visceral synovial layer is an uninterrupted membrane that defines the bursa dorsally. The subsynovial connective tissue consists of fibrous bundles that run parallel to the tendon, interconnected by smaller fibrous fibers. It connects to the synovial membrane and the flexor tendons. During tendon motion, the loose fibers between adjacent layers are stretched. The control tissue showed interconnections between all the parallel layers, whereas in patients with idiopathic carpal tunnel syndrome, these interconnections were absent, replaced with thicker parallel fibrous bundles. Similar changes were found in the cadaver carpal tunnel syndrome specimens. Pathologic changes in the patient and cadaver carpal tunnel syndrome specimens were most apparent close to the tendon and became progressively less severe in more superficial layers. CONCLUSIONS: The authors' observation that the most severe changes in the subsynovial connective tissue were found close to the tendon suggests that these changes may be the result of a shearing injury.",
author = "Ettema, {Anke M.} and Amadio, {Peter C} and Zhao, {Chunfeng D} and Wold, {Lester E.} and O'Byrne, {Megan M.} and Moran, {Steven Lawrence} and An, {Kai Nan}",
year = "2006",
month = "11",
doi = "10.1097/01.prs.0000239593.55293.c7",
language = "English (US)",
volume = "118",
pages = "1413--1422",
journal = "Plastic and Reconstructive Surgery",
issn = "0032-1052",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Changes in the functional structure of the tenosynovium in idiopathic carpal tunnel syndrome

T2 - A scanning electron microscope study

AU - Ettema, Anke M.

AU - Amadio, Peter C

AU - Zhao, Chunfeng D

AU - Wold, Lester E.

AU - O'Byrne, Megan M.

AU - Moran, Steven Lawrence

AU - An, Kai Nan

PY - 2006/11

Y1 - 2006/11

N2 - BACKGROUND: The subsynovial connective tissue lies between the flexor tendons and visceral synovium in the carpal tunnel. Although tenosynovial fibrosis is nearly universally noted in patients with carpal tunnel syndrome, the relationship, if any, between the fibrosis and nerve abnormalities is unknown. The authors used light and scanning electron microscope imaging of the subsynovial connective tissue to gather information about its organization. METHODS: Human subsynovial connective tissue was studied to determine its ultrastructural morphology. Biopsy specimens of 11 patients (12 hands) with idiopathic carpal tunnel syndrome, 14 cadaver controls, and two cadavers with a history of carpal tunnel syndrome were obtained for scanning electron microscopic imaging and histopathologic examination. RESULTS: The visceral synovial layer is an uninterrupted membrane that defines the bursa dorsally. The subsynovial connective tissue consists of fibrous bundles that run parallel to the tendon, interconnected by smaller fibrous fibers. It connects to the synovial membrane and the flexor tendons. During tendon motion, the loose fibers between adjacent layers are stretched. The control tissue showed interconnections between all the parallel layers, whereas in patients with idiopathic carpal tunnel syndrome, these interconnections were absent, replaced with thicker parallel fibrous bundles. Similar changes were found in the cadaver carpal tunnel syndrome specimens. Pathologic changes in the patient and cadaver carpal tunnel syndrome specimens were most apparent close to the tendon and became progressively less severe in more superficial layers. CONCLUSIONS: The authors' observation that the most severe changes in the subsynovial connective tissue were found close to the tendon suggests that these changes may be the result of a shearing injury.

AB - BACKGROUND: The subsynovial connective tissue lies between the flexor tendons and visceral synovium in the carpal tunnel. Although tenosynovial fibrosis is nearly universally noted in patients with carpal tunnel syndrome, the relationship, if any, between the fibrosis and nerve abnormalities is unknown. The authors used light and scanning electron microscope imaging of the subsynovial connective tissue to gather information about its organization. METHODS: Human subsynovial connective tissue was studied to determine its ultrastructural morphology. Biopsy specimens of 11 patients (12 hands) with idiopathic carpal tunnel syndrome, 14 cadaver controls, and two cadavers with a history of carpal tunnel syndrome were obtained for scanning electron microscopic imaging and histopathologic examination. RESULTS: The visceral synovial layer is an uninterrupted membrane that defines the bursa dorsally. The subsynovial connective tissue consists of fibrous bundles that run parallel to the tendon, interconnected by smaller fibrous fibers. It connects to the synovial membrane and the flexor tendons. During tendon motion, the loose fibers between adjacent layers are stretched. The control tissue showed interconnections between all the parallel layers, whereas in patients with idiopathic carpal tunnel syndrome, these interconnections were absent, replaced with thicker parallel fibrous bundles. Similar changes were found in the cadaver carpal tunnel syndrome specimens. Pathologic changes in the patient and cadaver carpal tunnel syndrome specimens were most apparent close to the tendon and became progressively less severe in more superficial layers. CONCLUSIONS: The authors' observation that the most severe changes in the subsynovial connective tissue were found close to the tendon suggests that these changes may be the result of a shearing injury.

UR - http://www.scopus.com/inward/record.url?scp=33750258173&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33750258173&partnerID=8YFLogxK

U2 - 10.1097/01.prs.0000239593.55293.c7

DO - 10.1097/01.prs.0000239593.55293.c7

M3 - Article

C2 - 17051112

AN - SCOPUS:33750258173

VL - 118

SP - 1413

EP - 1422

JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

IS - 6

ER -