Pathology of the flexor tendon sheath in the spontaneous carpal tunnel syndrome

Neal, N. C.; McManners, J.; Stirling, G. A.

doi:10.1016/0266-7681(87)90020-9

Cited by 67 publications

(45 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As the tunnel size and shape is uncommonly altered, increased pressure is assumed to result from a change in volume or material properties of the contents of the tunnel, 8,9 of which the most likely is the SSCT, which is known to be fibrotic in patients with CTS. 8,[10][11][12] Ultrasound imaging has been described to detect pathologies such as thickening of the flexor tendons 13 and transverse carpal ligament, 14 shape and echogenicity alterations, restricted median nerve sliding in the carpal tunnel, 15,16 synovial proliferation, soft-tissue infection and joint effusion, tissue calcification and tumors, 17 persistent median artery, 18 tendinous and ligamentous injuries and swelling of the median nerve in the proximal part of the carpal tunnel, and flattening of the median nerve in the distal part of the carpal tunnel. 6,14,[19][20][21] High-resolution ultrasonography with approximately 7 MHz transducers is suitable for assessment of dynamic changes in the tunnel.…”

Section: Introductionmentioning

confidence: 99%

High‐resolution ultrasound analysis of subsynovial connective tissue in human cadaver carpal tunnel

Ettema

Bělohlávek

Zhao

et al. 2006

Journal Orthopaedic Research

View full text Add to dashboard Cite

The carpal tunnel contains the median nerve, nine flexor tendons, two synovial bursae, and peritendinous subsynovial connective tissue (SSCT). Fibrosis of the SSCT is the most consistent pathological finding in patients with carpal tunnel syndrome. We investigated the anatomy and gliding characteristics of the flexor digitorum superficialis tendon and its adjacent SSCT with high-resolution ultrasound (15 MHz). Our hypotheses were that tendon and SSCT are distinguishable by ultrasound and that their velocities during tendon excursion are different. Qualitative ultrasound analysis of a flexor tendon and its SSCT was performed on five cadaver wrists and correlated to respective findings after anatomical study of the same cadavers. Quantitative Doppler velocity analysis of eight cadaver wrists was done to assess the sliding movement of the tendon and its SSCT within the carpal tunnel. No significant difference was found between the thickness of SSCT measured by ultrasound and that measured directly after dissection. The SSCT moved slower than its flexor tendon. The SSCT velocities were statistically different from the tendon velocities (t-test, p > 0.001). High-resolution ultrasound is a very precise method to display the anatomy of the tendon and SSCT within the carpal tunnel, and their different velocities can be detected with Doppler. Noninvasive assessment of the thickness and velocity of the tenosynovium in carpal tunnel syndrome by high-resolution sonography might be a new diagnostic tool for disorders affecting the SSCT, especially carpal tunnel syndrome. ß

show abstract

Section: Introductionmentioning

confidence: 99%

High‐resolution ultrasound analysis of subsynovial connective tissue in human cadaver carpal tunnel

Ettema

Bělohlávek

Zhao

et al. 2006

Journal Orthopaedic Research

View full text Add to dashboard Cite

show abstract

“…In carpal tunnel syndrome (CTS), histological studies of the tenosynovium typically show edema, fibrosis, and microvascular damage [8,9,15,[19][20][21]23,26]. While the pathology of the SSCT has been characterized under light microscopy ( Fig.…”

Section: Introductionmentioning

confidence: 99%

Immunolocalization of collagen types in the subsynovial connective tissue within the carpal tunnel in humans

Jinrok¹,

Zhao²,

Amadio³

et al. 2005

Journal Orthopaedic Research

View full text Add to dashboard Cite

The tenosynovium within the carpal tunnel consists of a single layer of synovial cells, which lines the bursae within the carpal tunnel, and the subsynovial connective tissue (SSCT), which contains the tendon vasculature and other structural elements. In this study, we used immunogold labeling to localize collagen types within the SSCT in three cadaver specimens and three patients with carpal tunnel syndrome. Positive labeling for collagen types I, 111 and VI was found with immunoelectron microscopy. Collagen types I and 111 were codistributed within the SSCT. Type VI was primarily located in microfibrillar structures between collagen bundles, between elastin and collagen bundles and between collagen bundles and cells. There was no difference in the distribution of collagen types when comparing cadaver specimens and carpal tunnel patients.

show abstract

“…Histological studies have demonstrated that drastic connective tissue remodeling takes place in the flexor tenosynovium with progression of CTS, with various inflammatory mediators such as cytokines, prostaglandins, and proteases being involved in the process (7)(8)(9)(10)(11)(12)(13)(14)(15). Since the critical pathophysiology of CTS arises in the flexor tenosynovium, with the median nerve affected secondarily as a result of changes in the physical properties of the tenosynovium, magnetic resonance imaging (MRI), with its ability to detect soft-tissue abnormalities, has been suggested as an ideal diagnostic adjunct to evaluate the soft tissues within the carpal tunnel.…”

mentioning

confidence: 99%

Palmar bowing of the flexor retinaculum on wrist MRI correlates with subjective reports of pain in carpal tunnel syndrome

Tsujii

Hirata

Morita

et al. 2009

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Purpose:To investigate the utility of palmar bowing of the flexor retinaculum (PBFR) on magnetic resonance imaging (MRI) as an adjunct to presurgical evaluation of carpal tunnel syndrome (CTS). Materials and Methods:The CTS group comprised 48 women with CTS diagnosed from clinical history, physical examination, and electrophysiological findings. Another 21 healthy women with no symptoms of CTS served as controls. The CTS group was divided into four subgroups based on symptom duration. CTS patients were preoperatively assessed for symptom severity using a Likert scale. In both groups, palmar bowing of the flexor retinaculum (PBFR) was measured on MRI. Furthermore, relationships with disease duration, subjective symptom severity, and electrophysiological findings were assessed in the CTS group.Results: Although PBFR increased significantly in all CTS groups when compared to the control group, PBFR in patients who complained of severe pain tended to exceed that in patients with mild to moderate pain. Statistical analysis showed a positive correlation between PBFR and pain severity. In contrast, PBFR did not reflect median nerve function.Conclusion: PBFR as seen on MRI seems to correlate significantly with patients' subjective reports of pain severity.Key Words: carpal tunnel syndrome; magnetic resonance imaging; palmar flexor bowing of flexor retinaculum; pain severity.

show abstract

Pathology of the flexor tendon sheath in the spontaneous carpal tunnel syndrome

Cited by 67 publications

References 8 publications

High‐resolution ultrasound analysis of subsynovial connective tissue in human cadaver carpal tunnel

High‐resolution ultrasound analysis of subsynovial connective tissue in human cadaver carpal tunnel

Immunolocalization of collagen types in the subsynovial connective tissue within the carpal tunnel in humans

Palmar bowing of the flexor retinaculum on wrist MRI correlates with subjective reports of pain in carpal tunnel syndrome

Contact Info

Product

Resources

About