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Sonographic Measurements of Subsynovial Connective Tissue Thickness in Patients With Carpal Tunnel Syndrome

2012; Wiley; Volume: 31; Issue: 1 Linguagem: Inglês

10.7863/jum.2012.31.1.31

1550-9613

Margriet H. M. van Doesburg, Aebele Mink van der Molen, Jacqueline Henderson, S. Stephen, Kai An, Peter C. Amadio,

Tribology and Lubrication Engineering

Journal of Ultrasound in MedicineVolume 31, Issue 1 p. 31-36 Original Research Sonographic Measurements of Subsynovial Connective Tissue Thickness in Patients With Carpal Tunnel Syndrome Margriet H. M. van Doesburg MD, Margriet H. M. van Doesburg MD Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center, Utrecht, the Netherlands Search for more papers by this authorAebele Mink van der Molen MD, PhD, Aebele Mink van der Molen MD, PhD Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center, Utrecht, the Netherlands Search for more papers by this authorJacqueline Henderson PhD, Jacqueline Henderson PhD Department of Orthopedic Biomechanics Laboratory, Division of Orthopedic Research)Search for more papers by this authorStephen S. Cha MS, Stephen S. Cha MS Division of Biomedical Statistics and Informatics Mayo Clinic, Rochester, Minnesota USASearch for more papers by this authorKai Nan An PhD, Kai Nan An PhD Department of Orthopedic Biomechanics Laboratory, Division of Orthopedic Research)Search for more papers by this authorPeter C. Amadio MD, Corresponding Author Peter C. Amadio MD [email protected] Department of Orthopedic Biomechanics Laboratory, Division of Orthopedic Research)Address correspondence to Peter C. Amadio, MD, Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA.Search for more papers by this author Margriet H. M. van Doesburg MD, Margriet H. M. van Doesburg MD Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center, Utrecht, the Netherlands Search for more papers by this authorAebele Mink van der Molen MD, PhD, Aebele Mink van der Molen MD, PhD Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center, Utrecht, the Netherlands Search for more papers by this authorJacqueline Henderson PhD, Jacqueline Henderson PhD Department of Orthopedic Biomechanics Laboratory, Division of Orthopedic Research)Search for more papers by this authorStephen S. Cha MS, Stephen S. Cha MS Division of Biomedical Statistics and Informatics Mayo Clinic, Rochester, Minnesota USASearch for more papers by this authorKai Nan An PhD, Kai Nan An PhD Department of Orthopedic Biomechanics Laboratory, Division of Orthopedic Research)Search for more papers by this authorPeter C. Amadio MD, Corresponding Author Peter C. Amadio MD [email protected] Department of Orthopedic Biomechanics Laboratory, Division of Orthopedic Research)Address correspondence to Peter C. Amadio, MD, Orthopedic Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA.Search for more papers by this author First published: 01 January 2012 https://doi.org/10.7863/jum.2012.31.1.31Citations: 15Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract Objectives A major pathologic finding in patients with idiopathic carpal tunnel syndrome is noninflammatory fibrosis and thickening of the subsynovial connective tissue. The objective of this study was to determine the ability of sonography to depict this thickening by comparing subsynovial connective tissue thickness in patients with carpal tunnel syndrome and healthy control participants. Methods Longitudinal sonograms of the middle finger superficial flexor tendon and subsynovial connective tissue were obtained at 3 levels: at the wrist crease (proximal tunnel), at the hook of the hamate (mid tunnel), and at the distal edge of the transverse carpal ligament (distal tunnel). The thickness of the subsynovial connective tissue perpendicular to the direction of the tendon and the diameter of the flexor digitorum superficialis tendon at the same level were measured. Then, a thickness ratio was created. Results At all 3 levels, the subsynovial connective tissue was thicker in patients than in controls (P < .0001) with a thickness ranging from 0.60 to 0.63 mm in patients and 0.46 to 0.50 mm in controls. The thickness ratio was significantly greater in patients at the hamate and distal levels (P = .018 and .013, respectively). Conclusions With this study, we have shown that it is possible to measure subsynovial connective tissue thickness with sonography, and the tissue is thicker in patients with carpal tunnel syndrome than in healthy controls. References 1Guimberteau JC. The sliding system: vascularized flexor tendon transfers. In: New Ideas in Hand Flexor Tendon Surgery. Pessac, France: Institut Aquitain De La Main; 2001: 17–32. 2Erel E, Dilley A, Greening J, Morris V, Cohen B, Lynn B. Longitudinal sliding of the median nerve in patients with carpal tunnel syndrome. J Hand Surg Br 2003; 28: 439–443. 3Greening J, Lynn B, Leary R, Warren L, O'Higgins P, Hall-Craggs M. The use of ultrasound imaging to demonstrate reduced movement of the median nerve during wrist flexion in patients with non-specific arm pain. J Hand Surg Br 2001; 26: 401–408. 4Lee D, van Holsbeeck MT, Janevski PK, Ganos DL, Ditmars DM, Darian VB. Diagnosis of carpal tunnel syndrome: ultrasound versus electromyography. Radiol Clin North Am 1999; 37: 859–872, x. 5Lluch AL. Thickening of the synovium of the digital flexor tendons: cause or consequence of the carpal tunnel syndrome? J Hand Surg Br 1992; 17: 209–212. 6Duncan I, Sullivan P, Lomas F. Sonography in the diagnosis of carpal tunnel syndrome. AJR Am J Roentgenol 1999; 173: 681–684. 7Lee CH, Kim TK, Yoon ES, Dhong ES. Correlation of high-resolution ultrasonographic findings with the clinical symptoms and electrodiagnostic data in carpal tunnel syndrome. Ann Plast Surg 2005; 54: 20–23. 8Nakamichi K, Tachibana S. Restricted motion of the median nerve in carpal tunnel syndrome. J Hand Surg Br 1995; 20: 460–464. 9Wong SM, Griffith JF, Hui AC, Lo SK, Fu M, Wong KS. Carpal tunnel syndrome: diagnostic usefulness of sonography. Radiology 2004; 232: 93–99. 10Ettema AM, Belohlavek M, Zhao C, Oh SH, Amadio PC, An KN. High-resolution ultrasound analysis of subsynovial connective tissue in human cadaver carpal tunnel. J Orthop Res 2006; 24: 2011–2020. 11Stevens JC. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve 1997; 20: 1477–1486. 12Donato G, Galasso O, Valentino P. Pathological findings in subsynovial connective tissue in idiopathic carpal tunnel syndrome. Clin Neuropathol 2009; 28: 129–135. 13Jinrok O, Zhao C, Amadio PC, An KN, Zobitz ME, Wold LE. Vascular pathologic changes in the flexor tenosynovium (subsynovial connective tissue) in idiopathic carpal tunnel syndrome. J Orthop Res 2004; 22: 1310–1315. 14Ettema AM, Amadio PC, Zhao C, Wold LE, An KN. A histological and immunohistochemical study of the subsynovial connective tissue in idiopathic carpal tunnel syndrome. J Bone Joint Surg Am 2004; 86-A: 1458–1466. 15Galasso O, Mariconda M, Donato G. Histopathological, clinical, and electrophysiological features influencing post operative outcomes in carpal tunnel syndrome. J Orthop Res 2011; 29: 1298–1304. 16Korstanje JW, Selles RW, Stam HJ, Hovius SE, Bosch JG. Development and validation of ultrasound speckle tracking to quantify tendon displacement. J Biomech 2010; 43: 1373–1379. Citing Literature Volume31, Issue1January 2012Pages 31-36 ReferencesRelatedInformation