Dextrose-Induced Subsynovial Connective Tissue Fibrosis in the Rabbit Carpal Tunnel: A Potential Model to Study Carpal Tunnel Syndrome?

Oh, Sangho; Ettema, Anke M.; Zhao, Chunfeng; Zobitz, Mark E.; Wold, Lester E.; An, Kai Nan; Amadio, Peter C.

doi:10.1007/s11552-007-9058-y

Cited by 42 publications

(39 citation statements)

References 29 publications

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“…We have shown that a single injection of 10% dextrose, which is metabolized and removed within hours by the local cells, stimulated proliferation of collagen over time (12 weeks) in both this study and a pilot study 26. These changes are similar to the changes seen in the SSCT in CTS patients, including a marked increase in fibroblast density, collagen fiber size,11 deformation of collagen fibrils and phagocytosis of aberrant collagen fibrils and elastin 40.…”

Section: Discussionsupporting

confidence: 71%

“…Because we evaluated a single time point, we have no data on the time course of the changes we observed. A pilot study showed sequential structural changes in the SSCT and median nerve in a rabbit model 26. Because we wanted to evaluate evidence of demyelination, we used a different embedding process for nerve histology than had been used in the pilot study.…”

Section: Discussionmentioning

confidence: 99%

“…In a pilot study, a single injection of 10% dextrose did indeed induce progressive fibrosis in the SSCT in a rabbit model 26. Based on this preliminary data, we designed a study to investigate more completely the effects of hypertonic dextrose injection on the SSCT in the rabbit model, specifically to determine if the single injection of hypertonic dextrose consistently induced fibrosis in a larger series of animals, and to determine if such changes were associated with changes in nerve conduction and SSCT material properties, similar to those seen in patients with CTS.…”

mentioning

confidence: 90%

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The Effects of Hypertonic Dextrose Injection on Connective Tissue and Nerve Conduction Through the Rabbit Carpal Tunnel

Yoshii

Zhao

Schmelzer

et al. 2009

Archives of Physical Medicine and Rehabilitation

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Objective To investigate the effects of hypertonic dextrose injection on the subsynovial connective tissue (SSCT) in a rabbit model. We hypothesized that dextrose injection would induce proliferation of the SSCT, hinder median nerve conduction, and alter SSCT mechanical properties similar to what is observed in patients with carpal tunnel syndrome (CTS). Design Randomized, controlled prospective study. Setting Not applicable. Participants New Zealand white rabbits (N=28) weighing 4.0 to 4.5kg. Intervention One fore paw was randomly injected with 0.1ml of 10% dextrose solution. The contralateral paw was injected with a similar amount of 0.9% saline solution as a control. Animals were sacrificed at 12 weeks after injection. Main Outcome Measures Animals were evaluated by electrophysiology (EP), mechanical testing, and histology. EP was evaluated by distal motor latency and amplitude. Shear force was evaluated when the middle digit flexor digitorum superficialis tendon was pulled out from the carpal tunnel. The ultimate tensile load and the energy absorption were also measured. Tissue for histology was evaluated qualitatively. Results EP demonstrated significant prolongation of distal motor latency. The energy absorption and stiffness were also significantly increased in the dextrose group. Histologically, the dextrose group showed thickening of the collagen bundles and vascular proliferation within the SSCT compared to the saline group. Conclusions These results are consistent with the findings in CTS patients and suggest that hypertonic dextrose injection has the potential to create a novel animal model in which to study the evolution of CTS.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 90%

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The Effects of Hypertonic Dextrose Injection on Connective Tissue and Nerve Conduction Through the Rabbit Carpal Tunnel

Yoshii

Zhao

Schmelzer

et al. 2009

Archives of Physical Medicine and Rehabilitation

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“…Two previous studies have demonstrated that a single injection of 10% dextrose can induce SSCT fibrosis in a rabbit model, with some suggestion of an effect on nerve function. 10,11 Given this interesting preliminary finding, we wished to determine if there might be a dose-response effect and whether a larger single dose might result in a different response than two smaller doses totaling the same amount of dextrose. The purpose of this study was, therefore, to investigate the effects of different doses of hypertonic dextrose on rabbit carpal tunnel tissues and on median nerve morphologyand to compare these results with those previously reported.…”

Section: Introductionmentioning

confidence: 99%

Effects of hypertonic dextrose injections in the rabbit carpal tunnel

Yoshii

Zhao

Schmelzer

et al. 2011

Journal Orthopaedic Research

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Objective This study investigated the effects of different doses of hypertonic dextrose injection on the carpal tunnel subsynovial connective tissue (SSCT) and median nerve in a rabbit model. Methods Thirty-eight New Zealand white rabbits weighing 4.0–4.5 kg were used. One forepaw carpal tunnel was randomly injected with one of five different treatments: saline-single injection; saline-two injections one week apart; 10% dextrose-single injection; 20% dextrose-single injection; or 10% dextrose- two injections one week apart. Animals were sacrificed at 12 weeks after the initial injection and were evaluated by electrophysiology (EP), SSCT mechanical testing and histology. Results There were significant increases in the energy absorption of the SSCT in the 10% dextrose double injection group compared to the saline injection groups. SSCT stiffness was also significantly increased in the 10% dextrose-double injection group compared to the other groups. There was a significant increase in the thickness of the SSCT in the 10% dextrose-double injection group compared to the saline-single injection group and a significant decrease in the nerve short-long diameter ratio in the 10% dextrose double injection group compared to the saline-single injection group. There were no changes in EP among the groups. Conclusions SSCT fibrosis is present for up to 12 weeks after dextrose injection; multiple injections have bigger effects, including what appears to be a secondary change in nerve flattening. This model may be useful to study the effects of external fibrosis on nerve morphology and physiology, such as occurs clinically in carpal tunnel syndrome.

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“…[3][4][5][6][7][8] Thus, the suggested action mechanisms of prolotherapy include the induction of fibroblast proliferation, collagen deposition, and vascular proliferation, as well as the thickening of ligamentous structures. 1,2,9,10 Pneumatic injection therapy (PIT) is a needle-free, penetration-enhanced, transdermal method of delivering drugs into targeted areas of the skin. 11,12 A variety of solutions, including normal saline, 5% or 20% glucose solution, botulinum toxins, and soft tissue fillers, can be forcefully, but with minimal invasiveness, injected into the skin and subdermal layers, as well as the superficial musculoaponeurotic system (SMAS) or muscle layers, depending on the pressure settings.…”

Section: Introductionmentioning

confidence: 99%

Pneumatic Injection Therapy-Induced Transcutaneous Penetration of Hypertonic Glucose Solution: Macro- and Microscopic Analyses of Human and Rat Tissues

Kim¹,

Han

Park

et al. 2018

Medical Lasers

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Background and ObjectivesPneumatic injection therapy (PIT) is a needle-free, penetrationenhanced, transdermal method of delivering drugs into the skin. This study evaluated topographically the PIT-induced transcutaneous infiltration of a 20% hypertonic glucose solution in fresh human cadavers and outlined the microscopic patterns and reactions to PIT with a 20% glucose solution in in vivo rat skin. Materials and MethodsThe penetration depths of a 20% glucose solution by PIT were analyzed macroscopically in 10 hemifaces from fresh cadavers. In addition, the infiltration patterns of PIT with a 20% glucose solution performed in vivo in rats were analyzed through a histology evaluation. ResultsPneumatic injections of a hypertonic glucose solution generated PIT zones in the subcutaneous fat and superficial temporal fascia layers (10 out of 10 hemifaces), superficial layer of the deep temporal fascia (DTF; 8 out of 10 hemifaces), and deep layer of the DTF (7 out of 10 hemifaces). In addition, distinctive PIT zones were generated in rat tissues from the upper papillary deep to the muscle and fascia layers. ConclusionThe data suggest that PIT-induced, jet infiltration of a 20% hypertonic glucose solution contributes to clinical improvement of skin laxity by stimulating the wound repair processes and increasing collagen production throughout multiple layers of the skin. Key words

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Dextrose-Induced Subsynovial Connective Tissue Fibrosis in the Rabbit Carpal Tunnel: A Potential Model to Study Carpal Tunnel Syndrome?

Cited by 42 publications

References 29 publications

The Effects of Hypertonic Dextrose Injection on Connective Tissue and Nerve Conduction Through the Rabbit Carpal Tunnel

The Effects of Hypertonic Dextrose Injection on Connective Tissue and Nerve Conduction Through the Rabbit Carpal Tunnel

Effects of hypertonic dextrose injections in the rabbit carpal tunnel

Pneumatic Injection Therapy-Induced Transcutaneous Penetration of Hypertonic Glucose Solution: Macro- and Microscopic Analyses of Human and Rat Tissues

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