Idiopathic carpal tunnel syndrome: Histologic study of flexor tendon synovium

Schuind, Frédéric; Ventura, Manfredi; Pasteels, Jean Lambert

doi:10.1016/0363-5023(90)90070-8

Cited by 122 publications

(64 citation statements)

References 34 publications

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“…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

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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.

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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

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“…[21] Flexor tenosynovitis and thickening of the transverse carpal ligament are thought to be responsible pathophysiologic factors for work-related CTS. Schuind et al [22] found the combination of fibrous hypertrophy, focal necrosis and serous bursae with no obviously inflammatory cells and surmised that repeated trauma due to friction of excessive flexor tendon movement caused tenosynovial fibrous degenerative hypertrophy. The amount of extraneural pressure within the carpal tunnel has been shown to be higher in patients with CTS, compared to the normal population in various studies.…”

Section: Discussionmentioning

confidence: 99%

Carpal tunnel syndrome in manual tea harvesters

Çiftdemir

Çopuroğlu

Özcan

et al. 2013

Eklem Hastalik Cerrahisi

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Amaç: Bu çalışmada elle yapılan çay tarımına bağlı karpal tünel sendromunun (KTS) fizyopatolojik ve cerrahi boyutu, sinir ileti çalışmaları ve klinik skorlama sistemleri kullanarak değerlendirildi. Hastalar ve yöntemler: Şiddetli KTS nedeniyle cerrahi tedavi uygulanan 56 tarım işçisinin klinik ve nörofizyo-lojik skorları ile klinik ve mesleki değişkenleri; Boston anketi, İtalyan KTS çalışma grubunun modifiye kriterleri ve İtalyan KTS çalışma grubunun modifiye nörofizyolojik evreleme sistemi kullanılarak istatistiksel olarak değerlen-dirildi. Bulgular: Hastaların klinik evreleri, yaşları, toplam çalışma süreleri ile semptomların süresi arasında anlamlı istatistiksel ilişki bulundu. Hastalardaki KTS'nin nörofizyolojik evreleri ve semptomların süresi ile cerrahi tedavi öncesi ve sonrasında fonksiyonel sonuçlar arasında da anlamlı bir istatistiksel ilişki saptandı. Sonuç: Elle yapılan çay tarımının mesleğe bağlı KTS gelişimi için mesleki bir risk faktörü olabileceği düşünüldü. Bu alanda çalışan isçilerde KTS'nin cerrahi tedavisi ile tatminkar sonuçlar elde edildi.Anahtar sözcükler: Tarım isçileri hastalıkları; karpal tünel sendromu; sinir basısı sendromları; cerrahi uygulamalar, küçük; çay.Objectives: This study aims to present the physiopathological and surgical aspects of carpal tunnel syndrome (CTS) related to manual tea harvesting based on nerve conduction studies and clinical scoring systems. Patients and methods: Clinical and neurophysiological scores as well as clinical and occupational variables were statistically analyzed using Boston questionnaire, modified criteria of Italian CTS study group, and modified neurophysiologic grading system of Italian CTS study group in 56 agricultural laborers who underwent surgery due to severe CTS. Results: A statistically significant correlation was found among the clinical stages of the patients and age, working duration and duration of symptoms. There was a statistically significant relationship among neurophysiologic grades of the CTS in patients and the duration of symptoms and functional outcomes before and after surgery. Conclusion: We concluded that manual tea harvesting might be an occupational risk factor for work-related CTS development. Surgical treatment of CTS among manual tea harvesters revealed satisfactory results.

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“…In our practice tenosynovectomy is not done routinely but is considered in cases where there is clinical suspicion of tenosynovitis, although tenosynovitis has been shown to be a rare finding in histological analysis of the flexor tendon synovium during open carpal tunnel decompression [2,3,7]. The main aim of this study was to determine whether the presence of thick, cloudy white appearance of the flexor tendon synovium would be a higher predictive indicator of histology appearance of tenosynovitis.…”

Section: Discussionmentioning

confidence: 99%

“…Fibrotic thickening of the flexor tendon synovium is a common finding during carpal tunnel decompression and is believed by some to be due tenosynovitis which could be chronic [2] or non-specific [3][4][5][6][7][8]. The commonly encountered pathological findings of the tenosynovium include fibrotic thickening of the sheath, initmal hyperplasia, vascular proliferation and thrombosis [9].…”

Section: Introductionmentioning

confidence: 99%