A histopathologic study of the transverse carpal ligament and flexor tenosynovium in patients with idiopathic carpal tunnel syndrome
A Erdem Bagatur1, Sergülen Dervişoğlu2, Mehmet Albayrak1, Ahmet Doğan1, İ. Erhan Mumcuoğlu1, Gazi Zorer3
1İstanbul Eğitim ve Araştırma Hastanesi 1. Ortopedi ve Travmatoloji Kliniği, İstanbul, Türkiye
2İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Patoloji Anabilim Dalı, İstanbul, Türkiye
3Bezm-i Alem Valide Sultan Vakıf Gureba Eğitim ve Araştırma Hastanesi 2. Ortopedi ve Travmatoloji Kliniği
Keywords: Carpal tunnel syndrome/etiology/pathology; ligaments, articular/pathology; synovial membrane/pathology.
Objectives: In order to establish the histologic etiology of idiopathic carpal tunnel syndrome (CTS), we investigated histologic changes in the transverse carpal ligament and flexor tenosynovium.
Patients and methods: Biopsy specimens of the transverse carpal ligament and tenosynovium of the 3rd and 4th flexor digitorum superficialis tendons were taken from 39 consecutive patients (37 women, 2 men; mean age 51 years; range 42 to 63 years) who underwent surgery for idiopathic CTS, and from eight control patients (2 women, 6 men; mean age 47 years; range 39 to 55 years) who did not have any complaints or findings related to CTS and were operated on for distal radial intraarticular fractures. All the specimens were evaluated blindly by the same pathologist.
Results: In the study group, 34 specimens of the transverse carpal ligament and 32 specimens of the flexor tenosynovium, and all specimens of the control group were eligible for pathologic evaluation. No pathologic findings were present in the transverse carpal ligament in seven specimens (20.6%) and three specimens (37.5%) in the study and control groups, respectively. The remaining specimens exhibited myxoid degeneration, inflammation, chondrocytic cells, edema, or lipomatosis. Flexor tenosynovium specimens of both groups exhibited at least two pathologic findings, the most common being reactive perivascular mononuclear inflammation. There were no signs of dense lymphocyte infiltration. The only significant difference was increased vascularity in the study group (78.1% vs 37.5%; p<0.05).
Conclusion: Even though similar findings obtained in the two patient groups do not throw light on the histologic distinction of CTS, the role of increased vascularity needs further consideration.