Skip to main content

Advertisement

SpringerLink
Log in

Comparison of the histopathological findings of patients with diabetic and idiopathic carpal tunnel syndrome

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

This study is aimed to investigate whether there are any histopathological differences between diabetic and idiopathic carpal tunnel syndromes.

Methods

The biopsy specimens were taken from transverse carpal ligament (TCL), tenosynovium adjacent to median nerve and epineurium of median nerve and evaluated in 47 patients (21 diabetic and 26 idiopathic) who were diagnosed with carpal tunnel syndrome (CTS) and treated surgically with open carpal tunnel release. Fibroblast proliferation, fibrosis, perivascular inflammation, oedema, vascular proliferation and vascular wall thickness were determined and scored in all specimens.

Results

There weren’t any histopathological abnormalities in TCL specimens of both groups. Synovial hyperplasia, fibrosis and perivascular inflammation were not observed in tenosynovial analysis of both groups. Diabetic CTS patients, when compared with idiopathic CTS patients, had higher rates of synovial edema (idiopathic CTS 57 %, diabetic CTS 87 %), vascular proliferation (idiopathic CTS 30.8 %, diabetic CTS 90.5 %) and increased vascular wall thickness (idiopathic CTS 11.5 %, diabetic CTS 90.5 %). There was no oedema, fibrosis and perivascular inflammation of the epineurium in specimens of either group. But increases in vascular proliferation (idiopathic CTS 7.7 %, diabetic CTS 71.4 %) and vascular wall thickness (idiopathic CTS 3.8 %, diabetic CTS 71.4 %) was seen in the epineurium of diabetic patients and these differences were statistically significant (p < 0.05).

Conclusion

Because of the severe synovial and epineurial histopathological abnormalities and inadequate neural regeneration capacity, surgical open carpal tunnel decompression should be planned earlier in diabetic CTS patients. Further studies should be considered to evaluate the histopathological features of diabetic CTS patients early in the course of the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I (1999) Prevalence of carpal tunnel syndrome in a general population. JAMA 282(2):153–158

    Article  CAS  PubMed  Google Scholar 

  2. de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F (1992) Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 45(4):373–376

    Article  PubMed  Google Scholar 

  3. Uchiyama S, Itsubo T, Nakamura K, Kato H, Yasutomi T, Momose T (2010) Current concepts of carpal tunnel syndrome: pathophysiology, treatment, and evaluation. J Orthop Sci 15(1):1–13. doi:10.1007/s00776-009-1416-x

    Article  PubMed  Google Scholar 

  4. Perkins BA, Olaleye D, Bril V (2002) Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care 25(3):565–569

    Article  PubMed  Google Scholar 

  5. Sud V, Tucci MA, Freeland AE, Smith WT, Grinspun K (2002) Absorptive properties of synovium harvested from the carpal tunnel. Microsurgery 22(7):316–319. doi:10.1002/micr.10051

    Article  PubMed  Google Scholar 

  6. Uchiyama S, Itsubo T, Yasutomi T, Nakagawa H, Kamimura M, Kato H (2005) Quantitative MRI of the wrist and nerve conduction studies in patients with idiopathic carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 76(8):1103–1108. doi:10.1136/jnnp.2004.051060

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Ettema AM, Amadio PC, Zhao C, Wold LE, O’Byrne MM, Moran SL, An KN (2006) Changes in the functional structure of the tenosynovium in idiopathic carpal tunnel syndrome: a scanning electron microscope study. Plast Reconstr Surg 118(6):1413–1422. doi:10.1097/01.prs.0000239593.55293.c7

    Article  CAS  PubMed  Google Scholar 

  8. Oh J, Zhao C, Zobitz ME, Wold LE, An KN, Amadio PC (2006) Morphological changes of collagen fibrils in the subsynovial connective tissue in carpal tunnel syndrome. J Bone Joint Surg Am 88(4):824–831. doi:10.2106/jbjs.e.00377

    Article  PubMed  Google Scholar 

  9. Osamura N, Zhao C, Zobitz ME, An KN, Amadio PC (2007) Evaluation of the material properties of the subsynovial connective tissue in carpal tunnel syndrome. Clın Bıomech 22(9):999–1003. doi:10.1016/j.clinbiomech.2007.07.009

    Google Scholar 

  10. Lundborg G (2005) Nerve injury and repair. Regeneration, reconstruction, and cortical remodeling. Chronic Nerve Compression, 2nd edn. Churchill Livingstone, New York

    Google Scholar 

  11. Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH (1981) The carpal tunnel syndrome. A study of carpal canal pressures. J Bone Joint Surg Am 63(3):380–383

    CAS  PubMed  Google Scholar 

  12. Thomas PK, Fullerton PM (1963) Nerve fibre size in the carpal tunnel syndrome. J Neurol Neurosurg Psychiatry 26:520–527

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Ebrahimzadeh MH, Mashhadinejad H, Moradi A, Kachooei AR (2013) Carpal tunnel release in diabetic and non-diabetic patients. Arch Bone Jt Surg 1(1):23–27

    PubMed Central  PubMed  Google Scholar 

  14. Curtis RM, Eversmann WW Jr (1973) Internal neurolysis as an adjunct to the treatment of the carpal-tunnel syndrome. J Bone Joint Surg Am 55(4):733–740

    CAS  PubMed  Google Scholar 

  15. Palazzi S, Palazzi JL (1980) Neurolysis in compressive neuropathies. Int Surg 65(6):509–514

    CAS  PubMed  Google Scholar 

  16. Ting J, Weiland AJ (2002) Role of ancillary procedures in surgical management of carpal tunnel syndrome: epineurotomy, internal neurolysis, tenosynovectomy, and tendon transfers. Hand Clin 18(2):315–323

    Article  PubMed  Google Scholar 

  17. Chammas M, Bousquet P, Renard E, Poirier JL, Jaffiol C, Allieu Y (1995) Dupuytren’s disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus. J Hand Surg Eur 20(1):109–114. doi:10.1016/s0363-5023(05)80068-1

    Article  CAS  Google Scholar 

  18. Papanicolaou GD, McCabe SJ, Firrell J (2001) The prevalence and characteristics of nerve compression symptoms in the general population. J Hand Surg Eur 26(3):460–466. doi:10.1053/jhsu.2001.24972

    Article  CAS  Google Scholar 

  19. Singh R, Gamble G, Cundy T (2005) Lifetime risk of symptomatic carpal tunnel syndrome in type 1 diabetes. Diabet Med 22(5):625–630. doi:10.1111/j.1464-5491.2005.01487.x

    Article  CAS  PubMed  Google Scholar 

  20. Ferry S, Hannaford P, Warskyj M, Lewis M, Croft P (2000) Carpal tunnel syndrome: a nested case–control study of risk factors in women. Am J Epidemiol 151(6):566–574

    Article  CAS  PubMed  Google Scholar 

  21. Padua L, Aprile I, Caliandro P, Padua L, Tonali P (2001) Is the occurrence of carpal tunnel syndrome in men underestimated? Epidemiology 12(3):369

    Article  CAS  PubMed  Google Scholar 

  22. Ibrahim T, Majid I, Clarke M, Kershaw CJ (2009) Outcome of carpal tunnel decompression: the influence of age, gender, and occupation. Int Orthop 33(5):1305–1309. doi:10.1007/s00264-008-0669-x

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Nakamichi K, Tachibana S (1998) Histology of the transverse carpal ligament and flexor tenosynovium in idiopathic carpal tunnel syndrome. J Hand Surg Eur 23(6):1015–1024

    Article  CAS  Google Scholar 

  24. Alizadeh K, Tavangar S-M (2002) Histologic findings in idiopathic carpal tunnel syndrome: report of 209 cases. Arch Iran Med 5(2):100

    Google Scholar 

  25. Yoshii Y, Zhao C, Zhao KD, Zobitz ME, An KN, Amadio PC (2008) The effect of wrist position on the relative motion of tendon, nerve, and subsynovial connective tissue within the carpal tunnel in a human cadaver model. J Orthop Res 26(8):1153–1158. doi:10.1002/jor.20640

    Article  PubMed Central  PubMed  Google Scholar 

  26. Fuchs PC, Nathan PA, Myers LD (1991) Synovial histology in carpal tunnel syndrome. J Hand Surg Eur 16(4):753–758

    Article  CAS  Google Scholar 

  27. Jinrok O, Zhao C, Amadio PC, An KN, Zobitz ME, Wold LE (2004) Vascular pathologic changes in the flexor tenosynovium (subsynovial connective tissue) in idiopathic carpal tunnel syndrome. J Orthop Res 22(6):1310–1315. doi:10.1016/j.orthres.2004.03.005

    Article  PubMed  Google Scholar 

  28. Faithfull DK, Moir DH, Ireland J (1986) The micropathology of the typical carpal tunnel syndrome. J Hand Surg 11(1):131–132

    Article  CAS  Google Scholar 

  29. Neal NC, McManners J, Stirling GA (1987) Pathology of the flexor tendon sheath in the spontaneous carpal tunnel syndrome. J Hand Surg 12(2):229–232

    Article  CAS  Google Scholar 

  30. Chalidis BE, Dimitriou CG (2013) One portal simultaneous bilateral endoscopic carpal tunnel release under local anaesthesia. Do the results justify the effort? Int Orthop 37(8):1501–1505. doi:10.1007/s00264-013-1951-0

    Article  PubMed Central  PubMed  Google Scholar 

  31. Holmgren-Larsson H, Leszniewski W, Linden U, Rabow L, Thorling J (1985) Internal neurolysis or ligament division only in carpal tunnel syndrome—results of a randomized study. Acta Neurochir 74(3–4):118–121

    Article  CAS  PubMed  Google Scholar 

  32. Borisch N, Haussmann P (2003) Neurophysiological recovery after open carpal tunnel decompression: comparison of simple decompression and decompression with epineurotomy. J Hand Surg 28(5):450–454

    Article  CAS  Google Scholar 

  33. Crnkovic T, Bilic R, Trkulja V, Cesarik M, Gotovac N, Kolundzic R (2012) The effect of epineurotomy on the median nerve volume after the carpal tunnel release: a prospective randomised double-blind controlled trial. Int Orthop 36(9):1885–1892. doi:10.1007/s00264-012-1565–y

    Article  PubMed Central  PubMed  Google Scholar 

  34. Gulabi D, Cecen G, Guclu B, Cecen A (2014) Carpal tunnel release in patients with diabetes result in poorer outcome in long-term study. Eur J Orthop Surg Traumatol 24(7):1181–1184. doi:10.1007/s00590-014-1418-z

    Article  PubMed  Google Scholar 

  35. Yasuda H, Terada M, Maeda K, Kogawa S, Sanada M, Haneda M, Kashiwagi A, Kikkawa R (2003) Diabetic neuropathy and nerve regeneration. Prog Neurobiol 69(4):229–285

    Article  CAS  PubMed  Google Scholar 

  36. Kennedy JM, Zochodne DW (2005) Impaired peripheral nerve regeneration in diabetes mellitus. J Peripher Nerv Syst 10(2):144–157. doi:10.1111/j.1085-9489.2005.0010205.x

    Article  CAS  PubMed  Google Scholar 

  37. Dellon AL (1992) Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves. Plast Reconstr Surg 89(4):689–697, discussion 698–689

    Article  CAS  PubMed  Google Scholar 

  38. Dellon AL (2011) Discussion. The role of peripheral nerve surgery in diabetic limb salvage. Plast Reconstr Surg 127(Suppl 1):270s–274s. doi:10.1097/PRS.0b013e3182006831

    Article  CAS  PubMed  Google Scholar 

  39. Dellon AL, Muse VL, Nickerson DS, Akre T, Anderson SR, Barrett SL, Biddinger KR, Bregman PJ, Bullard BP, Dauphinee DM, DeJesus JM, DeJesus RA, Ducic I, Dunkerly J, Galina MR, Hung V, Ichtertz DR, Kutka MF, Jacoby RP, Johnson JB, Mader DW, Maloney CT Jr, Mancuso PJ, Martin RC, Martin RF, McDowel BA, Rizzo VJ, Rose M, Rosson GD, Shafiroff BB, Steck JK, Stolarski RG, Swier P, Wellens-Bruschayt TA, Wilke B, Williams EH, Wood MA, Wood WA, Younes MP, Yuksel F (2012) Prevention of ulceration, amputation, and reduction of hospitalization: outcomes of a prospective multicenter trial of tibial neurolysis in patients with diabetic neuropathy. J Reconstr Microsurg 28(4):241–246. doi:10.1055/s-0032-1306372

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Keçiören Training and Research Hospital, Pınarbaşı Mah. Sanatoryum Cad. Ardahan Sok. No:25, 06380, Keçiören, Ankara, Turkey

    Fatih Tekin, Mehmet Sürmeli, Soner Tezcan & Ömer Faruk Taner

  2. Department of Pathology, Artvin State Hospital, Artvin, Turkey

    Hülya Şimşek

  3. Department of Plastic and Reconstructive Surgery, Ankara Atatürk Training and Research Hospital, Ankara, Turkey

    Candemir Ceran

  4. Department of Pathology, Keçiören Training and Research Hospital, Ankara, Turkey

    Gülçin Şimşek

Authors
  1. Fatih Tekin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehmet Sürmeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hülya Şimşek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Candemir Ceran
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Soner Tezcan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ömer Faruk Taner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gülçin Şimşek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fatih Tekin.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tekin, F., Sürmeli, M., Şimşek, H. et al. Comparison of the histopathological findings of patients with diabetic and idiopathic carpal tunnel syndrome. International Orthopaedics (SICOT) 39, 2395–2401 (2015). https://doi.org/10.1007/s00264-015-2790-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-015-2790-y

Keywords

Search

Navigation