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Morphological Changes of Collagen Fibrils in the Subsynovial Connective Tissue in Carpal Tunnel Syndrome
Jinrok Oh, MD1; Chunfeng Zhao, MD1; Mark E. Zobitz, MS1; Lester E. Wold, MD1; Kai-Nan An, PhD1; Peter C. Amadio, MD1
1 Biomechanics Laboratory, Division of Orthopedic Research (J.O., C.Z., M.E.Z., K.-N.A., and P.C.A.), and the Department of Pathology (L.E.W.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for P.C. Amadio: pamadio@mayo.edu
View Disclosures and Other Information
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institutes of Health (NIAMS AR 49823) and the Mayo Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Biomechanics Laboratory, Division of Orthopedic Research, and the Department of Pathology, Mayo Clinic, Rochester, Minnesota

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Apr 01;88(4):824-831. doi: 10.2106/JBJS.E.00377
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Background: Pathologic changes occur commonly in the subsynovial connective tissue in patients with carpal tunnel syndrome. The purposes of this study were to investigate the ultrastructural changes of the subsynovial connective tissue in these patients and compare them with the findings in cadaver controls.

Methods: The diameter and density of collagen fibrils were measured by transmission electron microscopy in specimens of subsynovial connective tissue from ten patients with idiopathic carpal tunnel syndrome and from ten fresh-frozen cadavers of individuals without known symptoms of carpal tunnel syndrome.

Results: We noted deformed collagen fibrils with a spiraled appearance in the specimens from the patients. We also observed phagocytosis of elastin fibrils in all of those specimens. These changes were noted only rarely in the cadaver controls. The mean diameter (and standard deviation) of the collagen fibrils was 45.5 ± 8.0 nm in the control group and 54.8 ± 15.2 nm in the patient group (p < 0.05). The mean number of collagen fibrils per 0.04 µm2 (density) was 201.38 ± 48.88 in the control group and 157.08 ± 54.38 in the patient group (p < 0.05).

Conclusions: These ultrastructural findings suggest that subsynovial collagen in patients with carpal tunnel syndrome is structurally different from that in individuals without carpal tunnel syndrome, but the processes resulting in that abnormal morphology remain to be elucidated.

Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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