Absorptive properties of synovium harvested from the carpal tunnel.

Abstract

Ischemia-induced reperfusion injury seems to play an important role in the pathophysiology of "idiopathic" carpal tunnel syndrome (CTS). The common final pathway in this developmental sequence is thought to be an intermittent increase in interstitial pressure, leading to degenerative changes in the flexor tenosynovium and fibrotic changes in the perineural tissue. We hypothesize that this concurrently leads to alteration in the physical properties of the synovium, leading to its rapid and persistent swelling. A prospective study was conducted on synovial tissue obtained from 27 CTS patients. The in vitro synovial absorption rate of CTS patients was significantly higher in the first hour compared to controls (n = 7). This difference was maintained up to 5-6 h, albeit at a slower rate. Rapid absorption and retention of fluid by the synovium led to increased interstitial pressure and nerve compression, resulting in early and persistent manifestation of symptoms in sensitized patients.