Subsynovial connective tissue thickness in carpal tunnel syndrome: A systematic review.

BACKGROUND

Non-inflammatory thickening of the subsynovial connective tissue is a common histological finding in carpal tunnel syndrome. This subsynovial connective tissue thickening may precede changes in electrodiagnostic testing. Therefore, measuring subsynovial connective tissue thickness may help in detecting early changes in carpal tunnel syndrome.

METHODS

To provide an overview of subsynovial connective tissue thickness characteristics in subjects with and without carpal tunnel syndrome, a systematic review of articles, assessing human subsynovial connective tissue, was performed using MEDLINE, CENTRAL and EMBASE.

FINDINGS: Seven studies were included for qualitative analysis. Measurements were done ex vivo (laser (n = 3), photographic (n = 1), micrometric (n = 1)) and in vivo (ultrasound (n = 3)). All four case-control studies showed a significant difference in subsynovial connective tissue thickness between subjects with and without carpal tunnel syndrome. One study showed good correlation between ultrasound and anatomical measurements. No correlation was found between subsynovial connective tissue thickness and symptom duration, electrodiagnostic changes, age and sex.

INTERPRETATION: Subsynovial connective tissue thickness may be a valuable aid in diagnosing carpal tunnel syndrome. No factors influencing subsynovial connective tissue thickness are identified, although they are not well investigated.