Gliding characteristics of flexor tendon and tenosynovium in carpal tunnel syndrome: A pilot study

Anke M. Ettema, Chunfeng Zhao, Peter C. Amadio, Megan M. O'Byrne, Kai Nan An

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


The characteristic pathological finding in carpal tunnel syndrome (CTS) is non-inflammatory fibrosis of the synovium. How this fibrosis might affect tendon function, if at all, is unknown. The subsynovial connective tissue (SSCT) lies between the flexor tendons and the visceral synovium (VS) of the ulnar tenosynovial bursa. Fibrosis of the SSCT may well affect its gliding characteristics. To investigate this possibility, the relative motion of the flexor tendon and VS was observed during finger flexion in patients undergoing carpal tunnel surgery, and for comparison in hands without CTS, in an in vitro cadaver model. We used a camera to document the gliding motion of the middle finger flexor digitorum superficialis (FDS III) tendon and SSCT in three patients with CTS during carpal tunnel release and compared this with simulated active flexion in three cadavers with no antemortem history of CTS. The data were digitized with the use of Analyze Software (Biomedical Imaging Resource, Mayo Clinic, Rochester, MN). In the CTS patients, the SSCT moved en bloc with the tendon, whereas, in the controls the SSCT moved smoothly and separately from the tendon. The ratio of VS to tendon motion was higher for the patients than in the cadaver controls. These findings suggest that in patients with CTS the synovial fibrosis has altered the gliding characteristics of the SSCT. The alterations in the gliding characteristics of the SSCT may affect the ability of the tendons in the carpal tunnel to glide independently from each other, or from the nearby median nerve. These abnormal tendon mechanics may play a role in the etiology of CTS.

Original languageEnglish (US)
Pages (from-to)292-299
Number of pages8
JournalClinical Anatomy
Issue number3
StatePublished - 2007


  • Carpal tunnel syndrome
  • Flexor tendon
  • Tendon gliding
  • Tenosynovium

ASJC Scopus subject areas

  • Anatomy
  • Histology


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