The biomechanics of subsynovial connective tissue in health and its role in carpal tunnel syndrome

V. J.M.M. Festen-Schrier, P. C. Amadio

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations


Carpal Tunnel Syndrome (CTS) is the most common surgically treated problem in the hand. Aside from the neuropathy itself, the most common findings are fibrosis of the subsynovial connective tissue (SSCT) and increased intra carpal tunnel pressure. Normally, the SSCT is a multilayer tissue interspersed among the carpal tendons and nerve. As the tendons move, successive SSCT layers are recruited, forming a gliding unit and providing a limit to differential movement. Exceeding this limit, damages the SSCT as has been shown in both cadavers and animal models. This damage leads to a non-inflammatory response with progressive fibrosis and nerve ischemia leaving the SSCT more susceptible to injury. Although the direct consequences for patients are not fully understood, ultrasound research shows that this fibrosis restricts median nerve displacement during tendon loading. This article aims to provide insights into the mechanical properties of SSCT described so far and place it in the context of CTS pathophysiology. A theoretical damage model concerning the SSCT is proposed showing a chain of events and vicious cycles that could lead to the nerve compression as it is found in CTS. Although not complete, this model could explain the pathophysiological pathway of idiopathic CTS.

Original languageEnglish (US)
Pages (from-to)232-239
Number of pages8
JournalJournal of Electromyography and Kinesiology
StatePublished - Feb 2018


  • Carpal tunnel syndrome
  • Subsynovial connective tissue

ASJC Scopus subject areas

  • Neuroscience (miscellaneous)
  • Biophysics
  • Clinical Neurology


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