title: The effect of low- and high-velocity tendon excursion on the mechanical properties of human cadaver subsynovial connective tissue.
abstract: Fibrosis of the subsynovial connective tissue (SSCT) in the carpal tunnel is the most common histological finding in carpal tunnel syndrome (CTS). Fibrosis may result from damaged SSCT. Previous studies found that with low-velocity (2 mm/s), tendon excursions can irreversibly damage the SSCT. We investigated the effect of tendon excursion velocity in the generation of SSCT damage. Nine human cadaver wrists were used. Three repeated cycles of ramp-stretch testing were performed simulating 40%, 60%, 90%, and 120% of the middle finger flexor tendon superficialis physiological excursion with an excursion velocity of 60 mm/s. Energy and force were calculated and normalized by values obtained in the first cycle for each excursion level. Data were compared with low-velocity excursion data. For high-velocity excursions, a significant drop in the excursion energy ratio was first observed at an excursion level of 60% physiological excursion (p < 0.024) and that for low-velocity excursions was first observed at 90% physiological excursion (p < 0.038). Furthermore, the energy ratio was lower at 60% for high velocities (p ≤ 0.039). Increasing velocity lowers the SSCT damage threshold. This finding may be relevant for understanding the pathogenesis of SSCT fibrosis, such as that accompanying CTS, and a relationship with occupational factors.
authors.affiliation: Biomechanics Laboratory and Tendon and Soft Tissue Biology Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota, 55905; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine and Physical Therapy, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Anika
authors.initials: A
authors.lastname: Filius
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Thoreson
authors.forename: Tai-Hua
authors.initials: TH
authors.lastname: Yang
authors.forename: Matthias
authors.initials: M
authors.lastname: Vanhees
authors.forename: Kai-Nan
authors.initials: KN
authors.lastname: An
authors.forename: Chunfeng
authors.initials: C
authors.lastname: Zhao
authors.forename: Peter C
authors.initials: PC
authors.lastname: Amadio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena / Q000502:physiology; D002102:Cadaver; D002349:Carpal Tunnel Syndrome / Q000503:physiopathology*; D003238:Connective Tissue / Q000502:physiology*; D005260:Female; D005355:Fibrosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009068:Movement / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology; D013583:Synovial Membrane / Q000502:physiology*; D013710:Tendons / Q000502:physiology*
keywords: biomechanics; carpal tunnel; human cadaver; subsynovial connective tissue; velocity
references.citation: PLoS One. 2010 Mar 08;5(3):e9595
references.pmid: 20221406
references.citation: Muscle Nerve. 2012 May;45(5):721-9
references.pmid: 22499100
references.citation: Br J Ind Med. 1971 Jan;28(1):83-9
references.pmid: 5543631
references.citation: Clin Orthop Relat Res. 1998 Jun;(351):78-89
references.pmid: 9646750
references.citation: Am J Ind Med. 2001 Jun;39(6):581-6
references.pmid: 11385642
references.citation: J Appl Physiol. 1966 Jul;21(4):1231-6
references.pmid: 5916656
references.citation: Biomed Sci Instrum. 1997;33:246-51
references.pmid: 9731366
references.citation: J Orthop Res. 2012 Mar;30(3):443-7
references.pmid: 21898581
references.citation: J Biomech. 2011 Apr 29;44(7):1414-6
references.pmid: 21276970
references.citation: Plast Reconstr Surg. 2006 Nov;118(6):1413-1422
references.pmid: 17051112
references.citation: J Biomech. 1986;19(11):951-5
references.pmid: 3793742
references.citation: Am Ind Hyg Assoc J. 1997 Apr;58(4):278-85
references.pmid: 9115085
references.citation: J Bone Joint Surg Am. 2004 Jul;86(7):1458-66
references.pmid: 15252093
references.citation: J Musculoskelet Neuronal Interact. 2005 Mar;5(1):85-90
references.pmid: 15788874
references.citation: J Hand Surg Am. 2010 Sep;35(9):1410-7
references.pmid: 20728285
references.citation: J Orthop Res. 2012 Nov;30(11):1732-7
references.pmid: 22573580
references.citation: Proc Inst Mech Eng H. 2004;218(2):109-19
references.pmid: 15116898
references.citation: Br J Gen Pract. 2001 Apr;51(465):311-4
references.pmid: 11458486
references.citation: Int J Artif Organs. 2006 Sep;29(9):852-7
references.pmid: 17033992
references.citation: Chir Main. 2010 Jun;29(3):155-66
references.pmid: 20537576
references.citation: J Biomech. 2008;41(2):292-8
references.pmid: 17953971
references.citation: JAMA. 1999 Jul 14;282(2):153-8
references.pmid: 10411196
references.citation: J Biomech. 2010 Oct 19;43(14):2785-91
references.pmid: 20678772
references.citation: Am Ind Hyg Assoc J. 1990 Sep;51(9):510-8
references.pmid: 2220569
references.citation: J Biomech Eng. 2003 Oct;125(5):726-31
references.pmid: 14618932
references.citation: J Occup Environ Med. 2007 Nov;49(11):1189-96
references.pmid: 17993922
references.citation: Epidemiology. 1998 May;9(3):342-5
references.pmid: 9583428
references.citation: Orthop Rev. 1992 Apr;21(4):451-3
references.pmid: 1579357
references.citation: J Hand Surg Am. 1992 Nov;17(6):1028-30
references.pmid: 1430930
references.citation: Surg Radiol Anat. 1997;19(1):31-4
references.pmid: 9060114
references.citation: J Biomech Eng. 1997 Nov;119(4):400-5
references.pmid: 9407277
references.citation: J Orthop Res. 2011 Jan;29(1):62-6
references.pmid: 20607819