Comparison of the histopathological findings of patients with diabetic and idiopathic carpal tunnel syndrome.
OBJECTIVE
This study is aimed to investigate whether there are any histopathological differences between diabetic and idiopathic carpal tunnel syndromes.


METHODS
The biopsy specimens were taken from transverse carpal ligament (TCL), tenosynovium adjacent to median nerve and epineurium of median nerve and evaluated in 47 patients (21 diabetic and 26 idiopathic) who were diagnosed with carpal tunnel syndrome (CTS) and treated surgically with open carpal tunnel release. Fibroblast proliferation, fibrosis, perivascular inflammation, oedema, vascular proliferation and vascular wall thickness were determined and scored in all specimens.


RESULTS
There weren't any histopathological abnormalities in TCL specimens of both groups. Synovial hyperplasia, fibrosis and perivascular inflammation were not observed in tenosynovial analysis of both groups. Diabetic CTS patients, when compared with idiopathic CTS patients, had higher rates of synovial edema (idiopathic CTS 57 %, diabetic CTS 87 %), vascular proliferation (idiopathic CTS 30.8 %, diabetic CTS 90.5 %) and increased vascular wall thickness (idiopathic CTS 11.5 %, diabetic CTS 90.5 %). There was no oedema, fibrosis and perivascular inflammation of the epineurium in specimens of either group. But increases in vascular proliferation (idiopathic CTS 7.7 %, diabetic CTS 71.4 %) and vascular wall thickness (idiopathic CTS 3.8 %, diabetic CTS 71.4 %) was seen in the epineurium of diabetic patients and these differences were statistically significant (p < 0.05).


CONCLUSIONS
Because of the severe synovial and epineurial histopathological abnormalities and inadequate neural regeneration capacity, surgical open carpal tunnel decompression should be planned earlier in diabetic CTS patients. Further studies should be considered to evaluate the histopathological features of diabetic CTS patients early in the course of the disease.
Department of Plastic and Reconstructive Surgery, Keçiören Training and Research Hospital, Pınarbaşı Mah. Sanatoryum Cad. Ardahan Sok. No:25, 06380, Keçiören, Ankara, Turkey. drfatihtekin@hotmail.com.
Fatih
F
Tekin
Department of Plastic and Reconstructive Surgery, Keçiören Training and Research Hospital, Pınarbaşı Mah. Sanatoryum Cad. Ardahan Sok. No:25, 06380, Keçiören, Ankara, Turkey.
Mehmet
M
Sürmeli
Department of Pathology, Artvin State Hospital, Artvin, Turkey.
Hülya
H
Şimşek
Department of Plastic and Reconstructive Surgery, Ankara Atatürk Training and Research Hospital, Ankara, Turkey.
Candemir
C
Ceran
Department of Plastic and Reconstructive Surgery, Keçiören Training and Research Hospital, Pınarbaşı Mah. Sanatoryum Cad. Ardahan Sok. No:25, 06380, Keçiören, Ankara, Turkey.
Soner
S
Tezcan
Department of Plastic and Reconstructive Surgery, Keçiören Training and Research Hospital, Pınarbaşı Mah. Sanatoryum Cad. Ardahan Sok. No:25, 06380, Keçiören, Ankara, Turkey.
Ömer Faruk
ÖF
Taner
Department of Pathology, Keçiören Training and Research Hospital, Ankara, Turkey.
Gülçin
G
Şimşek
D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000473:pathology* / Q000601:surgery; D003920:Diabetes Mellitus / Q000473:pathology*; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000473:pathology*; D008297:Male; D008475:Median Nerve / Q000473:pathology*; D008875:Middle Aged; D014955:Wrist Joint / Q000473:pathology*
Carpal tunnel syndrome; Diabetes mellitus; Histopathology; Idiopathic carpal tunnel syndrome