Carpel Tunnel Synovium: Does Clinical Abnormality Correspond with Histological Abnormality?

Background: Fibrous thickening of the flexor tendon synovium is a common finding during carpel tunnel decompression. This is generally accepted to indicate tenosynovistis. The aim of the study was to determine whether non-transparent, cloudy white thickening of the flexor tenosynovium corresponds to histological appearance of tenosynovitis. Method: We retrospectively identified 49 wrists in 47 patients who underwent flexor tenosynovectomy during treatment for carpel tunnel decompression. The indication for synovectomy was clinical abnormality of the tenosynovium intra-operatively. Histological reports were retrospectively reviewed. A post-operative functional outcome score was compared between patients who underwent decompression alone and those who underwent decompression and synovectomy. Complication rates between the two groups were compared. Results: Of the 49 slides analysed, inflammation was present in 10.1% 5 slides) only. Oedema was present in 51% 25 Slides). The mean functional outcome score for group 1 was 10 and 11.7 for group 2. This was statistically insignificant p 0.065). The complication rates between the two groups were equal. Conclusion: We conclude that clinical abnormality is a poor predictor of histological appearance of tenosynovitis.