The Use of Amniotic membrane in Carpal Tunnel Syndrom, a Cadaver Study

Abstract

Introduction: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome worldwide. Even after surgery in 2-25% of patients symptoms persist. Most commonly the carpal tunnel was not completely released. In the other cases perineural scarring is causing recurrent compression of the nerve. The literature states different treatment options including “nerve wraps,” made out of autologous veins or synthetic materials, to protect the nerve from scarring. The human amniotic membrane (HAM) has been proven to express anti-inflammatory and anti-fibrotic properties, without causing a immune reaction. In a rat model it has been shown that nerve gliding could be improved by the application of HAM after introducing a fibrotic scar. The application of HAM in CTS and it´s possible influence on nerve gliding has been examined. Materials and Methods: Fourteen (7 female, 7 male) fresh body donors were dissected. The carpal tunnel was released and a nerve wrap out of HAM was sutured around the median nerve with continuous stitches (7-0). The position of the HAM was measured and the skin was closed (3-0) Next the arm was moved according to a protocol, creating a largest possible movement of the nerve. The position was again evaluated. This was done after 25, 50, 100, 150, 200, 250 movement cycles. Results: The HAM on the median nerve did not change its position significantly between the timepoints. From the beginning to the end of the movements it contracted and reduced its size to about 92% of its starting length. The evaluation of the gliding properties is still in progress. Conclusion: The HAM showed to stay in place and only minor contract on both ends in the carpal tunnel. The application of HAM in the carpal tunnel worked well without any complications and can be seen as feasible treatment method for recurrent carpal tunnel syndrome.