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THE STRUCTURE OF THE TRANSVERSE CARPAL LIGAMENT: ITS COLLAGEN FIBER ORIENTATION AND THE EFFICACY OF COLLAGENASE IN DECREASING ITS STIFFNESS

Prantil, Ryan/RKP (2012) THE STRUCTURE OF THE TRANSVERSE CARPAL LIGAMENT: ITS COLLAGEN FIBER ORIENTATION AND THE EFFICACY OF COLLAGENASE IN DECREASING ITS STIFFNESS. Master's Thesis, University of Pittsburgh.

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    Abstract

    Carpal tunnel syndrome (CTS) currently affects more than three million Americans each
    year. Hand surgeons treat CTS by targeting the transverse carpal ligament (TCL) which acts as
    the palmar roof of the carpal tunnel. Based on general observation, the TCL appears to be an
    inextensible collagenous matrix with fibers roughly oriented along the transverse direction.
    Several studies on the TCL’s configuration argue for different fiber orientations consisting of
    either oblique or transverse orientations; whereas, most findings were based on an
    observational methodology. Very few studies have determined such fiber orientations;
    whereas, even fewer studies have researched the ligament’s mechanical properties.
    Furthermore, the potential of altering the TCL’s microstructure may provide a potential,
    alternative to the currently accepted, invasive standards.
    Previous studies attempting to lengthen the TCL found that such procedures can effectively
    diminish CTS symptoms and also decrease the progression of several post-operative
    complications. However, these procedures consist of transecting the transverse carpal ligament
    in an attempt to increase its length. Furthermore, mechanical stimuli cannot alter the ligament
    because it is too stiff. In addition, such procedures also require invasive surgery and can cause
    complications that arise from carpal tunnel release. Therefore, a solution might lie in the
    application of collagenase where antecedent works have shown its capacity to reduce the
    v
    mechanical properties of a tissue.
    The following studies have emphasized the transverse carpal ligament’s collagen
    orientation and its mechanical response to subsequent collagenase treatment. The preferential
    collagen direction was quantified through the use of small angle light scattering (SALS).
    Results showed that transverse orientation was the most prevalent with minimal changes found
    within its orientation along its thickness. As for the TCL’s response to collagenase, standard
    concentrations of collagenase were applied to the TCL for each specimen through successive
    mechanical loading protocols along with successive observations to analyze the progressive
    changes within the ligament by slowly eliminating its collagen network. Collagenase
    effectively decreased the transverse carpal ligament’s stiffness without significantly changing
    its mechanical properties. Furthermore, these studies could contribute to a more sophisticated
    model of the TCL and lead to the development of a minimally invasive therapy contrary to
    current, invasive standards.


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    Item Type: University of Pittsburgh ETD
    Creators/Authors:
    CreatorsEmailPitt UsernameORCID
    Prantil, Ryan/RKPrkp12@pitt.edurkp12@pitt.edu
    ETD Committee:
    ETD Committee RoleCommittee MemberEmailPitt UsernameORCID
    Committee ChairLi, Zong-Ming/ZMLliz4@ccf.orgliz4@ccf.org
    Committee MemberWoo, Savio L-Y/SLWslyw@pitt.eduslyw@pitt.edu
    Committee MemberAbramowitch, Steven/SDAsdast9@pitt.edusdast9@pitt.edu
    Title: THE STRUCTURE OF THE TRANSVERSE CARPAL LIGAMENT: ITS COLLAGEN FIBER ORIENTATION AND THE EFFICACY OF COLLAGENASE IN DECREASING ITS STIFFNESS
    Status: Published
    Abstract:

    Carpal tunnel syndrome (CTS) currently affects more than three million Americans each
    year. Hand surgeons treat CTS by targeting the transverse carpal ligament (TCL) which acts as
    the palmar roof of the carpal tunnel. Based on general observation, the TCL appears to be an
    inextensible collagenous matrix with fibers roughly oriented along the transverse direction.
    Several studies on the TCL’s configuration argue for different fiber orientations consisting of
    either oblique or transverse orientations; whereas, most findings were based on an
    observational methodology. Very few studies have determined such fiber orientations;
    whereas, even fewer studies have researched the ligament’s mechanical properties.
    Furthermore, the potential of altering the TCL’s microstructure may provide a potential,
    alternative to the currently accepted, invasive standards.
    Previous studies attempting to lengthen the TCL found that such procedures can effectively
    diminish CTS symptoms and also decrease the progression of several post-operative
    complications. However, these procedures consist of transecting the transverse carpal ligament
    in an attempt to increase its length. Furthermore, mechanical stimuli cannot alter the ligament
    because it is too stiff. In addition, such procedures also require invasive surgery and can cause
    complications that arise from carpal tunnel release. Therefore, a solution might lie in the
    application of collagenase where antecedent works have shown its capacity to reduce the
    v
    mechanical properties of a tissue.
    The following studies have emphasized the transverse carpal ligament’s collagen
    orientation and its mechanical response to subsequent collagenase treatment. The preferential
    collagen direction was quantified through the use of small angle light scattering (SALS).
    Results showed that transverse orientation was the most prevalent with minimal changes found
    within its orientation along its thickness. As for the TCL’s response to collagenase, standard
    concentrations of collagenase were applied to the TCL for each specimen through successive
    mechanical loading protocols along with successive observations to analyze the progressive
    changes within the ligament by slowly eliminating its collagen network. Collagenase
    effectively decreased the transverse carpal ligament’s stiffness without significantly changing
    its mechanical properties. Furthermore, these studies could contribute to a more sophisticated
    model of the TCL and lead to the development of a minimally invasive therapy contrary to
    current, invasive standards.

    Date: 30 January 2012
    Date Type: Publication
    Defense Date: 12 July 2011
    Approval Date: 30 January 2012
    Submission Date: 22 November 2011
    Release Date: 30 January 2012
    Access Restriction: No restriction; The work is available for access worldwide immediately.
    Patent pending: No
    Number of Pages: 101
    Institution: University of Pittsburgh
    Thesis Type: Master's Thesis
    Refereed: Yes
    Related URLs:
    Degree: MS - Master of Science
    Uncontrolled Keywords: Carpal Tunnel Mechanics Carpal Tunnel Syndrome Collagenase Collagen Fiber Orientation Small Angle Light Scattering Transverse Carpal Ligament
    Schools and Programs: Swanson School of Engineering > Bioengineering
    Date Deposited: 30 Jan 2012 15:51
    Last Modified: 16 Jul 2014 17:03

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