Abstract
Background: Carpal tunnel syndrome (CTS) is a condition seen commonly in clinical practice; high-flow arteriovenous malformations (AVM) can be a rare but important cause. Case Report: We discuss a case of a patient who had developed left CTS in the fifth decade of life as the result of a progressively enlarging congenital peripheral AVM affecting his left upper limb. This case illustrates the clinical challenges encountered in the surgical and interventional management of this complex issue. Discussion:High-flow AVMs affecting the extremities may be comprised of a convoluted network of vessels in high-flow, low-resistance systems that often recur despite intervention. Conclusion: Peripheral AVM affecting the hand can be a rare and therapeutically challenging cause of carpal tunnel syndrome that warrants multidisciplinary team discussion.
Highlights
Carpal tunnel syndrome (CTS) is a condition commonly encountered by physicians and surgeons alike, with the prevalence in the general population ranging from 3–5%1 and accounting for up to 90% of all entrapment neuropathies[2]
The finding of a congenital arteriovenous malformation (AVM) is a much less common occurrence in clinical practice, with some studies suggesting a prevalence of 1 in 100,000, with the majority of these occurring in the head and neck, with peripheral limb arteriovenous malformations (AVM) rarer still[3]
AVMs have a tendency to grow progressively larger with age, only becoming symptomatic when associated with haemodynamic instability or compression of surrounding structures[4]
Summary
Carpal tunnel syndrome (CTS) is a condition commonly encountered by physicians and surgeons alike, with the prevalence in the general population ranging from 3–5%1 and accounting for up to 90% of all entrapment neuropathies[2]. Literature review Medline, PubMed, Ovid, WorldCat, ProQuest and Access Medicine databases were accessed with the input of the following search terms: arteriovenous malformation; arteriovenous malformation upper limb; arteriovenous malformation flexor retinaculum; compressive lesion upper limb. At this visit it was observed that his AVM had significantly reduced in size macroscopically and the patient reported improvement in his symptoms This change correlated with a volumetric reduction on repeat CT angiogram; it was postulated that this could be attributed to a delayed fibrosis following embolisation (Figure 2). The patient’s case was subsequently discussed at several multidisciplinary meetings, eventually a high-risk surgical procedure involving resection of the AVM with multiple vascular graft reconstruction was offered to the patient He decided to continue living with his symptoms rather than risk compromising his hand function or viability
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