Nerve Tumors

Abstract

A 58-year-old right-handed woman was referred for a 5-year history of numbness in the left median nerve distribution and a slowly growing volar wrist mass. Her examination was notable for a nontender, firm, midline mass extending from the proximal wrist flexion crease to the distal palmar crease. Phalen's test and Tinel's tests were positive. Semmes-Weinstein monofilament testing was 3.61 in the median nerve distribution and 2.83 in the remainder of the hand. Electrophysiological tests demonstrated muscle denervation within the thenar muscles and undetectable motor and sensory latencies. Magnetic resonance imaging (MRI) revealed median nerve enlargement extending from the distal forearm to the distal metacarpal region with fatty infiltration. Educational Objectives •State the most common types of peripheral nerve sheath tumors. •Discuss the differences between neurofibromas and schwannomas. •List the schwannoma characteristics associated with permanent neurologic dysfunction following excision via intracapsular enucleation. •Describe risk factors associated with elevated risk for peripheral nerve tumors. •Summarize the MRI findings consistent with a malignant peripheral nerve tumor. Earn up to 2 hours of CME credit per JHS issue when you read the related articles and take the online test. To pay the $20 fee and take this month’s test, visit http://www.assh.org/professionals/jhs. •State the most common types of peripheral nerve sheath tumors. •Discuss the differences between neurofibromas and schwannomas. •List the schwannoma characteristics associated with permanent neurologic dysfunction following excision via intracapsular enucleation. •Describe risk factors associated with elevated risk for peripheral nerve tumors. •Summarize the MRI findings consistent with a malignant peripheral nerve tumor. Earn up to 2 hours of CME credit per JHS issue when you read the related articles and take the online test. To pay the $20 fee and take this month’s test, visit http://www.assh.org/professionals/jhs. Journal CME QuestionsJournal of Hand SurgeryVol. 35Issue 9Preview Full-Text PDF