Paralysis of the median nerve due to a lipofibrohamartoma in the carpal tunnel

Abstract

IntroductionThe lipofibrohamartoma is a rare entity of unknown origin that can affect any peripheral nerves, but mainly being found in the median nerve within the carpal tunnel. The lipofibrohamartoma is frequently associated with other conditions such as macrodactyly, the Proteus and Klippel–Trenaunay–Weber syndromes and multiple exostosis, among others. Clinical casesTwo cases of lipofibrohamartoma in the carpal tunnel with associated median nerve palsy are described in the present article. They were treated by simple decompression of the median nerve by releasing the transverse carpal ligament and a palmaris longus tendon transfer to improve the thumb abduction (Camitz procedure). In one of the cases, (a previously multi-operated median nerve entrapment at the carpal tunnel), a posterior interosseous skin flap was employed to improve the quality of the soft tissues on the anterior side of the wrist. DiscussionA review of the literature is also presented on lipofibrohamartoma of the median nerve, covering articles from 1964 to 2010. The literature suggests that the most recommended treatment to manage this condition is simple release of the carpal tunnel, which should be associated with a tendon transfer when a median nerve palsy is noticed.