Case Of Carpal Tunnel Syndrome Research Articles

Free anterolateral thigh flap with vascularized lateral femoral cutaneous nerve for the treatment of neuroma‐in‐continuity and recurrent carpal tunnel syndrome after carpal tunnel release

Treatment of recurrent carpal tunnel syndrome (CTS) is challenging, especially in a case with recurrent CTS and a neuroma formation. Resection of the neuroma causing the syndrome, reconstruction of the nerve gap of the median nerve, and covering up the reconstructed median nerve with well-vascularized soft tissue for prevention of CTS re-recurrence are the essential procedures. We report a case of recurrent CTS with severe pain due to a neuroma-in-continuity successfully treated using a free anterolateral thigh (ALT) flap with a vascularized lateral femoral cutaneous nerve (LFCN). A 2 cm neuroma existed in the median nerve and was resected. The nerve gap was repaired using a vascularized LFCN included in the ALT flap. The ALT flap was transferred to the wrist to cover the median nerve. The severe pain disappeared completely and the sensory and motor impairment of the median nerve improved 5 months after the free flap surgery, as the Tinel's sign moved distally away from the wrist and disappeared. The result of the Semmes-Weinstein test improved from 5.08 to 4.31 and she was able to flex and extend the right wrist and fingers without pain. CTS did not recur 15 months after the surgery. A free ALT flap with vascularized LFCN allows nerve reconstruction for the median nerve gap created after neuroma resection and coverage of the median nerve with well-vascularized soft tissue to prevent adhesion and CTS recurrence.

Carpal Tunnel Syndrome with Paracoccidioidomycosis

Carpal Tunnel Syndrome with Paracoccidioidomycosis

Carpal Tunnel Syndrome as an Occupational Disease

Carpal tunnel syndrome (CTS) has been listed since 2003 in the European Union's list of occupational diseases. In 2001, it took sixth place in frequency among all occupational diseases recognized in the European Union. It was not listed as an occupational disease in Germany until July 2009, when the medical expert advisory panel of the German Federal Ministry of Labour and Social Affairs issued an evaluative paper supporting its listing. We selectively reviewed the literature on the potential causation of CTS by occupational activities. Repetitive manual work tasks involving flexion and extension at the wrist, forceful grip with the hand, and/or vibrations of the hand and arm, such as are induced (for example) by hand-held vibrating tools, can damage the median nerve and cause CTS. A combination of these exposures has been found to raise the risk of CTS with a more than additive effect. Harmful exposures arise in a wide variety of occupations; in judging whether a particular case of CTS is of occupational origin, the physician has to consider the actual manual tasks performed by the patient, rather than merely the job title. Working at a computer keyboard seems not to raise the risk of CTS. The causation of CTS by occupational activities, either alone or in combination with other factors, has been well documented by epidemiological data and is pathophysiologically plausible. In Germany, a physician who diagnoses carpal tunnel syndrome in an employee with a relevant, damaging occupational exposure is required to report the case to the German Social Accident Insurance.

A case of carpal tunnel syndrome in hemihypertrophy

A case of carpal tunnel syndrome in hemihypertrophy

Carpal Tunnel Syndrome due to Fibrolipomatous Hamartoma of the Median Nerve

Nervous lipofibromatous hamartoma is a rare tumor-like condition involving the peripheral nerves, whereby the epineurium and perineurium are enlarged and distorted by excess of fatty and fibrous tissues that infiltrate between and around nerve boundaries. The median nerve is much more likely to develop a hamartoma than other nerves with a predilection for the carpal tunnel. We present a case of carpal tunnel syndrome in an adult caused by fibrolipomatous hamartoma of the median nerve, successfully removed by excision of the fibrolipomatous tissue and decompression.

Carpal tunnel syndrome caused by cysticercosis

ABSTRACTWe present a case of carpal tunnel syndrome (CTS) due to compression of the median nerve within the carpal tunnel, caused by cysticercosis. Nerve conduction studies revealed severe CTS. Magnetic resonance imaging suggested an inflammatory mass compressing the median nerve in carpal tunnel. The histological diagnosis was consistent with cysticercosis. The case resolved with conservative treatment. Such solitary presentation of entrapment median neuropathy as CTS caused by cysticercosis is extremely rare. To our knowledge, this is the only case of its kind reported in literature till date.

Modeling the cost–benefit of nerve conduction studies in pre-employment screening for carpal tunnel syndrome

The aim of this study was to evaluate the costs associated with pre-employment nerve conduction testing as a screening tool for carpal tunnel syndrome (CTS) in the workplace. We used a Markov decision analysis model to compare the costs associated with a strategy of screening all prospective employees for CTS and not hiring those with abnormal nerve conduction, versus a strategy of not screening for CTS. The variables included in our model included employee turnover rate, the incidence of CTS, the prevalence of median nerve conduction abnormalities, the relative risk of developing CTS conferred by abnormal nerve conduction screening, the costs of pre-employment screening, and the worker's compensation costs to the employer for each case of CTS. In our base case, total employer costs for CTS from the perspective of the employer (cost of screening plus costs for workers' compensation associated with CTS) were higher when screening was used. Median costs per employee position over five years were US$503 for the screening strategy versus US$200 for a no-screening strategy. A sensitivity analysis showed that a strategy of screening was cost-beneficial from the perspective of the employer only under a few circumstances. Using Monte Carlo simulation varying all parameters, we found a 30% probability that screening would be cost-beneficial. A strategy of pre-employment screening for CTS should be carefully evaluated for yield and social consequences before being implemented. Our model suggests such screening is not appropriate for most employers.

Carpal tunnel syndrome caused by cysticercosis

We present a case of carpal tunnel syndrome (CTS) due to compression of the median nerve within the carpal tunnel, caused by cysticercosis. Nerve conduction studies revealed severe CTS. Magnetic resonance imaging suggested an inflammatory mass compressing the median nerve in carpal tunnel. The histological diagnosis was consistent with cysticercosis. The case resolved with conservative treatment. Such solitary presentation of entrapment median neuropathy as CTS caused by cysticercosis is extremely rare. To our knowledge, this is the only case of its kind reported in literature till date.

Carpal Tunnel Syndrome and Hiv Infection. A Case Report and Literature Review

The first clinical case of carpal tunnel syndrome (CTS) in Cuban HIV-infected patient was described, and the scientific literature indexed in: PUBMED/MEDLINE, LILACS and BIREME were revised. The case presented was a male with HIV infection without preceding opportunistic illnesses, CD4+ T cell count over 200 cells/mm3 and clinical symptoms of pain, tingling and numbness in the right hand and wrist for three months. The electrophysiological study was compatible with CTS. The pharmacological treatment did not modify the symptoms and the patient received specific surgical treatment with absolute resolution of symptoms. CTS is a compressive neuropathy that can occur in HIV-positive individuals with as similar frequency as in the general population. The association between HIV infection and CTS is scarcely described in the medical scientific literature and probably does not represent a different phenomenon from what happens in the HIV-negative population. Nevertheless, its clinical recognition among other neurological and muscle-skeletal manifestations in HIV-infected patients is important.

Digital ulcers as the first manifestation of carpal tunnel syndrome

While carpal tunnel syndrome (CTS) is the most common entrapment neuropathy presented at rheumatologic consultation, its ulcerative variant is rarely described. We report of a case of severe bilateral medial nerve palsy, presented to us for diagnosis of chronic digital ulcers which had been suspected to be rheumatologic in origin. Careful examination revealed an unusual case of CTS in an advanced stage, which presented itself with skin changes only, lacking all the typical neurologic symptoms or rheumatologic background. Our case stresses the importance for rheumatologists to be aware of the ulcerative form of CTS as one of the etiologic differential diagnostic options of digital ulcers.

Median Nerve Enterapment Secondary To Carpal Osteophyte: A Case Report

Carpal tunnel syndrome secondary to space occupying lesion is a relatively rare condition. Median nerve compression secondary to carpal osteophyte is extremely rare. We report a case of carpal tunnel syndrome due to osteophytic bony projection in the carpal tunnel in a 54-year-old man with antecedent traumatic wrist injury before 20 years. To our knowledge, this is the second reported case. Complete excision of osteophyte resulted in complete relief of sensory symptoms.

Median Nerve Enterapment Secondary To Carpal Osteophyte: A Case Report

Carpal tunnel syndrome secondary to space occupying lesion is a relatively rare condition. Median nerve compression secondary to carpal osteophyte is extremely rare. We report a case of carpal tunnel syndrome due to osteophytic bony projection in the carpal tunnel in a 54-year-old man with antecedent traumatic wrist injury before 20 years. To our knowledge, this is the second reported case. Complete excision of osteophyte resulted in complete relief of sensory symptoms.

Carpal Tunnel Syndrome Due to Fibrolipomatous Hamartoma of the Median Nerve in Klippel-Trénaunay Syndrome

Klippel-Trenaunay syndrome is a rare congenital disorder that is characterized by the triad of cutaneous capillary malformation, varicose veins, and hypertrophy of bone and soft tissue1. It is associated with numerous digital anomalies, including macrodactyly, which is observed in 24% of patients2. Carpal tunnel syndrome is rarely associated with Klippel-Trenaunay syndrome, and only a few cases have been reported3-7. The proposed pathogenesis of carpal tunnel syndrome in a patient with Klippel-Trenaunay syndrome is either lymphatic obstruction or abnormal lymphatic proliferation, which causes an increase in pressure inside the carpal tunnel, or cavernous hemangioma surrounding the median nerve. We report a rare case of carpal tunnel syndrome due to fibrolipomatous hamartoma of the median nerve in a patient with Klippel-Trenaunay syndrome. Fibrolipomatous hamartoma is characterized by the expansion of the epineurium by fibrofatty tissue that surrounds and separates the nerve fascicles8; it usually involves the median nerve3,8-10. The pathophysiology of the structures inside the carpal tunnel was investigated in our patient, and attempts were made to compare the findings in the present case with those of idiopathic carpal tunnel syndrome. The patient was informed that data concerning the case would be submitted for publication, and he consented. A forty-six-year-old man with bilateral macrodactyly presented with pain and numbness in the thumb and the index and long fingers of the right (dominant) hand. He had been diagnosed with Klippel-Trenaunay syndrome at birth. The family history was unremarkable for congenital abnormalities. At twelve years of age, the patient began to experience numbness in the thumb and the index and long fingers of the right hand. At fifteen years of age, he noticed a soft mass in the right palm, although the symptoms remained unchanged. At the age …

A case of carpal tunnel syndrome with fibrolipomatous harmartoma

A case of carpal tunnel syndrome with fibrolipomatous harmartoma

ACUTE CARPAL TUNNEL SYNDROME SECONDARY TO CALCIFIC TENDINITIS: CASE REPORT

Acute carpal tunnel syndrome (CTS) secondary to calcific deposition is rarely reported. In this article we describe a case of acute CTS in the dominant hand of a 94-year-old female patient secondary to calcific tendinitis within the carpal tunnel. Diagnosis was difficult clinically and radiologically. Urgent complete median nerve decompression led to a good clinical recovery.

Carpal tunnel syndrome caused by volar dislocation of the lunate in a patient with rheumatoid arthritis

We report a case of carpal tunnel syndrome caused by volar dislocation of the lunate in a patient with rheumatoid arthritis. A 74-year-old woman complained of numbness in her fingers. Carpal tunnel syndrome was diagnosed, and carpal tunnel release was performed. However, the symptoms recurred. Three-dimensional computed tomography and magnetic resonance imaging revealed volar dislocation of the lunate and synovitis around the distal radioulnar joint, respectively. Resection of the lunate and the Sauvé-Kapandji procedure were effective.

Study of Hand Function in a Group of Shoe Factory Workers Engaged in Repetitive Work

Work related hand and wrist musculoskeletal disorders are well known. The contributing factors could be repetitive movements, forceful work and awkward posture. It is not known how these movements affect grip or pinch strength and other functional aspects of the hand. To study a group of shoe factory workers doing repetitive thumb and wrist movements for prevalence of musculoskeletal disorders and consequence on grip and pinch strength, two-point discrimination and perceived disability. 39 shoe factory workers who put straps into 900 to 1000 pairs of rubber sandals per day and 29 hospital clerks as a control group were evaluated for musculoskeletal disorders, grip and pinch strength, two-point discrimination and perceived disability (by questionnaire). Proportions were compared by chi squared or Fisher Exact test and quantitative outcome by t-test or multiple linear regressions. Common musculoskeletal diseases of thumb/wrist were absent among shoe factory workers as in the clerks. Increased two-point discrimination over thumb (p=0.01, right; p=0.02, left) and a clear trend for reduced pinch strength between thumb and index finger (p=0.06, right; p=0.07, left) were noted compared to clerks after adjusting for years on the job. Perceived disabilities included pain and localised dermal thickening over the thumb. No case of carpal tunnel syndrome or hand/wrist tendinitis was detected among workers doing highly repetitive thumb/wrist movement. Pinch strength decreased and two-point discrimination was adversely affected while grip strength remained unaffected. The main perceived disabilities of pain and skin changes over the thumb adversely affected their day-to-day life.

Bilateral carpal tunnel syndrome in wrist burn: a case report

Carpal tunnel syndrome (CTS) is a common problem. Fissette et al. [1] apparently first reported wrist burn trauma as a cause of median nerve compression at the wrist in 1981. Helm et al. [2] had earlier listed ‘‘median nerve entrapment at the wrist’’ as a complication of burn trauma generally. The Liege group [1] reported 22 patients with 39 wrist burns. Nineteen of these patients had clinical CTS and 14 showed electrophysiologically compromised median nerves. The median nerve was more affected than the ulnar nerve. They however did not indicate the size of burn in the patients, what treatment, if any, was given and the result. Frank and Robson [3], in the same year, reported four patients with 11 involved nerves. All their patients had burns more than 15% total body surface area and they were assessed for CTS before discharge. Their patients developed symptoms 4–14 months after discharge which were promptly relieved following surgery. This problem has since received very little attention in medical literature. Is it therefore very uncommon or just under-reported? We report a 6-month retrospective review of burns involving the wrist and a case of bilateral CTS following wrist burns.

EXTRASKELETAL CHONDROMA AS A CAUSE OF CARPAL TUNNEL SYNDROME: A CASE REPORT

We report a case of carpal tunnel syndrome as a result of an extraosseous chondroma in a 47-year-old gentleman. This case demonstrates the importance of clinical examination and occasional radiographs in this not uncommon condition. We also highlight that this well known entrapment syndrome is not only caused by the common causes that we all know, but also any space-occupying lesion in the carpal tunnel compressing the median nerve.

Bilateral median neuropathy and growth hormone use: A case report

Dickerman RD, Douglas JA, East JW. Bilateral median neuropathy and growth hormone use: a case report. Arch Phys Med Rehabil 2000;81:1594-5. A male elite bodybuilder suffered bilateral median nerve neuropathy during a self-administered course of growth hormone (GH). Nerve conduction velocities revealed bilateral median neuropathy consistent with carpal tunnel syndrome (CTS). This is the first case of GH-induced CTS occurring in an athlete. Contrary to earlier studies, this report demonstrates that GH-induced CTS is not an age-related phenomenon and alerts physicians to include GH abuse as a possible etiology of median neuropathy in athletes. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation