Thickening of the Synovium of the Digital Flexor Tendons: Cause or Consequence of the Carpal Tunnel Syndrome?

1992 ◽  
Vol 17 (2) ◽  
pp. 209-211 ◽  
Author(s):  
A. L. LLUCH
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Endothelial Damage ◽  
En Bloc ◽  
Flexor Tendons ◽  
Wire Suture ◽  
Round Cell Infiltration ◽  
Vascular Proliferation ◽  
Tunnel Syndrome ◽  
Fibroblastic Activity

Using a monofilament wire suture, the radial and ulnar edges of the flexor retinaculum were approximated in 14 white New Zealand rabbits. As a result, the volume of the carpal tunnel was diminished, and “carpal tunnel syndrome” was produced. At various intervals after this procedure the animals were sacrificed. The median nerve and all the digital flexor tendons passing through the carpal tunnel were excised “en bloc”, and sent for histological examination. Vascular proliferation with perivascular round cell infiltration and oedema, and large areas of fibroblastic activity were observed around the digital flexor tendons. This was probably due to increased vascular permeability secondary to ischaemic endothelial damage. These findings are similar to those observed in the synovium of patients operated on for carpal tunnel syndrome.

Mycobacterial Tenosynovitis of the Flexor Tendons of the Hand

1996 ◽  
Vol 21 (3) ◽  
pp. 351-354 ◽  
Author(s):  
P-J. Regnard ◽  
P. Barry ◽  
J. Isselin
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Corticosteroid Therapy ◽  
Carpal Tunnel ◽  
Functional Result ◽  
Flexor Tendons ◽  
Long Term Follow Up ◽  
Tunnel Syndrome

We present five cases of mycobacterial tenosynovitis of the flexor tendons of the fingers. These cases were observed during the last 12 years and treated by the same surgeon. This pathology is uncommon now, but it is becoming more frequent, especially in patients with diminished immunity. The diagnosis was most commonly made after synovectomy in patients presenting with carpal tunnel syndrome associated with slightly painful swelling at the wrist. Histological and bacteriological examinations are very important and revealed tuberculosis in four of our patients and mycobacterium in one, and the treatment consists of synovectomy and appropriate antibiotics. The functional result is usually good, but recurrence is not uncommon. Long-term follow-up is necessary. Local corticosteroid therapy could have a part in the causation of this condition.

scholarly journals Carpal Tunnel Syndrome with Wrist Trigger Caused by Hypertrophied Lumbrical Muscle and Tenosynovitis

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Ayuko Shimizu ◽  
Masayoshi Ikeda ◽  
Yuka Kobayashi ◽  
Ikuo Saito ◽  
Joji Mochida
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Synovial Proliferation ◽  
Flexor Tendons ◽  
Active Flexion ◽  
Tunnel Syndrome ◽  
Lumbrical Muscle ◽  
Open Carpal Tunnel Release

We present a case of carpal tunnel syndrome involving wrist trigger caused by a hypertrophied lumbrical muscle with flexor synovitis. The case was a 40-year-old male heavy manual worker complaining of numbness and pain in the median nerve area. On active flexion of the fingers, snapping was observed at the carpal area, and forceful full grip was impossible. Tinel’s sign was positive and an electromyographic study revealed conduction disturbance of the median nerve at the carpal tunnel. Magnetic resonance imaging revealed edematous lumbrical muscle with synovial proliferation around the flexor tendons. Open carpal tunnel release was performed under local anesthesia. Synovial proliferation of the flexor tendons was found and when flexing the index and middle fingers, the lumbrical muscle was drawn into the carpal tunnel with a triggering phenomenon. After releasing the carpal tunnel, the triggering phenomenon and painful numbness improved.

Carpal tunnel syndrome caused by gouty tophus of the flexor tendons of the fingers: Sonographic features

2011 ◽  
Vol 39 (8) ◽  
pp. 463-465 ◽  
Author(s):  
Aravindakannan Therimadasamy ◽  
Yeong Pin Peng ◽  
Thomas Choudary Putti ◽  
Einar Patrick Vincent Wilder-Smith
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Flexor Tendons ◽  
Tunnel Syndrome ◽  
Gouty Tophus

scholarly journals Results of Tenosynovectomy of Flexor Tendons for Carpal Tunnel Syndrome.

1999 ◽  
Vol 48 (4) ◽  
pp. 994-996
Author(s):  
Toshiyuki Tsuruta ◽  
Akihiko Asami ◽  
Motoki Sonohata
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Flexor Tendons ◽  
Tunnel Syndrome

Carpal Tunnel Syndrome Due to Gouty Infiltration of the Lumbrical Muscles and Flexor Tendons

Hand Surgery ◽  
2003 ◽  
Vol 08 (01) ◽  
pp. 121-125 ◽  
Author(s):  
G. Tan ◽  
W. Chew ◽  
C. H. Lai
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Symptomatic Relief ◽  
Surgical Decompression ◽  
Muscle Involvement ◽  
Flexor Tendons ◽  
Tunnel Syndrome ◽  
Lumbrical Muscle ◽  
Lumbrical Muscles

A case of gout first presenting as carpal tunnel syndrome due to intratendinous and lumbrical muscle involvement with tophi is reported. Surgical decompression with excision of tophi and diseased muscle produced symptomatic relief.

A Mycobacterium Malmoense Infection of the Hand Presenting as Carpal Tunnel Syndrome

1988 ◽  
Vol 13 (3) ◽  
pp. 328-330
Author(s):  
HEATHER PRINCE ◽  
PURVIN ISPAHANI ◽  
M. BAKER
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Lymph Nodes ◽  
Carpal Tunnel ◽  
Tuberculous Infection ◽  
Cervical Lymph Nodes ◽  
Flexor Tendons ◽  
Tunnel Syndrome ◽  
A Site ◽  
First Time ◽  
Mycobacterium Malmoense

We report an atypical tuberculous infection by Mycobacterium Malmoense of the synovium of the flexor tendons at the wrist presenting as carpal tunnel syndrome. This is the first time this organism has been described in a site other than the lungs or the cervical lymph nodes.

Clinical Update: Assessing Maximum Medical Improvement in Carpal Tunnel Syndrome

2003 ◽  
Vol 8 (4) ◽  
pp. 4-5
Author(s):  
Christopher R. Brigham ◽  
James B. Talmage
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Proper Time ◽  
Carpal Tunnel Release ◽  
Hand Function ◽  
Factors Affecting ◽  
Early Results ◽  
Medical Evaluation ◽  
Nerve Recovery ◽  
Tunnel Syndrome

Abstract Permanent impairment cannot be assessed until the patient is at maximum medical improvement (MMI), but the proper time to test following carpal tunnel release often is not clear. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) states: “Factors affecting nerve recovery in compression lesions include nerve fiber pathology, level of injury, duration of injury, and status of end organs,” but age is not prognostic. The AMA Guides clarifies: “High axonotmesis lesions may take 1 to 2 years for maximum recovery, whereas even lesions at the wrist may take 6 to 9 months for maximal recovery of nerve function.” The authors review 3 studies that followed patients’ long-term recovery of hand function after open carpal tunnel release surgery and found that estimates of MMI ranged from 25 weeks to 24 months (for “significant improvement”) to 18 to 24 months. The authors suggest that if the early results of surgery suggest a patient's improvement in the activities of daily living (ADL) and an examination shows few or no symptoms, the result can be assessed early. If major symptoms and ADL problems persist, the examiner should wait at least 6 to 12 months, until symptoms appear to stop improving. A patient with carpal tunnel syndrome who declines a release can be rated for impairment, and, as appropriate, the physician may wish to make a written note of this in the medical evaluation report.

Clinical Update: Understanding Causation: An Example Using Carpal Tunnel Syndrome

2007 ◽  
Vol 12 (6) ◽  
pp. 5-8 ◽  
Author(s):  
J. Mark Melhorn
Keyword(s):  
Risk Factors ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Legal Responsibility ◽  
Medical Evidence ◽  
Anatomic Structure ◽  
Legal Professionals ◽  
Compensation Systems ◽  
Tunnel Syndrome ◽  
Four Levels

Abstract Medical evidence is drawn from observation, is multifactorial, and relies on the laws of probability rather than a single cause, but, in law, finding causation between a wrongful act and harm is essential to the attribution of legal responsibility. These different perspectives often result in dissatisfaction for litigants, uncertainty for judges, and friction between health care and legal professionals. Carpal tunnel syndrome (CTS) provides an example: Popular notions suggest that CTS results from occupational arm or hand use, but medical factors range from congenital or acquired anatomic structure, age, sex, and body mass index, and perhaps also involving hormonal disorders, diabetes, pregnancy, and others. The law separately considers two separate components of causation: cause in fact (a cause-and-effect relationship exists) and proximate or legal cause (two events are so closely related that liability can be attached to the first event). Workers’ compensation systems are a genuine, no-fault form of insurance, and evaluators should be aware of the relevant thresholds and legal definitions for the jurisdiction in which they provide an opinion. The AMA Guides to the Evaluation of Permanent Impairment contains a large number of specific references and outlines the methodology to evaluate CTS, including both occupational and nonoccupational risk factors and assigning one of four levels of evidence that supports the conclusion.

Sign in / Sign up

Export Citation Format

Share Document