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

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.

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Prediction of the Outcome 24 Hours after Carpal Tunnel Decompression

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(93)90101-k ◽

1993 ◽

Vol 18 (2) ◽

pp. 180-181 ◽

Cited By ~ 11

Author(s):

A. M. CLARKE ◽

D. STANLEY

Keyword(s):

Carpal Tunnel Syndrome ◽

Prospective Study ◽

Carpal Tunnel ◽

Symptomatic Relief ◽

Surgical Decompression ◽

Subjective Improvement ◽

Excellent Outcome ◽

Good Outcome ◽

Tunnel Syndrome ◽

A Prospective Study

A prospective study has been performed on 47 wrists treated by surgical decompression for carpal tunnel syndrome. In all cases where there was symptomatic relief within the first 24 hours postoperatively, a good or excellent outcome was obtained when the patients were reviewed six weeks after surgery. If subjective improvement was not obtained by 24 hours, a good outcome was still possible but a poor outcome became more likely.

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First Lumbrical Muscle Flap for Recurrence of Carpal Tunnel Syndrome: Anatomical Study and Surgical Technique

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0041-1730391 ◽

2021 ◽

Vol 49 (01) ◽

pp. 079-087

Author(s):

Esther Fernández Tormos ◽

Fernando Corella Montoya ◽

Blanca Del Campo Cereceda ◽

Montserrat Ocampos Hernández ◽

Teresa Vázquez Osorio ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Revision Surgery ◽

Muscle Flap ◽

Anatomical Study ◽

Physical Barrier ◽

Adjacent Structures ◽

Tunnel Syndrome ◽

Lumbrical Muscle

AbstractRecurrence of carpal tunnel syndrome implies the reappearance of symptoms after release surgery. If the cause of recurrence is not an incomplete release, but a traction neuritis, the tendency is to add to the revision surgery of the carpal tunnel the use of flaps to cover the median nerve. These flaps establish a physical barrier between the nerve and the rest of the adjacent structures, preventing adhesions, and providing neovascularization and better nerve sliding.In the present work, we detail a revision surgery in which the first lumbrical muscle is used as a covering flap. This flap has two benefits. Firstly, it acts as a vascularized coverage for the median nerve (avoiding the formation of fibrosis and favoring its sliding); secondly, a structure that takes up space is removed from the carpal tunnel, thus reducing the pressure within it.Along with the explanation of the technique, the present article provides a detailed description of the anatomical variability of the first lumbrical muscle and its vascularization, as well as the results of a cadaveric study on the location of the vascular pedicle of the first lumbrical muscle.

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Point Blank: A Retrospective Review of Self-inflicted Gunshot Wounds to the Hand

Hand ◽

10.1177/15589447211014603 ◽

2021 ◽

pp. 155894472110146

Author(s):

Brian W. Starr ◽

Douglas R. Dembinski ◽

Frank Yuan ◽

Elizabeth A. Lax ◽

Suma Yalamanchili ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Adverse Events ◽

Carpal Tunnel ◽

Gunshot Wounds ◽

Surgical Decompression ◽

Low Energy ◽

Wound Infections ◽

Tunnel Syndrome ◽

Acute Carpal Tunnel Syndrome ◽

Surgical Release

Background A paucity of literature exists specifically examining self-inflicted (SI) gunshot wounds (GSWs) to the hand and wrist, which impart greater energy and have a higher risk of adverse events than non–self-inflicted (NSI) GSWs. Methods We retrospectively reviewed records of patients who presented to our plastic surgery service after sustaining acute GSWs involving the hand and wrist between 2016 and 2018. Results We identified 60 patients who sustained GSWs involving the hand and wrist; 17 (28%) were SI, and 43 (72%) were NSI. Within the SI group, 100% of patients were Caucasian, with an average age of 54 years. Within the NSI cohort, 77% of patients were Black, 19% were Caucasian, and 4% identified as other. While not statistically significant, we noted a substantial increase in patients requiring operative intervention in the SI cohort (65% SI vs 37% NSI, P = .08). There was a statistically significant increase in patients requiring more than 1 operation in SI patients (24% SI vs 5% NSI, P = .04). Patients who sustained SI injuries were also more likely to present with acute carpal tunnel syndrome requiring urgent surgical release and to develop wound infections (12% vs 0%, P = .08). Conclusions Self-inflicted GSWs involving the hand and wrist are associated with greater morbidity than their low-energy NSI counterparts. Individuals presenting with SI GSWs are more likely to be older, to require multiple operations, to develop infections, and to present with acute carpal tunnel syndrome requiring urgent surgical decompression.

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1287 A Comparison of Surgical Decompression and Steroid Injections to Treat Carpal Tunnel Syndrome: A Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab259.831 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

F La Costa

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Steroid Injection ◽

Muscular Atrophy ◽

Meta Analysis ◽

Surgical Decompression ◽

Optimal Treatment ◽

Post Treatment ◽

Entrapment Neuropathies ◽

Tunnel Syndrome

Abstract Introduction Carpal tunnel syndrome (CTS) is caused by compression of the median nerve at the wrist. It accounts for 90% of all entrapment neuropathies, with a 7-16% in the UK. It has a significant impact on patients’ daily lives. Clinically, CTS results in paraesthesia, while extreme cases may involve muscular atrophy and weakness. There is currently a disparity between optimal treatments for CTS. Therefore, this paper aims to identify the optimal treatment for CTS with post-treatment BCTQ (Boston Carpal Tunnel Questionnaire) scores (including both functional and symptomatic severity) at 1, 3 and 6 months. Method The BCTQ scores for were sited from PubMed, Google Scholar and the University of Dundee Library search engine by entering key words such as “carpal tunnel syndrome”, “surgical decompression”, “surgical release” and “steroid injection”. Means and standard deviations for pre- and post-treatment after 1, 3 and 6 months were obtained. From this, forest plots were constructed using a software where steroid injection and surgical decompression were inputted separately, and effect sizes were then compared for 1, 3 and 6 months. Results The meta-analysis included reviewing 133 articles. The effect size was determined using the random effects model. Steroid injection was more effective than surgical decompression after 1 and 3 months. However, after 6 months, surgical decompression was more effective. Conclusions Identification of long-term relief of CTS through surgical decompression allows the reduction of symptom recurrence and thus costly follow-up appointments. This study provides robust clinical findings for the optimal treatment of CTS.

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Use of a Wheel Aesthesiometer for Testing Sensibility in the Hand Results in patients with carpal tunnel syndrome

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_86_90255-x ◽

1986 ◽

Vol 11 (2) ◽

pp. 182-186

Author(s):

D. R. MARSH

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Surgical Decompression ◽

Spatial Discrimination ◽

Sensory Impairment ◽

Discrimination Test ◽

New Instrument ◽

Before And After ◽

Tunnel Syndrome

Tests of spatial discrimination were performed on the hands of patients with carpal tunnel syndrome, before and after surgical decompression. Impairment of sensibility and its recovery after treatment were better demonstrated by a new instrument, the wheel aesthesiometer, than by the moving two-point discrimination test. The psychophysics of the new test and the nature of the sensory impairment in carpal tunnel syndrome are discussed.

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The Natural History of Carpal Tunnel Syndrome in Lactation

Journal of the Royal Society of Medicine ◽

10.1177/014107688908200612 ◽

1989 ◽

Vol 82 (6) ◽

pp. 349-350 ◽

Cited By ~ 16

Author(s):

J S Wand

Keyword(s):

Carpal Tunnel Syndrome ◽

Natural History ◽

Carpal Tunnel ◽

Surgical Decompression ◽

Steroid Injections ◽

History Of ◽

Tunnel Syndrome ◽

Inflammatory Drugs ◽

One Year ◽

Primiparous Women

In a retrospective postal study of 27 women who have developed carpal tunnel syndrome (CTS) in the puerperium, the condition was found to affect predominantly elderly primiparous women (mean age 31.5 years). The condition was associated with breastfeeding in 24 women. The three who did not breastfeed had less severe symptoms which resolved within one month of onset. The symptoms developed a mean of 3.5 weeks following delivery, lasted 6.5 months and started to resolve within 14 days of weaning. Symptomatic treatments with either splint-age, diuretics, non-steroidal anti-inflammatory drugs or steroid injections provided some benefit. Two patients required surgical decompression. All patients were symptom-free by one year.

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Carpal Tunnel Syndrome Produced by an Organising Haematoma Within the Anomalous Second Lumbrical Muscle

HAND ◽

10.1016/s0072-968x(81)80038-1 ◽

1981 ◽

Vol os-13 (1) ◽

pp. 87-91 ◽

Cited By ~ 9

Author(s):

A. Nather ◽

R. W. H. Pho

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Rare Case ◽

Complete Relief ◽

Anomalous Muscle ◽

Tunnel Syndrome ◽

Lumbrical Muscle

A rare case of carpal tunnel syndrome due to an anomalous second lumbrical muscle passing through the carpal tunnel is described. Its presentation as an organising haematoma in the anomalous muscle due to trauma precipitating the syndrome has not been reported in the literature previously. The anomalous muscle with its contained haematoma was excised with complete relief of symptom.

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Incidental finding of a persistent median artery (palmar type) during a routine carpal tunnel decompression: a case report

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0088 ◽

2017 ◽

Vol 99 (7) ◽

pp. e204-e205

Author(s):

J Butt ◽

AK Ahluwalia ◽

A Dutta

Keyword(s):

Case Report ◽

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Incidental Finding ◽

Surgical Decompression ◽

Iatrogenic Injury ◽

Palmar Fascia ◽

Tunnel Syndrome ◽

Median Artery

Carpal tunnel syndrome is characterised by compression of the median nerve. The mainstay of treatment is surgical decompression. This case report highlights the occurrence of a persistent median artery, which could complicate surgery. A 55-year-old woman underwent carpal tunnel decompression. An incidental finding of a large-calibre persistent median artery, which was superficial to the flexor sheath, could have been damaged. This was carefully retracted and the procedure was completed, without any complications. Several studies have shown the prevalence of persistent median artery to range from 1.1–27.1%. It is usually found deep to the flexor retinaculum but in this case it was found to be just beneath the palmar fascia. There is increased chance of iatrogenic injury with this particular variant. Surgeons performing the procedure should be mindful of this variation, because accidental damage could result in devastating consequences to the hand.

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