scholarly journals Carpal tunnel syndrome - anatomical variations and tests for their diagnosis

2017 ◽  
Vol 6 (2) ◽  
pp. 79
Author(s):  
Veselina Mihaleva ◽  
Mariyana Mihaylova ◽  
Stoyan Pavlov ◽  
Desislava Marinova ◽  
Meglena Angelova ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Anatomical Variations ◽  
Tunnel Syndrome

scholarly journals Conservative treatment for Carpal Tunnel Syndrome caused by persistent median artery: a case report

2021 ◽  
Vol 10 (12) ◽  
pp. e483101220884
Author(s):  
Beatriz Pereira Vaz Tamiozzo ◽  
Eduardo Tavares Lima Trajano ◽  
Marco Aurélio dos Santos Silva ◽  
Larissa Alexsandra da Silva Neto Trajano
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Clinical Manifestations ◽  
Clinical Importance ◽  
Anatomical Variations ◽  
Left Hand ◽  
Compressive Neuropathy ◽  
Volar Aspect ◽  
Tunnel Syndrome ◽  
Median Artery

Knowledge of a persistent median artery, defined as an anatomical vascular variation, is of clinical importance because it can be an unusual etiology of carpal tunnel syndrome. This report describes the case of a 42-year-old female patient with acute pain and paresthesia involving the volar aspect of the first, second, and third fingers of the left hand. The clinical manifestations pointed to compressive neuropathy of the median nerve, and diagnostic imaging showed anatomical vascular variation. Details were collected through interviews with the patient, and photographic records of imaging exams were thoroughly analyzed. This case study shows the importance of the identification and knowledge about anatomical variations considering that under specific pathological conditions, they can be a cause of clinical syndromes. Such knowledge is also important in the field of surgery for the prevention of iatrogenic injuries.

scholarly journals Anatomical variation of the median nerve and its thenar branch: Clinical and surgical application in the treatment of carpal tunnel syndrome

2021 ◽  
Vol 09 (03) ◽  
pp. 326-329
Author(s):  
Charaf eddine Elkassimi ◽  
Mustapha Fadili ◽  
Sami Rouadi ◽  
Abdelhak Garch
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Annular Ligament ◽  
Surgical Application ◽  
Tunnel Syndrome ◽  
Open Surgical Treatment

Carpal tunnel syndrome is the most common root canal pathology. The surgical treatment corresponds to a release of the median nerve by incision of the anterior annular ligament of the carpus by open surgical treatment or endoscopy. Knowledge of the normal anatomy and anatomical variations of the median nerve at the wrist is fundamental to avoiding complications in median nerve release in the treatment of carpal tunnel syndrome. Through this work we will show the interest of knowledge of the anatomy of the median nerve as well as its anatomical variations in order to derive the main clinical applications and to avoid the risks associated with open or endoscopic surgery in the treatment of carpal tunnel syndrome.

scholarly journals A Case of Penetrating Foreign Body Causing Mild Symptoms of Acute Carpal Tunnel Syndrome

2020 ◽  
Vol 6 ◽  
pp. 2513826X2094698
Author(s):  
Rashed N. AlHasan ◽  
Nayef A. Louri
Keyword(s):  
Foreign Body ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Complete Recovery ◽  
Anatomical Variations ◽  
Obese Women ◽  
Women In Literature ◽  
Tunnel Syndrome ◽  
The Right ◽  
Acute Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a neuropathy brought about by the entrapment and compression of the median nerve as it travels through the carpal tunnel. The hallmark of classic CTS is pain or paraesthesia (numbness, burning, or tingling) in the palmar aspect of the first 3 digits, as well as the radial aspect of the fourth digit. Although idiopathic in nature, many risk factors have been attributed to the development of CTS. These factors include diabetes mellitus, acromegaly, thyroid disease, rheumatoid arthritis, pregnancy, the use of steroids, and the repetitive use of hand and wrist. The prevalence also seems to be higher in obese women. In literature, trauma, foreign body, tumors, or anatomical variations are considered to be infrequent causes of CTS. A rare form of CTS is the acute carpal tunnel syndrome (ACTS) that presents mainly after injuries to the upper extremities. The patient typically acknowledges trauma to the wrist secondary to a foreign body at the time of injury. In some cases, small fragments may penetrate the wrist and remain unnoticed causing acute neurological symptoms. In literature, there were limited studies that reported the development of ACTS secondary to missed foreign bodies following trauma. This report presents a case of ACTS sustained following a penetrating foreign body (pellet) to the right wrist. Removal of the foreign body resulted in complete recovery with no neurological sequelae.

Sonographic diagnosis of anatomical variations associated with carpal tunnel syndrome

2013 ◽  
Vol 42 (6) ◽  
pp. 371-374 ◽  
Author(s):  
P. De Franco ◽  
C. Erra ◽  
G. Granata ◽  
D. Coraci ◽  
R. Padua ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Anatomical Variations ◽  
Sonographic Diagnosis ◽  
Tunnel Syndrome

scholarly journals Carpal tunnel syndrome caused by the entrapment of a bifid Lanz IIIA Type anatomical variant of median nerve: A case report and systematic literature review

2021 ◽  
Vol 12 ◽  
pp. 37
Author(s):  
Emanuele La Corte ◽  
Clarissa A. E. Gelmi ◽  
Nicola Acciarri
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Anatomical Variant ◽  
Raising Awareness ◽  
Tunnel Syndrome ◽  
Median Artery

Background: Carpal tunnel syndrome (CTS) is the most common entrapment peripheral neuropathy. Median nerve may present several anatomical variations such as a high division or bifid median nerve (BMN). A thorough knowledge of the normal anatomy and variations of the median nerve at the wrist are fundamental to reduce complications during carpal tunnel release. Case Description: A 63-year-old man with CTS underwent preoperative ultrasound that showed the entrapment of the median nerve and disclosed a BMN Lanz IIIA Type anatomical variation at the carpal tunnel. During the surgery, the anatomical variant of a BMN at the wrist has been visualized. Both nervous rami entirely occupied the carpal canal and this may have predisposed to the development of the entrapment syndrome. Nor persistent median artery, or other associated abnormalities, have been identified. At the 6 months follow-up control, the patient referred a good surgical recovery with complete resolution of the preoperative symptoms of the median nerve entrapment. Conclusion: A rare case of Lanz IIIA BMN Type at the wrist has been encountered in a patient with a CTS and a systematic review and practical considerations have been presented with the aim of raising awareness to the neurosurgical community of a such rare variant that could be encountered during carpal tunnel release procedures. CTS may be caused by the entrapment of a BMN Lanz IIIA Type anatomical variant of median nerve. Preoperative US would help to identify such patients to reduce risk of iatrogenic injuries.

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.

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