Carpal tunnel syndrome caused by a fibrolipomatous hamartoma of the median nerve treated by endoscopic release of the carpal tunnel

Carpal tunnel syndrome is conventionally treated by open and endoscopic release surgeries in which transecting the transverse carpal ligament (TCL) relieves mechanical insults around the median nerve. The TCL release surgeries yield an increase in the tunnel cross-sectional area particularly within the volar aspect of the tunnel, the arch area, where the median nerve is located. As a result of increased arch area, post-operative follow-up studies using MRI confirmed a significant volar migration of the median nerve [1]. However, transecting the TCL compromises critical biomechanical roles of the carpal tunnel [2], and therefore, it is imperative to investigate an alternative method for treating carpal tunnel syndrome patients while preserving the TCL. Li et al. suggested that increasing the TCL length and narrowing the carpal arch width (CAW) as potential alternatives for increasing the arch area [3]. However, the data from their application of palmarly directed forces to the TCL from inside of the tunnel showed that the TCL length remained relatively constant while the carpal bones were mobilized to increase the arch area [3]. The purpose of this study was to investigate the relationship between CAW narrowing and the TCL-formed arch area by experimental and geometrical modeling.

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ENDOSCOPIC CARPAL TUNNEL RELEASE FOR RECURRENT CARPAL TUNNEL SYNDROME AFTER PREVIOUS OPEN RELEASE

Hand Surgery ◽

10.1142/s0218810404002327 ◽

2004 ◽

Vol 09 (02) ◽

pp. 235-239 ◽

Cited By ~ 12

Author(s):

Lam Chuan Teoh ◽

Puay Ling Tan

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Open Release ◽

Endoscopic Carpal Tunnel Release ◽

Endoscopic Release ◽

Tunnel Syndrome ◽

Open Carpal Tunnel Release ◽

Surgical Release

Recurrent carpal tunnel syndrome from various causes has been shown to occur in up to 19% of patients. Endoscopic carpal tunnel release has been used to decompress the median nerve in carpal tunnel syndrome for many years. However, endoscopic release for recurrent carpal tunnel syndrome after previous surgical release has not been reported. Nine hands in six patients had recurrent carpal tunnel syndrome five to 20 years after previous open carpal tunnel release. All the cases were successfully treated with endoscopic release.

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Carpal Tunnel Syndrome Caused by A Fibrolipomatous Hamartoma of the Median Nerve

BJR|case reports ◽

10.1259/bjrcr.20200090 ◽

2021 ◽

pp. 20200090

Author(s):

Fouad Aladel ◽

Ahmed Aldhafiri ◽

Thabet Alghazal ◽

Fahad Alsafran ◽

Zainab Alrashed ◽

...

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Peripheral Nerves ◽

Benign Lesion ◽

Invasive Procedure ◽

Fibrolipomatous Hamartoma ◽

Tunnel Syndrome ◽

The Right ◽

Patient At Risk

Fibrolipomatous hamartoma (FLH) of the nerve (also known as perineural lipoma, neural fibrolipoma, or lipomatosis of the nerve) is a well-known, rare benign lesion that can affect any peripheral nerve, resulting in significant enlargement of the involved nerve with fibrofatty infiltration. Although it is most commonly involving the median nerve, other peripheral nerves can be also involved. Being familiar with the pathognomonic characteristics on different imaging modalities and the association of this entity with macrodactyly help reach the diagnosis, avoid putting the patient at risk of an invasive procedure, and can guide management. We present to you a rare case of a FLH of the median nerve that was diagnosed on MRI of an adult female who presented with carpal tunnel syndrome (CTS) and progressive swelling of the right hand and wrist.

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Fibrolipomatous hamartoma of median nerve: A rare cause of carpal tunnel syndrome and macrodactyly

Journal of Orthopaedics and Allied Sciences ◽

10.4103/2319-2585.158517 ◽

2015 ◽

Vol 3 (2) ◽

pp. 63 ◽

Cited By ~ 1

Author(s):

Ashish Verma ◽

Anand Bansal ◽

Chandan Mourya

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Fibrolipomatous Hamartoma ◽

Tunnel Syndrome

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Fibrolipomatous hamartoma of the median nerve: A cause of acute bilateral carpal tunnel syndrome in a three-year-old child: A case report and comprehensive literature review

Plastic Surgery ◽

10.1177/229255031402200307 ◽

2014 ◽

Vol 22 (3) ◽

pp. 201-206 ◽

Cited By ~ 8

Author(s):

Jenna-Lynn Senger ◽

Dale Classen ◽

Garth Bruce ◽

Rani Kanthan

Keyword(s):

Case Report ◽

Carpal Tunnel Syndrome ◽

Literature Review ◽

Median Nerve ◽

Carpal Tunnel ◽

Fibrolipomatous Hamartoma ◽

Comprehensive Literature Review ◽

Tunnel Syndrome ◽

Bilateral Carpal Tunnel Syndrome

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Carpal Tunnel Syndrome Secondary to Fibrolipomatous Hamartoma of the Median Nerve

Cureus ◽

10.7759/cureus.15363 ◽

2021 ◽

Author(s):

Christopher R Michel ◽

Christopher Dijanic ◽

Mark Woernle ◽

Justin Fernicola ◽

Jamie Grossman

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Fibrolipomatous Hamartoma ◽

Tunnel Syndrome

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Dual-portal Endoscopic Release of the Transverse Ligament in Carpal Tunnel Syndrome

Neurosurgery ◽

10.1227/01.neu.0000223500.25131.99 ◽

2006 ◽

Vol 59 (2) ◽

pp. 333-340 ◽

Cited By ~ 21

Author(s):

Joachim Oertel ◽

Henry W.S. Schroeder ◽

Michael R. Gaab

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Surgical Complication ◽

Postoperative Recovery ◽

Endoscopic Technique ◽

Reliable Technique ◽

Endoscopic Release ◽

Carpal Tunnel Surgery ◽

Tunnel Syndrome

Abstract OBJECTIVE: Endoscopic release of carpal tunnel syndrome is still under debate. The main advantages of the technique are considered to be minor postoperative pain and a more rapid postoperative recovery. Disadvantages are thought to be the impossibility of a direct median nerve neurolysis and a higher surgical complication rate, including injury to the median nerve. METHODS: The results of 411 consecutive endoscopic carpal tunnel procedures performed between March 1995 and September 2004 are presented. All patients were prospectively followed. RESULTS: In the present series, a success rate of 98.05% was observed. There was no permanent morbidity and, in particular, there was no injury of the median nerve. In four (0.97%) patients, the preoperative symptoms did not improve. In two (0.49%) of these patients, an incomplete release of the carpal ligament occurred. In another four patients (0.97%), a switch to open surgery was required. CONCLUSION: The present data prove that the endoscopic technique is a safe and reliable technique for carpal tunnel surgery. The data do not support the current discussion of a higher risk of median nerve injury with endoscopic carpal tunnel surgery. Thus, for our group, the endoscopic technique represents the therapy of choice for the primary idiopathic carpal tunnel syndrome.

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