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 Multifocal acquired demyelinating sensory and motor neuropathy misdiagnosed as carpal tunnel syndrome: a case report

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199889
Author(s):  
Soyoung Kwak ◽  
Mathieu Boudier-Revéret ◽  
Hee Kyung Cho ◽  
Min Cheol Chang
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Peripheral Nerves ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Motor Neuropathy ◽  
Motor Weakness ◽  
Left Hand ◽  
Sensory Deficits ◽  
Compressive Neuropathy ◽  
Tunnel Syndrome

Multifocal acquired demyelinating sensory and motor neuropathy (MADSAM), a subtype of chronic inflammatory demyelinating polyneuropathy, is a non-compressive peripheral nerve disorder. Symptoms of MADSAM include asymmetrical weakness and sensory deficits in the distribution of individual peripheral nerves, which are frequently noted in the distal portion of peripheral nerves. MADSAM can be easily misdiagnosed as any of the various compressive peripheral neuropathies. Here, we present a case of MADSAM misdiagnosed as carpal tunnel syndrome (CTS). A 53-year-old woman had bilateral asymmetrical hand weakness (left hand: significant weakness, right hand: slight motor weakness) and a slight weakness of her bilateral lower extremities. Sensory deficit was found on the volar side of her left hand. She had visited many clinics previously and was diagnosed with CTS. However, an electrodiagnostic study performed in our hospital did not identify CTS but indicated a demyelinating peripheral neuropathy in all limbs. On the basis of the patient’s clinical symptoms and laboratory findings, she was diagnosed with MADSAM. When patients exhibit progressive aggravating motor weakness and sensory deficits in more than one distal limb without a specific finding of compressive neuropathy in electrodiagnostic studies, clinicians should consider the possibility of MADSAM.

Carpal Tunnel Syndrome and Trigger Wrist Caused by Localized Amyloidosis: A Case Report

2017 ◽  
Vol 22 (04) ◽  
pp. 508-511
Author(s):  
Takuma Wakasugi ◽  
Ritsuro Shirasaka ◽  
Toshiyuki Kawauchi ◽  
Koji Fujita ◽  
Atsushi Okawa
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Flexor Digitorum Profundus ◽  
Left Hand ◽  
Localized Amyloidosis ◽  
Volar Aspect ◽  
Tingling Sensation ◽  
Tunnel Syndrome ◽  
Trigger Wrist ◽  
Flexor Digitorum

We report a case of carpal tunnel syndrome and trigger wrist caused by localized amyloidosis. A 37-year-old man, who worked as a manufacturer, presented with a 5-month history of tingling sensation in the three radial fingers of the left hand and a painful click at the volar aspect of the wrist during digital motion. We divided the transverse carpal ligament and detected diffuse tenosynovitis that was especially severe around the flexor digitorum profundus tendons. Histological findings led to a diagnosis of amyloidosis. Localized amyloidosis could thus be a cause of trigger wrist. Systemic amyloidosis may develop in patients with localized amyloidosis; therefore, patients with trigger wrist caused by flexor tenosynovitis should be investigated for the existence of localized amyloidosis, with biopsy of the flexor tenosynovium.

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.

scholarly journals Thrombosis of persistent median artery as a cause of carpal tunnel syndrome : case report

2021 ◽  
Vol 87 (3) ◽  
pp. 529-532
Author(s):  
S Arnauw ◽  
G De Wachter
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Carpal Tunnel ◽  
Treatment Options ◽  
Surgical Excision ◽  
Acute Onset ◽  
Complete Relief ◽  
Anatomical Variant ◽  
Tunnel Syndrome ◽  
Median Artery

Carpal tunnel syndrome (CTS) is a common peripheral neuropathy, caused by compression of the median nerve. Symptoms usually are present for months and aggravate over time. Acute onset of complaints and symptoms, like coldness of the hand, should raise awareness of a possible vascular cause of CTS.Persistent median artery (PMA) is a very rare anatomical variant of the blood supply of the upper limb. The presence of a thrombosed PMA is an extremely rare cause of CTS. In this article a case is presented in which the patient has carpal tunnel syndrome of his left hand, caused by a thrombosed persistent median artery. Conservative treatment, consisting of rest, ice applica- tion and non-steroidal anti-inflammatory drugs, failed. Surgical excision of the thrombosis and open exploration of the carpal tunnel was performed, with complete relief of symptoms. In literature different treatment options, like conservative treatment with antiplatelet therapy or surgical excision of the throm- bosis and decompression of the nerve, are described with good results. However up until now, no consensus exists about the golden standard in treatment of a thrombosed persistent median artery.

scholarly journals Carpal Tunnel Syndrome Associated with Klippel-Trénaunay Syndrome: A Case Report

2020 ◽  
Vol 6 (3) ◽  
pp. 161-164
Author(s):  
Joan Arenas-Prat ◽  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Peripheral Nerves ◽  
Distribution Area ◽  
Left Hand ◽  
Nerve Involvement ◽  
Tunnel Syndrome ◽  
Operative Findings ◽  
Klippel Trenaunay Syndrome

Background and Importance: Klippel-Trénaunay syndrome is a rare congenital condition that rarely affects peripheral nerves. Median nerve involvement at the carpal tunnel level has only been reported on four occasions of this syndrome in the medical literature. Case Presentation: A 61-year-old Caucasian female patient with Klippel-Trénaunay syndrome presented with a 10-month history of paraesthesia and numbness affecting the median nerve distribution area of her left hand. The clinical and neurophysiological examination confirmed a moderately severe carpal tunnel syndrome that required surgical decompression. Conclusion: Pre-operative findings demonstrated diffuse vascular infiltration and engorgement of the median nerve. Flexor tendons had a normal appearance. The patient had a satisfactory post-operative period with full resolution of her symptoms 4 weeks after the procedure. Although peripheral nerves are rarely affected in patients with Klippel-Trénaunay syndrome, neurological symptoms could indicate nerve involvement and magnetic resonance imaging (MRI) examination should be considered to further assess the extension of the lesion.

A PERSISTENT MEDIAN ARTERY AND BIFID MEDIAN NERVE IN THE SETTING OF CARPAL TUNNEL SYNDROME

2012 ◽  
Vol 15 (02) ◽  
pp. 1272004
Author(s):  
M. Lee Spangler ◽  
Emad Almusa ◽  
Cynthia Britton
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Imaging Features ◽  
Anatomic Variants ◽  
Tunnel Syndrome ◽  
Median Artery

We present a case of bifid median nerve and a persistent median artery presenting in the setting of carpal tunnel syndrome. The importance of these anatomic variants and their imaging features and workup are discussed.

Additional value of ultrasound in the assessment of carpal tunnel syndrome in rheumatological daily practice. A case of persistent median artery thrombosis

2020 ◽  
Vol 87 (6) ◽  
pp. 666-667 ◽  
Author(s):  
Gianluca Smerilli ◽  
Jacopo Di Battista ◽  
Edoardo Cipolletta ◽  
Walter Grassi ◽  
Emilio Filippucci
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Daily Practice ◽  
Artery Thrombosis ◽  
Tunnel Syndrome ◽  
Median Artery ◽  
Additional Value

Cervical pneumatocyst

2011 ◽  
Vol 15 (3) ◽  
pp. 332-335 ◽  
Author(s):  
Jason M. Hoover ◽  
Doris E. Wenger ◽  
Laurence J. Eckel ◽  
William E. Krauss
Keyword(s):  
Cervical Spine ◽  
Carpal Tunnel Syndrome ◽  
Neck Pain ◽  
Carpal Tunnel ◽  
Chronic Neck Pain ◽  
Cervical Radiculopathy ◽  
Disc Disease ◽  
Left Hand ◽  
Tunnel Syndrome ◽  
Multilevel Fusion

The authors present the case of a 56-year-old right hand–dominant woman who was referred for chronic neck pain and a second opinion regarding a cervical lesion. The patient's pain was localized to the subaxial spine in the midline. She reported a subjective sense of intermittent left arm weakness manifesting as difficulty manipulating small objects with her hands and fingers. She also reported paresthesias and numbness in the left hand. Physical and neurological examinations demonstrated no abnormal findings except for a positive Tinel sign over the left median nerve at the wrist. Electromyography demonstrated bilateral carpal tunnel syndrome with no cervical radiculopathy. Cervical spine imaging demonstrated multilevel degenerative disc disease and a pneumatocyst of the C-5 vertebral body. The alignment of the cervical spine was normal. A review of the patient's cervical imaging studies obtained in 1995, 2007, 2008, and 2010 demonstrated that the pneumatocyst was not present in 1995 but was present in 2007. The lesion had not changed in appearance since 2007. At an outside institution, multilevel fusion of the cervical spine was recommended to treat the pneumatocyst prior to evaluation at the authors' institution. The authors, however, did not think that the pneumatocyst was the cause of the patient's neck pain, and cervical pneumatocysts typically have a benign course. As such, the authors recommended conservative management and repeated MR imaging in 6 months. Splinting was used to treat the patient's carpal tunnel syndrome.

Experimentally and Theoretically Narrowing Carpal Arch Width to Increase the Area Formed by the Transverse Carpal Ligament

2011 ◽  
Author(s):  
Suk H. Yu ◽  
Tracy A. Mondello ◽  
Zong-Ming Li
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Transverse Carpal Ligament ◽  
Cross Sectional ◽  
Arch Width ◽  
Endoscopic Release ◽  
Volar Aspect ◽  
Tunnel Syndrome

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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