Carpal tunnel syndrome secondary to intratendinous infiltration by tophaceous gout.

Carpal tunnel syndrome caused by gout is rare. We describe a case of entrapment of the median nerve secondary to intratendinous infiltration by gouty tophi in a 54-year-old man. The tophus was excised from the profundus tendon but the superficialis was too infiltrated and destroyed to be saved. The patient made an uneventful recovery with relief of his symptoms. This case illustrates the potential consequences this could have for hand function.     

Carpal tunnel syndrome due to heterotopic ossification

We report a rare case of carpal tunnel syndrome due to heterotopic ossification in the carpal tunnel in a 34-year-old woman without antecedents of neurological injury, musculoskeletal trauma, or metabolic disorder. To our knowledge, this is the first reported case. Incomplete excision of heterotopic ossification resulted in partial relief of symptoms.     

Fulminating carpal tunnel syndrome due to gout

Severe, fulminating carpal tunnel compression due to gout has not previously been described. We report such a case.     

痛风致腕管综合征一例

患者男，69岁。因左拇、示、中指疼痛并麻木2年，加重伴功能障碍3个月入院。2年前，患者无明显诱因出现左拇、示、中指麻木、疼痛，在门诊以颈椎病给予牵引、理疗，症状无明显改善。1年后又出现腕部疼痛，以夜间痛明显，在外院以类风湿关节炎治疗，也无明显效果。3个月前，手指麻木症状加重，伴手指精细动作受限，握捏困难。临床检查：左手桡侧三个半手指掌侧感觉明显减退，大鱼际肌萎缩（＋），拇对掌功能受限，环、小指屈曲受限，     

Carpal tunnel syndrome accompanying radial dysplasia due to thalidomide embryopathy

We performed endoscopic carpal tunnel release in four hands in three patients suffering from radial dysplasia due to thalidomide embryopathy. Carpal canal pressure measurements results confirmed the diagnoses. All operations were successfully performed and resulted in no complications. Tingling sensation and sensory disturbances of the hands subsided.     

Carpal tunnel pressure in patients with carpal tunnel syndrome due to long-term hemodialysis

We studied carpal tunnel pressure and outcome of endoscopic carpal tunnel release in 42 patients (53 hands) with carpal tunnel syndrome (CTS) and receiving long-term hemodialysis. We compared these results with those of 41 patients (49 hands) with idiopathic CTS. Pressure was measured peroperatively: first, before dilation of the carpal tunnel; second, after dilation but before release of the transverse carpal ligament; and third, after completion of the release. In patients receiving long-term hemodialysis, the highest pressures were 76.9, 56.0, and 7.8 mmHg respectively. In patients with idiopathic CTS, pressures were 68.8, 44.1, and 4.0 mmHg respectively. The clinical outcome was inferior in patients receiving long-term hemodialysis.     

Carpal tunnel syndrome due to fibrolipomatous hamartoma of the median nerve

Nervous lipofibromatous hamartoma is a rare tumor-like condition involving the peripheral nerves, whereby the epineurium and perineurium are enlarged and distorted by excess of fatty and fibrous tissues that infiltrate between and around nerve boundaries. The median nerve is much more likely to develop a hamartoma than other nerves with a predilection for the carpal tunnel. We present a case of carpal tunnel syndrome in an adult caused by fibrolipomatous hamartoma of the median nerve, successfully removed by excision of the fibrolipomatous tissue and decompression.     

Carpal tunnel syndrome

Summary The anatomy of the carpal tunnel was studied by postmortem dissection of both wrists in ten adults with normal wrists. Preoperative clinical and EMG examinations were performed on 28 wrists in 23 patients suffering from carpal tunnel syndrome. Anatomical and histological studies were made in connection with operation, and postoperatively the condition was followed clinically and by EMG. Numbness, tingling, and pain of the hands were markedly relieved during 2 months of follow-up, whereas clumsiness and weakness showed no significant change. Preoperatively, EMG showed sensory abnormalities in 96% of cases and motoric abnormalities in 82%. The diagnostic accuracy of EMG was good, in particular as regards the sensory aspect. The return to normal of EMG was slow. Pathoanatomical examination showed a normal tendon sheath and transverse carpal ligament in 52%, while rheuma was found in the specimens of 12%, fibrosis of the tendon sheath in 36%, and fibrosis of the transverse carpal ligament in 32%. No correlation was observed between the shape of the osseous carpal tunnel and the degree of clinical symptoms.

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Zusammenfassung Anhand von Autopsien bei 10 Erwachsenen (20 Gelenke) mit normalen Handgelenken wurde die Anatomie des Karpaltunnels untersucht. Bei 23 Patienten (28 Gelenke) mit Karpaltunnelsyndrom wurde präoperativ neben der klinischen Untersuchung ein EMG abgeleitet. Anatomische und histologische Studien wurden im Zusammenhang mit der Operation durchgeführt, postoperativ erfolgte die Kontrolle des EMG-Befundes. Im Ergebnis der Operation waren nach 2monatiger postoperativer Beobachtungszeit Hypästhesie, Parästhesie und Schmerz erheblich vermindert, während Störungen der Feinmotorik sowie Muskelschwäche keine signifikanten Veränderungen zeigten. Das präoperative EMG ergab sensible Störungen in 96% und motorische Störungen in 82% der Fälle. Das EMG erwies sich besonders bezüglich der Sensibilität als diagnostisch zuverlässig. Die Normalisierung des EMG-Befundes erfolgte langsam. Das Ergebnis der pathologisch-anatomischen Untersuchung des peritendinösen Syniovialgewebes sowie des Ligamentum carpi transversum war bei 52% normal, Rheuma wurde bei 12% der Präparate gefunden, Fibrosis des Sehnengleitgewebes bei 36%, Fibrosis des Ligamentum carpi transversum bei 32%. Zwischen der Form des knöchernen Karpaltunnels und dem Schweregrad der klinischen Symptome konnte kein Zusammenhang festgestellt werden.