A 57-year-old female presented with a history of a progressively enlarging palmar mass over three years, with associated numbness over the median nerve distribution and difficulty in gripping due to dimensions of the mass. Physical examination revealed a 4 x 5 cm, movable, non-tender mass over the thenar eminence and a 2 x 1 cm movable, non-tender mass over the center of the palm. Tinel’s sign was positive over the mass and the carpal tunnel.

Excision of the mass was performed under intravenous regional anesthesia. A curvilinear incision made from the thenar crease distally to the midline of the wrist overlying the carpal tunnel, proximally. Dissection was carried down to the transverse carpal ligament which was transected to allow visualization of the mass and its attachment to the median nerve.

The mass described in this present case report shares characteristics from cases in previously published literature. Its gross appearance was highly indicative of a lipoma and its close relationship with the median nerve suggested an epineural origin. Magnetic resonance imaging revealed a well-defined lesion, suggesting a mass that was more likely to be excised, potentially leading to better neurologic outcomes.

Intraneural lipomas (within the epineurium) are rare soft-tissue tumors that predominantly occur in the hand and forearm. Most cases reported involve the median nerve, followed by the radial nerve, posterior interosseus nerve and more rarely the brachial plexus. Compression of peripheral nerves by benign adipose tumors is infrequently reported in literature, with most publications restricted to case reports or series of a few patients. To the author’s knowledge, this is the first article describing an intraneural lipoma in the Filipino population.

Humans ; Carpal Tunnel Syndrome/surgery* ; Amyloidosis ; Joint Diseases

OBJECTIVE: To investigate the efficacy of self-made arthroscopic single channel in the treatment of carpal tunnel syndrome. METHODS: Sixty patients with primary carpal tunnel syndrome treated from January 2014 to December 2019 were divided into arthroscopic group and traditional open operation group. There were 30 cases in arthroscopic group, including 12 males and 18 females, aged (47.5±4.5) years and the course of disease was (6.6±4.2) months. There were 30 cases in the traditional operation group, including 10 males and 20 females, aged (48.5±3.5) years, and the course of disease was (5.6±4.4) months. Both groups were unilateral. According to the anatomy of wrist joint and the characteristics of transverse carpal ligament and arthroscopy, the instruments including cannula, inner heart and hook knife were designed. The patients in two groups were treated with decompression of transverse carpal ligament using arthroscopy combined with self-made instruments and traditional open sergery. The incision length, operation time, intraoperative bleeding, hospitalization cost, hospitalization time and recovery time of the two groups were observed and compared. Boston Carpal Tunnel Questionnaire (BCTQ) score was used to evaluate the clinical efficacy of arthroscopy combined with self made instruments in the treatment of carpal tunnel syndrome. RESULTS: Compared with the traditional group, the arthroscopic group had significant advantages in incision length, operation time, intraoperative bleeding and hospital stay, but the total cost of hospitalization was increased. The Boston score was significantly higher in the arthroscopic group than that in the traditional group at 1 month after operation, but not at 3 and 6 months after operation. CONCLUSION Arthroscopy combined with self-made instruments in the treatment of carpal tunnel syndrome is more reliable, minimally invasive and simplified than open surgery, but the patients should be clearly diagnosed and appropriately selected before operation to achieve satisfactory clinical effect.
Carpal Tunnel Syndrome/surgery* ; Decompression, Surgical ; Female ; Humans ; Ligaments, Articular ; Male ; Treatment Outcome ; Wrist/surgery* ; Wrist Joint/surgery*

OBJECTIVE: To explore the safety of classic Acupotomy in the treatment of carpal tunnel syndrome. METHODS: Twenty six adult specimens (15 males and 11 females), aged 60 to 95(82.54±6.94) years old, were selected from 10% formalin antiseptic fixation. There were 52 sides(two of them could not be tested). The study period was from November 2017 to May 2018. The specimens were collected from the body donation center of the school of basic medicine, Peking University. The operation of releasing the transverse carpal ligament on the human body specimen was simulated by the classic acupotomy, and the distance from the four points to the surrounding anatomical structure was measured to calculate the direct injury rate to the nerve and blood vessels, and the shortest distance between the acupotomy and the nerve and blood vessels was defined as ≥2 mm as safety. RESULTS: In the experimental operation, the direct injury rate of nerve and blood vessel was 14% and 12% respectively. There was significant difference in the rate of direct nerve injury between the four injection points (<0.05). There was no significant difference in the rate of direct vascular injury between the four injection points (>0.05). Among the four points, there was a statistically significant difference in the safety of nerves(<0.05), and the safety of point 1 and point 3 of radial injection was higher than that of point 2 and point 4 of ulnar injection(<0.05). There was significant difference in the safety of blood vessels between the four points(<0.05), and the safety of radial point 1 was higher than that of ulnar point 2 and point 4 (<0.05). CONCLUSION The safety of the classic Acupotomy for carpal tunnel syndrome is related to the location of the needle entry point, and the safety of theradial proximal end of the needle is the highest.
Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Carpal Tunnel Syndrome ; Female ; Humans ; Ligaments, Articular ; Male ; Median Nerve ; injuries ; Middle Aged ; Needles ; Wrist Joint

OBJECTIVE: To explore the application and clinical effect of wide awake local anesthesia no tourniquet technique in the surgery of bilateral carpal tunnel syndrome. METHODS: From March 2016 to August 2018, 20 patients (40 sides) with bilateral carpal tunnel syndrome were treated by wide awake technique. All patients were female, aged from 32 to 56 (50.8±6.4) years old. The anesthetic, intraoperative and postoperative pain and anxiety were evaluated, operative field bleeding in operation were assessed, postoperative skin healing of surgical area and anesthetic complications were observed, and Kelly grading were used to evaluate recovery of function. RESULTS: Twenty patients were followed up from 6 to 9 months with an average of 7.8 months. There was light anxiety before injection (NRS score rangedfrom 1 to 3), slight pain occurred during injection on the first poke (NRS ranged from 2 to 3);no pain and anxiety during operation (NRS score was 0);mild or moderate pain (NRS score ranged from 1 to 6) without anxiety(NRS score was 0) after operation was occurred. Surgical skin healed well at the stageⅠwithout side effect of anesthetic. At final follow-up, according to Kelly grading, 30 sides got excellent results, 8 sides good and 2 sides fair. CONCLUSION Wide awake technique is safe and effective in treating neurolysis of bilateral carpal tunnel syndrome, and could receive good clinical effects.
Adult ; Anesthesia, Local ; Carpal Tunnel Syndrome ; Female ; Humans ; Middle Aged ; Pain, Postoperative ; Wakefulness

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy with a high morbidity and healthcare-related costs. Currently there is no consensus about the best treatment option. The purpose of this prospective cohort study conducted at a single institution was to evaluate the clinical outcomes and patient satisfaction following a mini-open carpal tunnel release for idiopathic CTS. METHODS: A total of 72 patients (53 female and 19 male patients; mean age, 57.8±15.3 years; range, 24–94 years) had a mini-open carpal tunnel release performed by a single senior surgeon between June 2015 and June 2016. The patients were evaluated preoperatively, and at 3 and 12 months post-intervention. At every follow-up, the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and visual analogue scale (VAS) scores for pain and satisfaction were completed. Digital sensibility (using Semmes- Weinstein monofilaments) was assessed and pinch and grip strengths were measured. RESULTS: Statistically significant and clinically relevant improvement was found in terms of digital sensibility, grip and pinch strength (except for 2-point pinch), BCTSQ scores and pain scores. The complication rate was minimal, and no major complications occurred. Two patients experienced recurrence. The availability of follow-up records (including patient-reported outcomes, BCTSQ and VAS scores, and the complication rate) at 1-year post-intervention varied between 69% and 74% (50–53 patients) depending on which parameter was assessed. Patient satisfaction was high (mean, 80.9±26.0; range, 0–100). CONCLUSIONS: This study demonstrates that mini-incision carpal tunnel release is clinically effective in the short and long term.
Carpal Tunnel Syndrome ; Cohort Studies ; Consensus ; Decompression, Surgical ; Female ; Follow-Up Studies ; Hand Strength ; Humans ; Male ; Outcome Assessment (Health Care) ; Patient Satisfaction ; Pinch Strength ; Prospective Studies ; Recurrence ; Treatment Outcome

OBJECTIVE: The purpose of this study is to evaluate the usefulness of infrared thermography in patients with carpal tunnel syndrome by comparing with electrodiagnostic and ultrasonographic findings.METHOD: From January 2014 to October 2017, electrodiagnosis, ultrasound, and digital infrared thermal image (DITI) of unilateral carpal tunnel syndrome diagnosed in a single hospital were retrospectively analyzed. The subjects with bilateral symptoms of carpal tunnel syndrome, peripheral vascular disease, diabetes, thyroid disease, fibromyalgia, rheumatic disease, systemic infection, inflammation, malignant tumor, and other musculoskeletal disorders such as finger osteoarthritis, peripheral neuropathy, cervical radiculopathy, and the previous history of surgery were excluded.RESULTS: Of 53 patients diagnosed with carpal tunnel syndrome, 11 were male and 42 were female. The visual analogue scale was 4.9 ± 1.9, and the duration of symptom was 11.8 ± 12.5 months. There was no statistically significant difference in the body surface temperature between the unaffected and affected sides. The severity of symptoms, electrodiagnostic findings, and cross-sectional area of the median nerve significantly correlates to each other. The temperature difference between the second fingers of the affected and unaffected sides showed a weak correlation with the amplitude of sensory nerve action potential and onset latency of compound muscle action potential, when there was no significant correlation with the other parameters.CONCLUSION: The difference in temperature on the surface of the body, which can be confirmed by DITI, is little diagnostic value when DITI is performed in unilateral carpal tunnel syndrome patients, especially when compared with ultrasonography.
Action Potentials ; Carpal Tunnel Syndrome ; Electrodiagnosis ; Female ; Fibromyalgia ; Fingers ; Humans ; Inflammation ; Male ; Median Nerve ; Methods ; Osteoarthritis ; Peripheral Nervous System Diseases ; Peripheral Vascular Diseases ; Radiculopathy ; Retrospective Studies ; Rheumatic Diseases ; Thermography ; Thyroid Diseases ; Ultrasonography

Arterial variations in upper limbs are often reported commonly. Superficial arterial variations accounting for 4.2% of all arterial variations are hazardous during any invasive procedures of the upper limb, from routine intravenous injections to surgeries. Arterial variations are usually associated with inverted or absent palmaris longus. Palmaris profundus, a rare anomalous variation of palmaris longus has been reported in carpal tunnel syndrome as its tendon was associated with median nerve in the carpal tunnel. The authors reported a unique variation in the upper limb arterial pattern—the presence of bilateral superficial brachioulnar artery associated with unilateral palmaris profundus muscle and an abnormal radicle of musculocutaneous nerve to the median nerve in the left side.
Arteries ; Carpal Tunnel Syndrome ; Injections, Intravenous ; Median Nerve ; Musculocutaneous Nerve ; Tendons ; Upper Extremity

BACKGROUND: The present study aimed to investigate the basic characteristics of carpal tunnel syndrome (CTS) and its differences between occupations using Korea's National Health Insurance (NHI) and National Employment Insurance (NEI). METHODS: The study participants were obtained from the NEI and NHI data from 2008 to 2015, with a diagnosis code of G560 (CTS) as the main or sub-diagnosis. Data about gender, age, diabetes mellitus, smoking, drinking, and length of employment, information about type of occupation, and number of employees according to age and occupation were obtained from NHI and NEI data. In total, 240 occupations were classified into blue-collar (BC) and white-collar (WC) work. In addition, each occupation was classified as high-risk and low-risk groups depending on the degree of wrist usage. RESULTS: The number of patients with CTS per 100,000 individuals increased with advancing age, and it was higher in women (4,572.2) than in men (1,798.5). Furthermore, the number was higher in BC workers (3,247.5) than in WC workers (1,824.1) as well as in the high-risk group than in the low-risk group in both BC workers (3,527.8 vs. 1,908.2) and WC workers (1,829.9 vs. 1,754.4). The number of patients with CTS was higher in the high-risk group than in the low-risk group among male and female BC workers and female WC workers. However, the number was higher in the low-risk group among male WC workers. In the BC category, the number of patients with CTS was highest among food processing-related workers (19,984.5). In the WC category, the number of patients with CTS was highest among social workers and counselors (7,444.1). CONCLUSIONS: The results of this study are expected to help identify occupational differences in patterns of CTS. High number of patients with CTS was seen in new jobs, as well as in previous studies.
Carpal Tunnel Syndrome ; Counseling ; Diabetes Mellitus ; Diagnosis ; Drinking ; Employment ; Female ; Humans ; Insurance ; Male ; National Health Programs ; Occupations ; Smoke ; Smoking ; Social Work ; Social Workers ; Wrist

Anatomic variation of palmar digital nerve pathways were reported in several cases. Selective exploration of palmar digital nerves with a nerve conduction study has been challenging, because of technical issues. We report a patient who received bilateral carpal tunnel release operation, complaining of a tingling sensation, and hypoesthesia on the middle and ring fingers. An electrodiagnostic study revealed a sensory neuropathy of palmar digital nerve of the left median nerve, supplying the ulnar side of the middle finger, and radial side of the ring finger. She underwent re-operation of open left carpal tunnel release, and a branching site of common digital nerves of the median nerve was identified not at the palm, but at a far proximal site around the distal wrist crease. Usefulness of an orthodromic sensory conduction study was clarified to eliminate volume conducted response or co-activation of nearby nerves in the patient with selective involvement of palmar digital nerve.
Anatomic Variation ; Carpal Tunnel Syndrome ; Electrodiagnosis ; Fingers ; Humans ; Hypesthesia ; Median Nerve ; Median Neuropathy ; Neural Conduction ; Sensation ; Wrist