Yonsei Med J.  2009 Apr;50(2):257-261.

Carpal Tunnel Syndrome Caused by Space Occupying Lesions

• Kang HJ
• Jung SH
• Yoon HK
• Hahn SB
• Kim SJ

Abstract

PURPOSE
To evaluate the diagnosis and treatment of the carpal tunnel syndrome (CTS) due to space occupying lesions (SOL). MATERIALS AND METHODS: Eleven patients and 12 cases that underwent surgery for CTS due to SOL were studied retrospectively. We excluded SOL caused by bony lesions, such as malunion of distal radius fracture, volar lunate dislocation, etc. The average age was 51 years. There were 3 men and 8 women. Follow-up period was 12 to 40 months with an average of 18 months. The diagnosis of CTS was made clinically and electrophysiologically. In patients with swelling or tenderness on the area of wrist flexion creases, magnetic resonance imaging (MRI) and/or computed tomogram (CT) were additionally taken as well as the carpal tunnel view. We performed conventional open transverse carpal ligament release and removal of SOL. RESULTS: The types of lesion confirmed by pathologic examination were; tuberculosis tenosynovitis in 3 cases, nonspecific tenosynovitis in 2 cases, and gout in one case. Other SOLs were tumorous condition in five cases, and abnormal palmaris longus hypertrophy in 1 case. Tumorous conditions were due to calcifying mass in 4 cases and ganglion in 1 case. Following surgery, all cases showed alleviation of symptom without recurrence or complications. CONCLUSION: In cases with swelling or tenderness on the area of wrist flexion creases, it is important to obtain a carpal tunnel view, and MRI and/or CT should be supplemented in order to rule out SOLs around the carpal tunnel, if necessary.

Keyword

Carpal tunnel syndrome; space occupying lesion

MeSH Terms

Adult
Aged
Carpal Tunnel Syndrome/*diagnosis/*etiology/pathology
Female
Gout
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Retrospective Studies
Tenosynovitis
Tomography, X-Ray Computed
Wrist/pathology/surgery

Figure

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  Fig. 1 (A) Hypertrophied flexor digitorum profundus tenosynovium was noted in carpal tunnel on MRI (black arrow, hypertrophied tenosynovium). (B and C) Caseous necrosis, granuloma with Langerhan's giant cell, and lymphocytic infiltration show tuberculous tenosynovitis (black arrow, Langerhan's multinucleated giant cell).

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  Fig. 2 (A) Tophi infiltration was noted between flexor digitorum profundus tenosynovium and carpal bones on MRI (white arrow, tophi infiltration). (B) Urate crystal and lymphocyte infiltration show chronic tophaceous arthritis (H-E stain, ×200). (C) When examined with a polarizing filter, they are yellow when aligned parallel to the axis of the red compensator, but they turn blue when aligned across the direction of polarization (ie, they exhibit negative birefringence).

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  Fig. 3 Calcifying mass was noted on carpal tunnel view and wrist CT. (A) Carpal tunnel view. (B) Wrist axial CT (white arrow, calcifying mass).

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  Fig. 4 Hypertrophied palmaris longus is compressing the carpal tunnel on MRI (white arrow, hypertrophied palmaris longus muscle).

Reference

1. Backhouse KM, Churchill-Davidson D. Anomalous palmaris longus muscle producing carpal tunnel-like compression. Hand. 1975. 7:22–24.

2. Coessens B, De Mey A, Lacotte B, Vandenbroeck D. Carpal tunnel syndrome due to an haemangioma of the median nerve in a 12-year-old child. Ann Chir Main Memb Super. 1991. 10:255–257.

3. Edwards AJ, Sill BJ, Macfarlane I. Carpal tunnel syndrome due to dystrophic calcification. Aust N Z J Surg. 1984. 54:491–492.

4. Evangelisti S, Reale VF. Fibroma of tendon sheath as a cause of carpal tunnel syndrome. J Hand Surg Am. 1992. 17:1026–1027.

5. Chen WS. Median-nerve neuropathy associated with chronic anterior dislocation of the lunate. J Bone Joint Surg Am. 1995. 77:1853–1857.

6. Kang HJ, Park SY, Shin SJ, Kang ES, Hahn SB. Tuberculous tenosynovitis presenting as carpal tunnel syndrome. J Korean Soc Surg Hand. 2000. 5:137–141.

7. Kerrigan JJ, Bertoni JM, Jaeger SH. Ganglion cysts and carpal tunnel syndrome. J Hand Surg [Am]. 1988. 13:763–765.

8. Kremchek TE, Kremchek EJ. Carpal tunnel syndrome caused by flexor tendon sheath lipoma. Orthop Rev. 1988. 17:1083–1085.

9. Nakamichi K, Tachibana S. Unilateral carpal tunnel syndrome and space-occupying lesions. J Hand Surg [Br]. 1993. 18:48–49.

10. Pai CH, Tseng CH. Acute carpal tunnel syndrome caused by tophaceous gout. J Hand Surg [Am]. 1993. 18:667–669.

11. Bagatur AE, Zorer G. The carpal tunnel syndrome is a bilateral disorder. J Bone Joint Surg Br. 2001. 83:655–658.

12. Weiss AP, Steichen JB. Synovial sarcoma causing carpal tunnel syndrome. J Hand Surg [Am]. 1992. 17:1024–1025.

13. Nakamichi K, Tachibana S. Ultrasonography in the diagnosis of carpal tunnel syndrome caused by an occult ganglion. J Hand Surg [Br]. 1993. 18:174–175.

14. Horch RE, Allmann KH, Laubenberger J, Langer M, Stark GB. Median nerve compression can be detected by magnetic resonance imaging of the carpal tunnel. Neurosurgery. 1997. 41:76–82. discussion 82-3.

15. Kamolz LP, Schrögendorfer KF, Rab M, Girsch W, Gruber H, Frey M. The precision of ultrasound imaging and its relevance for carpal tunnel syndrome. Surg Radiol Anat. 2001. 23:117–121.

16. Yesildag A, Kutluhan S, Sengul N, Koyuncuoglu HR, Oyar O, Guler K, et al. The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Clin Radiol. 2004. 59:910–915.