Arch Hand Microsurg.  2020 Jun;25(2):124-127. 10.12790/ahm.20.0009.

Carpal Tunnel Syndrome due to Dorsal Intercalated Segmental Instability of the Wrist

• Jang MG
• Heo YM
• Kim TG
• Song JH
• Kim TH

• KMID: 2502708
• DOI: http://doi.org/10.12790/ahm.20.0009

Abstract

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy of the upper limb. Although most cases are idiopathic, it can occur due to various causes including an alteration of anatomical dimension of the carpal tunnel. CTS can be diagnosed mostly by clinical findings and electrodiagnostic test. As a result, the confirmation of structural change of carpal tunnel may be delayed as basic radiologic examinations such as simple radiography of the wrist are not performed. We confirmed carpal malalignment due to dorsal intercalated segmental instability on simple radiography of a patient with CTS whose symptoms did not improved by conservative managements. He had symptoms for more than 2 years, but had never undergone simple radiography of the wrist. Because structural changes of the carpal tunnel could be the main reason for CTS and affect the whole treatment process, the physician should always check standard radiography of the wrist before determining how to treat the patient.

Keyword

Median nerve; Carpal tunnel syndrome; Dorsal intercalated segmental instability

Figure

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  Fig. 1. Simple radiographs of the left wrist. (A) Posteroanterior image showing osteopenia of carpal bones and distal radius, osteoarthritis of distal radioulnar joint, widening of scapholunate gap, and cortical ring sign of flexed scaphoid. (B) Lateral image showing carpal malalignment due to dorsal intercalated segmental instability deformity.

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  Fig. 2. Magnetic resonance imaging of left wrist. (A) T1-weighted axial image showing decreased space of the carpal tunnel by volar protruded lunate. (B) T1-weighted fat-suppressed sagittal image showing synovial thickening of flexor tendon sheath and attrition of deep flexor tendons by volar protruded lunate.

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