J Korean Orthop Assoc.  2007 Oct;42(5):616-622. 10.4055/jkoa.2007.42.5.616.

Carpal Tunnel Syndrome Caused by Space Occupying Lesions

• Kang HJ
• Jung SH
• Choi CH
• Choi WJ
• Kim SJ
• Hahn SB

• KMID: 2186468
• DOI: http://doi.org/10.4055/jkoa.2007.42.5.616

Abstract

PURPOSE: To evaluate the diagnosis and treatment of the carpal tunnel syndrome (CTS) due to space occupying lesion (SOL)s.
MATERIALS AND METHODS
14 patients (15 cases) that underwent surgery from 1992 to 2002 for CTS due to SOL were studied. The average age was 51 years. There were 6 men and 8 women. Mean follow up period was 16 months. In patients with swelling or tenderness on the area of wrist flexion creases, MRI and/or CT scan 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 were, in three cases tuberculosis tenosynovitis, nonspecific tenosynovitis in three cases, gout in one case, mass in four cases, and abnormal palmaris longus hypertrophy in one case. Bony lesions were, in one case Kienbock's disease (stage III), neglected volar dislocation of lunate in two cases. Following surgery, all cases showed alleviation of symptoms.
CONCLUSION
In cases with swelling or tenderness on the area of wrist flexion creases, it is important to obtain a carpal tunnel view, and if necessary, MRI and/or CT should be supplemented in order to rule out SOLs.

Keyword

Carpal tunnel syndrome; Space occupying lesion

MeSH Terms

Carpal Tunnel Syndrome*
Diagnosis
Dislocations
Female
Follow-Up Studies
Gout
Humans
Hypertrophy
Ligaments
Magnetic Resonance Imaging
Male
Osteonecrosis
Tenosynovitis
Tomography, X-Ray Computed
Tuberculosis
Wrist

Figure

• 

  Fig. 1 (A) MRI shows hypertrophied flexor digitorum profundus tenosynovium in carpal tunnel (Black arrow: hypertrophied tenosynovium). (B) Pathologic findings were compatible with tuberculosis tenosynovitis. There were caseous necrosis and granuloma with Langerhan's giant cell (black arrow) and lymphocytic infiltration (H-E stain, ×200).

• 

  Fig. 2 (A) MRI shows tophi infiltration between flexor digitorum profundus tenosynovium and carpal bones (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, negative birefringence was noted.

• 

  Fig. 3 (A) MRI shows hypertrophied palmaris longus is compressing median nerve in carpal tunnel (white arrow: hypertrophied palmaris longus muscle). (B) Open transverse carpal ligament release and hypertrophied palmaris longus excision was performed.

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  Fig. 4 Carpal tunnel view (A) and CT scan (B) shows that calcifying mass is located just above the capitate.

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