Sonographic Findings of the Bifid Median Nerve and Persistent Median Artery in Carpal Tunnel: A Preliminary Study in Chinese Individuals

OBJECTIVE: The aim of this study was to investigate the prevalence of anatomic variations of the bifid median nerve, persistent median artery and persistent median vein in Chinese individuals and their relationship with carpal tunnel syndrome. METHODS: One hundred and sixty median nerves were examined using ultrasonography and colour Doppler ultrasonography. The location, shape, and size of the bifid median nerve, persistent median artery and persistent median vein were recorded. The cross-sectional area of the bifid median nerve (two trunks) was measured at the level of the pisiform. RESULTS: Among the 160 wrists examined, a bifid median nerve was observed in 15 (9.4%) wrists, and a persistent median artery was observed in 12 (7.5%) wrists. These two variations either coexisted or were observed independently, and the probability of coexistence (6.3%) was higher than the probability of existing independently (bifid median nerve only 3.1%, persistent median artery only 1.3%). The cross-sectional area of the radial trunk was greater than (13 in 15, 86.7%) the cross-sectional area of the ulnaris trunk. Persistent median vein was observed in 9 wrists (5.6%). CONCLUSIONS: The persistent median artery and bifid median nerve tend to coexist, and the persistent median vein sometimes runs parallel to the persistent median artery. Their positional relationship in carpal tunnel is uncertain, and thus, preoperative ultrasound is necessary. These three variations do not present any additional risk for the development of carpal tunnel syndrome.

Has the median nerve involvement in rheumatoid arthritis been overemphasized? / O envolvimento do nervo mediano na artrite reumatoide tem sido excessivamente valorizado?

Abstract Rheumatoid arthritis (RA) is a well and widely recognized cause of carpal tunnel syndrome (CTS). In the rheumatoid wrist, synovial expansion, joint erosions and ligamentous laxity result in compression of the median nerve due to increased intracarpal pressure. We evaluated the published studies to determine the prevalence of CTS and the characteristics of the median nerve in RA and its association with clinical parameters such as disease activity, disease duration and seropositivity. A total of 13 studies met the eligibility criteria. Pooled data from 8 studies with random selection of RA patients revealed that 86 out of 1561 (5.5%) subjects had CTS. Subclinical CTS, on the other hand, had a pooled prevalence of 14.0% (30/215). The cross sectional area of the median nerve of the RA patients without CTS were similar to the healthy controls. The vast majority of the studies (8/13) disclosed no significant relationship between the median nerve findings and the clinical or laboratory parameters in RA. The link between RA and the median nerve abnormalities has been overemphasized throughout the literature. The prevalence of CTS in RA is similar to the general population without any correlation between the median nerve characteristics and the clinical parameters of RA.

Resumo A artrite reumatoide (AR) é uma causa bem e amplamente reconhecida de síndrome do túnel do carpo (STC). No punho acometido pela artrite reumatoide, a expansão sinovial, as erosões articulares e a frouxidão ligamentar resultam em compressão do nervo mediano decorrente do aumento da pressão intracarpal. Avaliaram-se os estudos publicados para determinar a prevalência de STC e as características do nervo mediano na AR e sua associação com parâmetros clínicos, como a atividade e duração da doença e a soropositividade. Preencheram os critérios de elegibilidade 13 estudos. Os dados agrupados dos oito estudos com seleção aleatória de pacientes com AR revelaram que 86 de 1.561 (5,5%) indivíduos tinham STC. Por outro lado, a STC subclínica teve uma prevalência combinada de 14% (30/215). A área de seção transversa do nervo mediano dos pacientes com AR sem STC foi semelhante à de controles saudáveis. A grande maioria dos estudos (8/13) não apresentou relação significativa entre os achados no nervo mediano e os parâmetros clínicos ou laboratoriais na AR. A ligação entre a AR e as anormalidades do nervo mediano foi excessivamente valorizada em toda a literatura. A prevalência de STC na AR é semelhante à da população em geral, sem qualquer correlação entre as características do nervo mediano e os parâmetros clínicos da AR.

Schwannoma como etiologia de síndrome do túnel do carpo ­ relato de caso / Schwannoma as a Cause of Carpal Tunnel Syndrome ­ a Case Report

A síndrome do túnel do carpo (STC) é uma condição clínica resultante da compressão do nervo mediano no túnel do carpo. É a neuropatia de maior incidência no membro superior e apresenta diferentes etiologias, entre elas o distúrbio osteomuscular relacionado ao trabalho (DORT) e, mais raramente, a tumores de nervo periférico. O DORT é a etiologiamais comum da STC e vemaumentando sua incidência por causa de sua associação com o trabalho. Eentre os tumores que envolvem o nervo mediano está o schwannoma, ou neurilemoma, que também é o tumor benigno mais comum de nervos periféricos. Este relato almeja descrever um caso de schwannoma como etiologia da STC.

The carpal tunnel syndrome (CTS) is a clinical condition resulting from compression of the median nerve in the carpal tunnel. It is the neuropathy of higher incidence in the upper limb and as different etiologies, is related to work-related musculoskeletal disorders (WMSDs) and rarely tumors of peripheral nerve. The WMSDs are the most common, and its incidence is increasing more andmore due to the intimate association with type of work. Among the tumors involving median nerve is the Schwannoma, or neurilemoma. The Schwannoma is the most common benign tumor of the peripheral nerve. This report aims to describe a case of schwannoma as a cause of CTS.

Musculoskeletal Disorders among Dentists: A Review.

Dental professionals are facing a variety of occupational hazards. Technological advancements in the field of dental equipment and materials have not fully eliminated the musculoskeletal problems of dentists. When practicing, dentists sometimes are forced to adopt unhealthy postures that depend mainly on factors related to the working conditions. These lesion starts to appear at beginning of clinical practice as a student, and it will persist as they acquire independent posture and working habits during the professional life. Th e pervasive of musculoskeletal complaints among dentists is high and well documented. Based on the relevant literature, the present manuscript discusses the musculoskeletal problems of dental professionals.

Occurrence of Chandleronema longigutturata (Nematoda: Acuariidae) in Procyon cancrivorus in the Neotropical region / Ocorrência de Chandleronema longigutturata (Nematoda: Acuariidae) em Procyon cancrivorus na região neotropical

Procyon cancrivorus is a wild animal that is found from Central America to Uruguay and northeastern Argentina. It is one of the least studied carnivore species in Brazil. For the purpose of identifying helminths that parasitize P. cancrivorus, individuals of this species that had been run over and killed by motor vehicles were collected from highways in the southern part of the state of Rio Grande do Sul. At necropsy, their organs, along with organ contents and mucous membranes, were examined for parasite collection. The nematodes found in the stomachs of these Procyonidae were cleared with lactophenol and Chandleronema longigutturata was identified. This report provides the first record of occurrences of C. longigutturata in the Neotropical region and its parasitism in P. cancrivorus.

Procyon cancrivorus é um animal silvestre que se distribui desde a América Central até o Uruguai e Nordeste da Argentina. Está entre as espécies de carnívoros brasileiros menos estudadas. Com o objetivo de identificar helmintos que parasitam P. cancrivorus, estes foram coletados nas estradas, quando mortos por atropelamento automobilístico, na região Sul do Rio Grande do Sul. Após a necropsia, os órgãos foram examinados, assim como suas mucosas e conteúdos para a coleta de parasitos. Os nematoides encontrados no estômago desses procionídeos foram clarificados com lactofenol e identificados à Chandleronema longigutturata. Registra-se pela primeira vez a ocorrência de C. longigutturata na região neotropical, bem como o parasitismo em P. cancrivorus.

Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis)

Carpal tunnel syndrome (CTS) is defined by compression of the median nerve in the wrist. It is the commonest of the compressive syndromes and its most frequent cause is idiopathic. Even though spontaneous regression is possible, the general rule is that the symptoms will worsen. The diagnosis is primarily clinical, from the symptoms and provocative tests. Elec-troneuromyographic examination may be recommended before the operation or in cases of occupational illnesses...

A sindrome do túnel do carpo (STC) é definida pela compressão do nervo mediano no punho. É a mais frequente das sindromes compressivas e a causa mais frequente é a idiopática. Ainda que as regressões espontâneas sejampossiveis, o agravamento dos sintomas é a regra. O diagnóstico é, acima de tudo, clinico pelos sintomas e testes provocativos. Um exame eletroneuromiográfico pode ser recomendado no pré-operatório ou em caso de doença laboral...

Síndrome de mano diabetica / Diabetic hand

La diabetes mellitus (DBT) es un desorden metabólico producto de una deficiencia absoluta o relativa de insulina. Este trastorno tiene consecuencias de importancia en varios órganos y sistemas del cuerpo. Es bien conocido que la DBT está asociada con una cantidad de manifestaciones cutáneas y osteoarticulares. La más común de estas características afecta al pie (síndrome de pie diabético); sin embargo, similares lesiones se pueden observar en la mano (síndrome de mano diabética), generalmente asociadas a una larga evolución de la enfermedad, malos controles glicémicos y complicaciones microvasculares. En este artículo se realiza una revisión de la literatura para actualizar el diagnóstico y la terapéutica de manifestaciones musculo-esqueléticas en la mano de pacientes con DBT: movilidad articular limitada, contractura de Dupuytren, tenosinovitis del flexor (dedo en gatillo), infección por síndrome de mano diabética tropical, ulceración neuropática periférica, síndrome del túnel carpiano, neuropatía cubital y neuropatía en piel y uñas.

Diabetes mellitus (DBT) is a metabolic disorder caused by absolute or relative deficiency of insulin. This disorder has importance consequences in various organs and systems. It is well known that DBT is associated with cutaneous and osteoarticular manifestations; the most common of these complications affects the foot (diabetic foot syndrome). However, similar lesions can be observed in the hand (diabetic hand syndrome), usually associated with long standing disease, poor glycemic control and microvascular complications. This article makes a review of the literature to update diagnosis and therapy ofmusculoskeletal manifestations in patients with diabetic hand syndrome: limited joint mobility, Dupuytren’s contracture, trigger finger, tropical diabetic hand, peripheral neuropathic ulceration, carpal tunnel syndrome, cubital neuropathy, and skin and nail changes.

Síndrome del Túnel Carpal / Carpal Tunnel Syndrome

El Síndrome del Túnel Carpal (CTS) es una de las neuropatías periféricas más comunes. Afecta principalmente a mujeres de edad media. En la mayoría de los pacientes la causa exacta y la patogénesis no está clara. Varias ocupaciones se han relacionado con aumento de la incididencia y prevalencia de CTS. El riesgo de CTS es alto en personas con ocupaciones que implican la exposición a alta presión, mucha fuerza, trabajo repetitivo, y herramientas que vibran. Los síntomas clásicos de CTS incluyen dolor nocturno asociado con hormigueo y entumecimiento en la distribución del nervio mediano. La prueba estándar de oro son los estudios de conducción nerviosa. El diagnóstico de CTS debe basarse en la anamnesis, exploración física y resultados de los estudios electrofisiológicos. El paciente con síntomas leves de CTS se puede controlar con tratamiento conservador. Sin embargo, en casos moderados a severos, la cirugía es el único tratamiento que ofrece cura.

Obesity Affects Median Nerve Conduction - A Study in Armed Forces Individuals.

Background: Obesity, a growing public health concern, is associated with various disorders. Studies have suggested obesity as an independent risk factor that influences the prevalence of carpal tunnel syndrome (CTS) among active workers. The present study is an attempt to establish relationship between median nerve conduction velocity and obesity in people who do not have any other contributory factor for CTS other than obesity. CTS is the commonest entrapment neuropathy where the median nerve is compressed. Methods: The study was conducted in 15 obese subjects with Body Mass Index (BMI)>30 (group III) and 15 overweight subjects with BMI between 25&29.9 (group II) and 15 control subjects with BMI <25 (group I). The subjects were personnel from armed forces. Their body density was estimated using hydro-densitometry and the body fat percentage was calculated from density. The distal motor latency (DML) and the sensory conduction velocity (SCV) across the wrist on stimulation of median nerve at wrist 3cm proximal to distal crease were assessed in all subjects. Results: The mean values of DML in group I, II, and III were 3.52±0.25 ms, 3.50±0.30 ms and 3.65±0.20 ms respectively. Mean value of SCV among these groups were 48.99±3.23 m/s, 49.32±3.35 m/s and 48.69±4.00 m/s. Conclusion: No relationship could be established between BMI and DML as well as BMI and SCV. The relationship between percentage body fat and DML and SCV also found to be statistically insignificant. However, there was a correlation between BMI and body fat percentage. Carpal tunnel syndrome is uncommon even in obese armed forces personnel, which might be due to their regular body and hand exercise thereby having increased tone in hand muscles.

Analysis of MR imaging of wrists in female patients with carpal tunnel syndrome and healthy controls / Análisis de imágenes de RM de las muñecas en pacientes mujeres con síndrome del túnel carpiano y controles sanos

The objective of this study was to evaluate morphological changes of the median nerve in patients with carpal tunnel syndrome (CTS) and healthy controls, to correlate the MRI findings of wrists. This study compared not only morphological changes of the median nerve and also displayed descriptively structures in carpal tunnel between patients diagnosed with idopathic CTS and healthy controls. Our study involved 60 hand, 30 of hand were evaluated diagnosed with idiopathic CTS and 30 hand as healthy controls bilaterally. Two provocative tests (Phalen's and Tinel's test) were performed on each hand for both the patient group (60 wrist) and the control group (60 wrist). With regard to Phalen and Tinel's test results, 24 and 26 wrists were excluded from patient and control groups respectively. Totally 70 wrists were evaluated, and in terms of cross-sectional area of median nerve at the level of distal radio-ulnar joint, pisiform bone and the hook of hamate bone by MRI in the patient and control groups. In addition to evaluation of cross-sectional area of median nerve, we determined signal intensity of wrists and different localization of the median nerve in the carpal tunnel. Cross-sectional area of the median nerve measured by wrist magnetic resonance at the level of metacarpal bones and signal intensity of wrists may be considered as a valuable indicator to determine patients referred with idiopathic CTS.

El objetivo de este estudio fue evaluar los cambios morfológicos del nervio mediano en pacientes con síndrome del túnel carpiano (STC) y controles sanos, para correlacionar los hallazgos de las RM de muñeca. Este estudio comparó no sólo los cambios morfológicos del nervio mediano, también se muestran en forma descriptiva estructuras del túnel carpiano entre los pacientes diagnosticados con STC idiopatico y controles sanos. Nuestro estudio incluyó 60 manos, 30 manos fueron evaluados con diagnóstico de STC idiopático y 30 manos como controles sanos, bilateralmente. Dos pruebas de provocación (prueba de Phalen y prueba de Tinel) se realizaron en cada mano para el grupo de pacientes (60 muñecas) y el grupo control (60 muñecas). En lo que respecta a los resultados de prueba de Phalen y prueba de Tinel, 24 y 26 muñecas fueron excluidas del grupo paciente y grupo control respectivamente. En total 70 muñecas fueron evaluadas, en términos de la sección transversal del área del nervio mediano a nivel de la articulación radio-ulnar distal, el hueso pisiforme y el hamulus del hueso hamate por medio de resonancia magnética en gruposs paciente y control. Además de la evaluación de la sección del área del nervio mediano, se determinó la intensidad de la señal de la muñeca y las diferentes localizaciones del nervio mediano en el túnel carpiano. La sección transversal del área del nervio mediano medida por medio de resonancia magnética de muñeca a nivel de los huesos metacarpianos y la intensidad de la señal de las muñecas pueden ser considerados como un valioso indicador al evaluar pacientes referidos con STC idiopático.

Frequency of carpal tunnel syndrome and its related risk factors in patients upper extremity pain

A cross sectional study was performed on 1000 patients with upper limbs pain, among whom 250 cases [34 men and 216 women] aged 18-69 years were diagnosed to have CTS on basis of clinical history and electrodiagnostic criteria. Following factors were compared between CTS patients and controls: body mass index [BMI], wrist A-P/M-L diameter, occupation, average daily hours of computer use, history of steroid use, family history, diabetes mellitus, thyroid disease, chronic heart failure, renal failure, history of wrist and distal radius fracture, smoking, alcohol drinking, use of OCP, history of hysterectomy, pregnancy, menopause, radiculopathy, associated rheumatologic disease and other soft tissue rheumatism. The frequency of CTS among the studied subjects was 25%. Mean BMI was higher in patients with CTS in both genders [p < 0.000], but increasing of BMI excess 30, didn't raise the risk of CTS [NS]. Wrist [A-P/M-L] dimension was found to be higher in CTS group [p < 0.05].Steroid use was 2% in control group and 8% in CTS group [p < 0.05]. Colle? fracture was only reported among 2.4% of CTS subjects [p < 0.05]. Diabetes mellitus was 4% in controls versus 11.2% in CTS group [p < 0.05]. Severe CTS was associated with the following factors: BMI >/= 25, WD>0.7 and duration>6 month, female gender, and diabetes mellitus and Colle? fracture, in both genders. The prevalence of syndrome was quite high, therefore, supplementary investigation should be performed. The wrist A-P/M-L dimension was higher in both genders of CTS group, thus we suggest wrist A-P/M-L dimension as a risk factor for CTS, however it could be explained as a consequence of CTS pathology

Deux observations de syndrome canalaire du membre superieur d'etiologie exceptionnelle

Les syndromes canalaires du membre superieur couvrent des pathologies variees. Les manifestations vasculaires au cours de ces syndromes sont rares mais graves. Nous rapportons deux cas atypiques d'etiologie exceptionnelle; dont un cas du syndrome de canal carpien provoque par une tumeur de type rhabdomyosarcome alveolaire; de la partie distale de la face anterieure de l'avant bras et un cas de syndrome de la traversee cervico-thoraco-brachiale du a une exostose de l'extremite superieur de l'humerus. Notre objectif est de rapporter ces deux cas et de realiser une revue de la litterature sur les aspects clinique et therapeutique de ces affections

Avaliação do comprometimento neurológico e da prevalência da síndrome do túnel do carpo pacientes portadores de diabetes mellitus tipo 2 / Evaluation of the neurological involvement and prevalence of the carpal tunnel syndrome in patients with type-2 diabetes mellitus

Determinar a freqüência da síndrome do túnel do carpo (STC) em pacientes diabéticos tipo 2, verificar se está associada com a neuropatia diabética (ND) e identificar formas de evidenciar ambas com o exame dos membros superiores. Método: Os pacientes foram submetidos à anamnese, levantamento das queixas, avaliação da sensibilidade tátil e vibratória, estudo da condução nervosa sensitiva e motora (ECSM) e teste de Phalen (TPH). Considerou-se como critério diagnóstico de STC isolada: presença de alterações no ECSM, queixas de parestesias na área do nervo mediano e ausência de alterações sensitivas ou motoras na área do nervo ulnar e nas extremidades inferiores. Resultados: Entre os 94 pacientes estudados, 60 apresentaram parestesias. O ECSM detectou alteração em 88 pacientes e foi o que apresentou maior sensibilidade. No teste de discriminação de dois pontos estáticos (D2PE) observou-se alteração em 47 pacientes e, com os monofilamentos de Semmes-Weinstein, em 11. Com o bioestesiômetro, detectou-se alteração em 72 pacientes e, com o diapasão, em 4. A positividade do TPH ocorreu em 33 pacientes. Na correlação dos resultados observou-se que 92/94 pacientes apresentaram alteração nervosa, 11 no nervo mediano e 81 combinada nos nervos mediano e ulnar. Somente quatro apresentaram STC sem neuropatia subjacente. Conclusão: Os instrumentos mais sensíveis foram o bioestesiômetro e o D2PE. O exame neurofisiológico demonstrou a presença de neuropatia subjacente à STC. Apresentaram critérios clínicos e neurofisiológico para STC 31,91% dos pacientes: 27,66% com sinais de neuropatia subjacente e 4,25% sem neuropatia diabética. Os critérios clínicos devem ser considerados com preponderância sobre os demais testes e o neurofisiológico para se caracterizar a síndrome do carpo no paciente diabético.

Determine the frequency of the carpal tunnel syndrome (CTS) in patients with type 2 diabetes mellitus, verify whether it is associated with diabetic neuropathy (DN) and identify ways to recognize both by examining the upper limbs. Methods: The patients were submitted to anamnesis; the complaints were verified, tactile and vibratory sensitivity was evaluated, sensitive and motor nerve conduction (SMNC) was studied and Phalen?s test (PHT) was performed. The criteria for isolated CTS diagnosis were: alterations in the SMNC, complaints of paresthesia in the median nerve area and absence of either sensitive or motor alterations in the area of the ulnar nerve and lower extremities. Results: Of the 94 patients studied, 60 presented paresthesia. The SMNC study detected alterations in 88 patients (93.6%) and it was the most sensitive test. At the test of the static two-point discrimination (STPD) we observed alterations in 47 patients and with the Semmes-Weinstein test detected alterations in 11 patients. Alterations were detected in 72 patients (76.6%) using the bioesthesiometer and in 04 patients using the diapason. PHT was positive in 33 patients. The correlation of the results showed that neural alterations were present in 92/94 patients; 11 patients presented alterations only in the median nerve and 81 patients presented combined alterations in the ulnar and median nerves. Only 4 patients presented CTS without subjacent neuropathy. Conclusions: The most sensitive tools were the bio-thesiometer and the STPD. The neurophysiological examination demonstrated the presence of neuropathy subjacent to CTS. Clinical and neurophysiological criteria for CTS were presented by 31.91% of the patients; 27.66% with signs of subjacent neuropathy and 4.25% without diabetic neuropathy. Clinical criteria should be preponderant over the remaining tests and the neurophysiological test in order to characterize the carpal tunnel syndrome in the diabetic patient.

Chronic carpal tunnel syndrome: results of carbal tunnel release

Carpal tunnel syndrome [CTS] is the commonest entrapment neuropathy for which several conservative and surgical treatment options are available. In majority of cases the cause of CTS is unknown [idiopathic CTS], however, there are numerous medical conditions associated with CTS. Surgery for CTS is one of the most often performed procedures. The purpose of this study was to evaluate the clinical outcome of surgical treatment of chronic carpal tunnel syndrome. Thirty patients with chronic CTS were selected for open carpal tunnel release. Twenty patients had bilateral disease. Thirty hands had thenar muscle atrophy. Fifty hands of thirty patients were operated from May 1997 to December 2002. Sensation improved within three months in all patients. Nocturnal pain disappeared within first week after surgery. Grip strength improved gradually even up to two years after surgery. All of thirty hands with thenar muscle atrophy showed symptomatic relief, but recovery of the wasted muscle in term of regaining bulk was very slow in most of cases. Only ten hands showed complete recovery of bulk of thenar muscles in three years time. Surgery is an excellent treatment option in chronic CTS in terms of symptomatic relief. Wasted thenar muscles recover slowly in fraction of cases

Tuberculous tenosynovitis: a cause of carpal tunnel syndrome

To highlight the presentation of tuberculous tenosynovitis as Carpal Tunnel Syndrome [CTS]. A descriptive study conducted with purposive sampling on the patients presenting between April 2004 to January 2005 to the department of Plastic Surgery, CMH Rawalpindi, with the clinical picture of CTS. Symptoms and signs were recorded. The carpal tunnels were explored under nerve blocks. Where tenosynovitis was observed per-operatively, specimen of excised synovium were sent for histo-pathological examination, acid fast stains and bacterial cultures, to ascertain or rule out the presence of tuberculosis. A total of 53 patients predominantly males were included in the study. The median age was 43 years and average duration of symptoms was 9 months. Tenosynovitis was observed in three patients [6%] per-operatively, with histopathology suggestive of Tuberculous tenosynovitis. Point Prevalence of tuberculous tenosynovitis as a cause of CTS was 6%. These patients reported clinical improvement with anti-tuberculosis treatment. NCS/EMG co-related well with clinical relief. Tuberculous tenosynovitis is an uncommon cause of median nerve compression at the wrist. As symptoms are usually typical of CTS, diagnosis is frequently missed. Consideration of the possibility, examination of the opened canal at surgery and proper treatment can result in a successful outcome

Hamartoma fibrolipomatoso de nervo mediano: relato de caso / Fibrolipomatous hamartoma of the median nerve: case report

Fibrolipomatous hamartoma is a rare benign neoplasm that in some cases is associated with macrodactylia. We describe a 31-year-old man who had a tissue enlargement in the wrist, second and third fingers of the left hand since infancy. At 23-years-old he began with continuous, progressive and high intensity pain that occurred more frequently at night, localized in the left hand. It was associated with paraesthesias and hypostesias predominantly at the fingers described above. Investigation with X-ray, ultrasonography, electrodiagnosis, magnetic resonance image of the left wrist and hand showed carpal tunnel syndrome with macrodactylia by fibrolipomatous hamartoma of the median nerve. The patient did not a have good response to clinical therapy, so he was submitted to a surgical decompression of the left carpal tunnel, and after three months of follow up is asymptomatic.

O hamartoma fibrolipomatoso é neoplasia benigna rara que em alguns casos esta associada com macrodactilia. Descrevemos o caso de homem de 31 anos que apresentava desde o nascimento aumento de volume em região de punho, segundo e terceiro quirodáctilos da mão esquerda. Aos 23 anos iniciou dor contínua, de forte intensidade, predominante no período noturno e de evolução progressiva em mão esquerda. Associada à dor havia hipoestesia e parestesias de predomínio nos segundo e terceiro quirodáctilos esquerdos. A investigação complementar com radiografia, ultrassonografia, estudo eletrofisiológico e ressonância magnética de mão e punho esquerdos confirmaram a suspeita de síndrome do túnel do carpo secundária a macrodactilia com hamartoma fibrolipomatoso do nervo mediano. O paciente foi submetido à descompressão cirúrgica do túnel do carpo esquerdo devido a ausência de resposta ao tratamento clínico e evoluiu com melhora dos sintomas em avaliação após três meses do procedimento.

Síndrome del túnel carpiano: vinculación básico clínica / Syndrome of the carpal tunnel: basic-clinic tie

Se comenta acerca de la importancia de la mano en la evolución del hombre y la necesidad de su integridad anatómica para mantener su funcionalidad. Se realiza vinculación básico-clínica con una patología de relativa frecuencia como es el Síndrome del Túnel Carpiano, señalando algunos factores que inciden en su etiología y poniendo a consideración la posibilidad de su prevención...

Considerações sobre a Síndrome do Túnel do Carpo com ênfase no tratamento / Considerations about Carpal tunnel syndrome with emphasis on treatment

A síndrome do túner do carpo (STC) é uma neuropatia periférica cinco vezes mais freqüente no sexo feminino, causada pela compressão do nervo mediano na altura do punho. O sintoma marcante dessa síndrome é a parestesia matinal no território sensitivo deste nervo. O diagnóstico é basicamente clínico. Exames úteis para diagnóstico diferencial são a eletroneuromiografia e a RNM. O tratamento de escolha inicial deve ser conservador. Para os casos refratários está indicada a liberação cirúrgica do nervo mediano através da incisão do ligamento transverso do carpo, seja por via aberta ou endoscópica. É importante que o médico explique ao paciente as possíveis causas de tal patologia, pois a abstinência de atividades agravantes é fundamental para a cura definitiva

Síndrome do túnel do carpo / Carpal tunnel syndrome

Síndrome do túnel do carpo (STC) é a neuropatía compressíva mais comum do ser humano; o nervo mediano sofre efeitos pressóricos no túnel do carpo, 3-4 cm dístal à prega do pulso, com desmielinização nodal ou segmentar nas fases iniciais. O complexo sintomático incluí dor, dormância e fomigamento,noturnolpostural nas mãos, freqüentemente bilateral e mais comum em mulheres entre 40 e 60 anos. Fatores pessoais repre- sentam risco mais importante do que os ocupacionais, particularmente o aumento da idade, do índice de massa corporal e do índice do pulso (pulsos quadrados'@, várias condições nosológicas podem estar associadas a STC. Ressonância magnética da região carpal pode ser útil em casos selecionados e atípicos. A descompressão cirúrgica representa a melhor alternativa terapêutica com benefícios indiscutíveis, apesar de controvérsías com relação a seleção dos pacientes, tratamento conservador por meio de talas, retirada de fatores desencadeantes e uso de medicações sintomáticas podem ser utilizados nas fases iniciais com achados eletrofisioiógícos leves. O estudo da condução nervosa é o método complementar mais adequado para diagnóstico da STC, observan- do-se aumento das fatências dístais sensitivas e motoras do nervo mediano (redução da velocidade de condução na região carpal).(au)