ABSTRACT
Introduction: Nerve compression by anomalous masses located at the wrist and distal forearm is an infrequent condition. They may compress underlying structures in the carpal tunnel region, causing pain and paresthesias, which leads to the wrong diagnosis of carpal tunnel syndrome. Clinical cases: We present three cases of patients with symptomatology and clinical tests compatible with compression of the median nerve in the carpal tunnel but whose physical examination showed a soft mass in the distal region of the forearm which was compressing the median nerve, as demonstrated by ultrasound evaluation. Discussion: The reported cases of accessory muscles or lipomas described in the literature as causes of median nerve compression clinic are mainly described only after the surgical decompression of the carpal tunnel, due to the maintenance of residual symptoms. Conclusion: Careful examination with an ultrasound evaluation prior to surgery may help to identify these cases and help planning surgical treatment.(AU)
Introducción: La compresión del nervio mediano por masas anómalas localizadas en la muñeca y en el antebrazo distal es una condición infrecuente. Las estructuras subyacentes en la región del túnel carpiano pueden ser comprimidas, causando dolor y parestesias, pudiendo llevar al diagnóstico erróneo de síndrome del túnel carpiano. Casos clínicos: Se presentan 3 casos de pacientes con sintomatología y pruebas clínicas compatibles con compresión del nervio mediano en el túnel carpiano. Sin embargo, a la inspección presentaban leve edema en la región proximal del canal, y en la evaluación por ultrasonido se detectó sendas tumoraciones que comprimían el nervio mediano previo a su ingreso en el canal carpiano. Discusión: En la literatura, los casos de músculos accesorios o lipomas como causas de compresión del nervio mediano son las causas más probables de persistencia de los síntomas tras la descompresión quirúrgica del canal carpiano. Conclusión: La exploración clínica detallada junto con la evaluación ultrasonográfica antes de la cirugía pueden ayudar a identificar estos casos y planificar un mejor abordaje quirúrgico.(AU)
Subject(s)
Humans , Female , Nerve Crush , Forearm , Median Nerve , Lipoma , Inpatients , Physical Examination , Joints , Rheumatology , Rheumatic DiseasesABSTRACT
INTRODUCTION: Nerve compression by anomalous masses located at the wrist and distal forearm is an infrequent condition. They may compress underlying structures in the carpal tunnel region, causing pain and paresthesias, which leads to the wrong diagnosis of carpal tunnel syndrome. CLINICAL CASES: We present three cases of patients with symptomatology and clinical tests compatible with compression of the median nerve in the carpal tunnel but whose physical examination showed a soft mass in the distal region of the forearm which was compressing the median nerve, as demonstrated by ultrasound evaluation. DISCUSSION: The reported cases of accessory muscles or lipomas described in the literature as causes of median nerve compression clinic are mainly described only after the surgical decompression of the carpal tunnel, due to the maintenance of residual symptoms. CONCLUSION: Careful examination with an ultrasound evaluation prior to surgery may help to identify these cases and help planning surgical treatment.
Subject(s)
Carpal Tunnel Syndrome , Wrist , Carpal Tunnel Syndrome/etiology , Forearm , Humans , Median Nerve/diagnostic imaging , Wrist/diagnostic imaging , Wrist JointABSTRACT
A 28-year-old man visited the emergency department of our hospital with a chief complaint of palpitation and chest pain. The patient had undergone 4 operations at other hospitals for tetralogy of Fallot (TOF), left pulmonary atresia, an aberrant right coronary artery, and a right aortic arch. As a result of thorough investigations, we suspected that the cause of the patient's symptoms was an excess of the right ventricular pressure over the left ventricular pressure, which was caused by right ventricular compression resulted from an abnormal mass on the anterior surface of the right ventricle, and by pulmonary stenosis (PS) associated with right ventricular outflow tract stenosis (RVOTS). Excision of the mass, right ventricular outflow restoration (RVOTR), and pulmonary valve replacement (PVR) were indicated. The mass on the anterior surface of the right ventricular was found to have been caused by retention of serous fluid in the interstice formed by a folded expanded polytetrafluoroethylene (ePTFE) pericardial sheet. An ePTFE pericardial sheet, which is used to supplement the pericardium, has been reported to have advantages with respect to prevention of adhesion, denaturation of pericardial substitutes, and inflammatory thickening and adhesion of the epicardium, compared with other materials used as pericardial substitutes. However, epicardial thickening has been noted with the use of ePTFE pericardial sheets, and hence, its use is currently avoided in many cases. This case presents an extremely rare pathology in which the inflammatory reaction of the epicardium caused by an ePTFE pericardial sheet is suspected to have caused serous components to become tightly encapsulated in the interstice formed by the folded patch ; no definite cause was identified. Thus far, no other such case has been reported, and ePTFE pericardial sheets should be used with caution.