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
En el estudio de los tendones del músculo accesorio del abductor largo del pulgar, basados en la disección anatómica de 250 cadáveres adultos de raza mestiza del altiplano y valle, registramos que las variaciones anatómicas son muy frecuentes. La presencia de tendones accesorios ocurrió en todas las piezas disecadas. Este músculo constante, en nuestro medio se origina en el tercio inferior de la cara dorsal del radio, ulna y de la membrana interósea; diferenciandose del abductor largo del pulgar y del extensor corto del pulgar. Se dirige hacia abajo al nivel de la muñeca, pasa por debajo del retináculo extensor en la primera corredera osteofibrosa de la epífisis distal del radio junto con el abductor largo y extensor corto del dedo pulgar. Su inserción distal se realiza en primer metacarpiano.
In the study of the tendons of the accessory muscle of the long abductor of the thumb, based on the anatomical dissection of 250 mature cadavers of mestizo race of the highland and valley, we register that the anatomical variations are very frequent. The presence of accessory tendons happened in all the dissected pieces.This constant muscle, in our means, originates in the inferior third of the dorsal face of the radius, ulna and of the membrane interosseous; differing of the long abductor of the thumb and of the extending one short of the thumb. He she goes down, at the doll's level, it passes below the extending retináculo in the first sliding osteofibrosa of the lower extremity of the radius together with the short long and extending abductor of the thumb. Their insert distal is carried out in first metacarpal.
