Benign nerve tumors of the hand and the forearm.

We used a hand surgeon's 1978-1994 pathology reports to retrospectively review the incidence, preoperative and postoperative diagnoses, and presenting signs and symptoms of benign nerve tumors. Twenty-four (11.5%) of our series of 208 soft-tissue tumors of the hand and the forearm were benign nerve tumors. Nerve tumors were the third most common tumor after giant cell tumors of tendon sheath and inclusion cysts. Correct preoperative diagnosis was made in only 1 (4.2%) of the 24 cases. Schwannomas and neurofibromas were equally distributed (12 each), and 2 cases of neurofibromatosis (8.3%) were documented. Two (16.7%) of the 12 patients with schwannomas and 4 (33.3%) of the 12 patients with neurofibromas had neurologic symptoms. Six (85.7%) of the 7 digital tumors were dorsally located. In the literature, incidence of benign nerve tumors is much lower (ie, 1%-5%), and preoperative diagnosis consistently incorrect in our study. Incidence of neurologic symptoms (numbness, paresthesia) as presenting symptoms was higher in our study than previously documented. Although benign nerve tumors are most often located on the volar surface of the hand, 25% of the lesions we found were on the dorsal surface of the fingers.

Carpal tunnel syndrome due to tophaceous gout.

Tophaceous gout is a recognized cause of carpal tunnel syndrome. Of 2649 carpal tunnel releases, 15 hands in 13 patients were identified with tophaceous gout in the carpal tunnel. The incidence of tophaceous gout in the carpal tunnel was 0.6%. Twelve of 13 patients were male, and 8 of 10 patients with a history of gout developed carpal tunnel syndrome despite adequate medical treatment. Thus, consideration should be given for tophi as a cause of carpal tunnel syndrome, especially in older men despite medical treatment for gout.