Acute carpal tunnel syndrome as a result of spontaneous bleeding

Abstract

Acute carpal tunnel syndrome is the most common compression neuropathy of the upper extremity following trauma. A rare occurence of spontaneous bleeding into the carpal tunnel, presenting as acute carpal tunnel syndrome, is presented.Key Words: Carpal tunnel syndrome; Spontaneous bleeding Syndrome du tunnel carpien aigu consécutif à une hémorragie spontanée Le syndrome du tunnel carpien est la neuropathie par compression la plus fréquente à survenir au niveau des membres supérieurs par suite de traumatismes. On présente ici un cas rare d'hémorragie spontanée au niveau du tunnel carpien ayant donné lieu à un syndrome aigu du tunnel carpien. C lassic carpal tunnel syndrome (CTS) occurs most often in women, and manifests as hypoesthesia and tingling in the median nerve distribution distal to the wrist joint. In acute CTS (ACTS), the intracarpal interstitial pressure rises above the threshold, and capillary blood flow is reduced below the level of median nerve viability. This leads to ischemia of the muscles and nerves, resulting in the clinical signs and symptoms. ACTS due to spontaneous bleeding into the carpal tunnel is rare. We report a patient who developed ACTS from spontaneous bleeding into the carpal tunnel following strenuous exercise. CASE PRESENTATIONA 51-year-old man presented to the emergency department with acute pain and swelling of the right hand following a workout at a gym. He had no history of serious illness in the past. Medications included acetylsalicylic acid (81 mg/day) and vitamin E once per day. His pain started after his workout and increased over a 2 h period. There was no history of trauma. His hematological work-up was negative. He complained of tingling and paresthesia of the median nerve distribution.On examination, there was swelling of the hand with slight bluish discolouration (Figure 1). The wrist was maintained in a flexed position. The signs and symptoms were those of acute tenosynovitis originating in the common flexor synovial sheath at the wrist with associated paresthesia in the distribution area of the median nerve in the hand.X-rays of the wrist and hand were negative. A clinical diagnosis of ACTS was made. He underwent decompression of the carpal tunnel under general anesthesia. At exploration, blood was seen inside the carpal tunnel (Figure 2). The carpal tunnel was decompressed. His symptoms improved following decompression and at six weeks he had full function of the hand.

Acute Carpal Tunnel Syndrome Secondary to Iatrogenic Hemorrhage. A Case Report

“…With early operative intervention, the chances for full nerve recovery are high. Full hand function commonly recurs within 3–6 weeks independent of the etiology [1,2,9,14,31]. Our patient recovered fully from surgery with improved hand function and mild residual median nerve neuropathy.…”

“…According to the current literature, there is no “golden standard” algorithm reported for the diagnosis of aCTS. Imaging techniques, like wrist X-rays are useful in demonstrating a displaced fracture but do not demonstrate a hematoma in the carpal tunnel [1,2,9,14]. A CT scan [1,10] or MRI [35] may demonstrate fluid within the carpal tunnel.…”

“…Nontraumatic aCTS is a rare event that can occur with spontaneous bleeding such as occurs in hemophiliacs [19], patients with von Willebrand's disease [26], acute myelomonocytic leukemia [10], patients on anticoagulants [3][4][5]20], after strenuous exercise [2], and due to hemorrhage secondary to diffuse giant cell tumor of the tendon sheath [35]. Other nontraumatic etiologies of aCTS not attributed to hemorrhage have also been reported such as gout [21] or pseudogout [6] or the presence of a foreign body within the carpal tunnel [33].…”

Review of Epinephrine Solution Use in 400 Consecutive Cases of Burn Reconstruction. Are Infusion Pumps Safe?

“…4 By using the infusion pump, the amount of infiltration cannot reliably be controlled, and even just a few seconds of infiltration can result in large volume of infiltrate, thus compressing the nerve and causing the acute carpal tunnel syndrome. The infiltration at this level is a technical mistake that may have resulted in infiltration of epinephrine solution into the median nerve's perineural sheath or into the carpal tunnel around the nerve.…”

Acute Carpal Tunnel Syndrome From Burns of the Hand and Wrist

“…Phelan contributed much to the present understanding of the etiology, diagnosis and management of this syndrome (2). Carpal tunnel syndrome is associated with acute pyogenic infection, Hansen's disease, spontaneous hemorrhage, thrombosis of persistent median artery, foreign body, gout, pseudogout and aneurysms of the epineural vessels (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). When intracarpal canal interstitial pressure rises above a critical threshold pressure, capillary blood flow is reduced below the level required for median nerve viability.…”