Acute carpal tunnel syndrome from thrombosed persistent median artery

Balakrishnan, Chenicheri; Smith, Matthew F.; Puri, Pravin

doi:10.1016/s0736-4679(99)00011-6

Cited by 42 publications

(32 citation statements)

References 14 publications

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“…[11][12][13][14][15][16][17][18] Although a PMA has been described as an anatomic variation in angiographic studies, 19,20 to our knowledge, no report of ultrasonographic findings of a PMA associated with CTS has been published. We report the cases of 2 patients with a large PMA in association with CTS diagnosed on the basis of ultrasonography and color Doppler ultrasonography (CDUS).…”

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confidence: 99%

Persistent Median Artery in the Carpal Tunnel

Gassner

Schocke

Peer

et al. 2002

J of Ultrasound Medicine

111

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Objective. To describe the ultrasonographic and color Doppler ultrasonographic findings in 2 patients with carpal tunnel syndrome associated with a persistent median artery and to report the frequency of this anatomic variation in healthy volunteers. Methods. Two patients with the clinical appearance of carpal tunnel syndrome and 100 wrists and distal forearms of 50 asymptomatic volunteers were examined with ultrasonography and color Doppler ultrasonography. The frequency and size of a persistent median artery and its relationship to median nerve anatomy in the carpal tunnel were evaluated. Results. A large persistent median artery of 3 mm in diameter was found in the affected hands in both patients with carpal tunnel syndrome. Findings were confirmed at surgery. Among the asymptomatic volunteers, a persistent median artery could be found in 13 (26%, 10 [20%] unilateral and 3 [6%] bilateral), with a mean diameter of 1.1 mm (range, 0.5-1.7 mm). In 10 (63%) of 16 hands, the persistent median artery was associated with high division of the median nerve or a bifid nerve configuration in the carpal tunnel. Conclusions. A persistent median artery is a common condition in healthy individuals and in most cases is related to median nerve variations such as high division or a bifid nerve. Because a persistent median artery has a superficial course close to the transverse carpal ligament, preoperative diagnosis of this anatomic variation may be of clinical importance.

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confidence: 99%

Persistent Median Artery in the Carpal Tunnel

Gassner

Schocke

Peer

et al. 2002

J of Ultrasound Medicine

111

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“…Etiologies include bleeding secondary to chronic lymphatic leukemia, hemophilia, Colles' fracture of the wrist, epiphyseal fracture (Salter II) of the distal radius, bleeding secondary to giant cell tumour of the tendon sheath, unstable distal radioulnar joint, displaced intra-articular fracture of the distal radius, rheumatoid synovitis and vasculitis, Hansen's disease and trans-scaphoid perilunar fracture dislocation of the wrist. Other causes include gout, pseudogout, foreign body within the carpal tunnel and acute thrombosis of persistent median artery (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

Acute carpal tunnel syndrome as a result of spontaneous bleeding

Balakrishnan¹,

Jarrahnejad²,

Balakrishnan³

2008

J Plastic Surgery

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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.

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“…When intra-compartmental pressure rises above a critical threshold pressure, capillary blood flow is reduced below the level required for median nerve viability. This can occur from bleeding, a foreign body in the compartment, or thrombosis of the median artery or epineural vessels (2)(3)(4)(5). Although several conditions are associated with compression neuropathy of the median nerve, acute carpal tunnel syndrome is the most common neuropathy of the median nerve.…”

Section: Discussionmentioning

confidence: 99%