Acute Carpal Tunnel Syndrome in A Rheumatoid Patient on Warfarin Due to Spontaneous Median Nerve Intraneural Hemorrhage Treated Successfully with Carpal Tunnel Decompression

Abstract

Background: Acute carpal tunnel syndrome is a common complication following injuries of the wrist and hand. There are however a few reported cases in the literature where spontaneous intraneural bleeding following anticoagulation treatment with various agents. Case presentation:We present the case of a 53-year-old female patient with a past medical history of aortic valve replacement and rheumatoid arthritis treated with warfarin and methotrexate, who presented to our emergency department with symptoms of Acute Carpal Tunnel Syndrome (ACTS). Due to the escalating severity of the median nerve neuropathy, she underwent an ACTS decompression, which revealed a median intraneural hematoma. The hemorrhage restricted carpal tunnel space causing acute pressure on the median nerve. There was no diffuse bleeding inside the carpal tunnel or subcutaneously. Four weeks post operatively there was no sign of median nerve neuropathy. Conclusion:Acute carpal tunnel decompression can safely be performed in rheumatoid patients on warfarin and raised INR with ACTS due to spontaneous intraneural bleeding

Anti-cancer therapeutic agents and carpal tunnel syndrome: Clinical, electrodiagnostic, and ultrasound findings in seven patients

“…19,20 CTS has been reported as a rare complication of ICIs. 1,19,20 Other medications that have been reported to increase the risk of CTS include bisphosphonates, 21 fluoroquinolones, 22,23 anticoagulant therapy, [24][25][26] antiretroviral therapy, 27 and human growth hormone use. 28 Cases of acute CTS occurring in a patient with a tricyclic antidepressant overdose 29 and bilateral CTS following radioactive iodine-induced hypothyroidism have been reported.…”