Ischemia of the hand and forearm in a 33-year-old COVID-19 patient: a case report

The intent is to serve as an update of the hand surgery literature for the practicing general orthopaedic surgeon. Carpal Tunnel SyndromeCarpal tunnel syndrome is one of the most common disorders in hand surgery. Nevertheless, the optimum method for diagnosis remains controversial. A growing body of evidence suggests that electrodiagnostic studies [1][2][3][4] are not more sensitive and specific than diagnosis by ultrasound or clinical history and examination. D'Auria et al. 5 examined the role of electrodiagnostic studies compared with clinical judgment and found that the utility of electrodiagnostic studies may be greatest in patients for whom a diagnosis of carpal tunnel syndrome is questionable. Even so, electrodiagnostic studies are performed in many patients with carpal tunnel syndrome 6 . Less expensive, office-based diagnostic tools such as the Carpal Tunnel Syndrome 6 (CTS-6), a 26-point scale that incorporates aspects of the history and clinical examination to predict the probability of carpal tunnel syndrome, and ultrasound will likely supplant the routine use of electrodiagnostic studies for carpal tunnel syndrome.Strong evidence exists for the use of night splints and corticosteroid injections for early treatment of carpal tunnel syndrome. In a comparison of the 2 treatments, 100 patients with a diagnosis of carpal tunnel syndrome were randomized to a night splint or a corticosteroid injection 7 . In the 95 patients who completed follow-up, corticosteroid injections were superior in terms of nocturnal paresthesias, pain, and Boston Carpal Tunnel Questionnaire (BCTQ) function and symptom domains at 1, 3, and 6 months.A novel study on hand function with decreased sensation showed that a digital nerve block to the thumb had the greatest negative impact on dexterity and a loss of sensation in the index and long fingers caused decreased grip and chuck pinch strength, thus explaining the common symptoms of decreased dexterity and strength in patients with carpal tunnel syndrome 8 .Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G899).

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“…Finally, case reports have emerged with regard to digital ischemia 99 and hypercoagulable states affecting the upper limb 100 due to COVID-19.…”

Section: Covid-19mentioning

confidence: 99%

What’s New in Hand and Wrist Surgery

Bohn

Wise

2022

Journal of Bone and Joint Surgery

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“…There is a link between COVID-19 infection and complications of hypercoagulopathy. [1][2][3] The virus provokes an inflammatory cascade that leads to a prothrombotic state resulting in micro-and macrovascular endothelial damage. Most reports have focused on venous thromboembolism while arterial thrombotic events, particularly thrombosis of the large named arteries, have received less attention.…”

Section: Iranian Medicinementioning

confidence: 99%

Subclavian Artery Thrombosis in a COVID-19 Patient

2022

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“…The link between acute COVID-19 infection and the hypercoagulable state has been previously described in clinically obtunded patients and correlated with a generally poor prognosis ( Levi et al., 2020 ). Previous reports of critical limb ischaemia in COVID-19 infection have typically been in the high-dependency setting with multi-organ failure and with inotropic support ( Qian and Pan, 2020 ; Schultz and Wolf, 2020 ; Thiel et al., 2021 ). Our case is notable, as we describe critical limb ischaemia as the presenting condition 5 months after COVID-19 infection.…”

mentioning

confidence: 99%

Critical ischaemia of the hand and upper limb in a patient with long COVID-19 infection

Lees

Wong

Ibrahim

2021

J Hand Surg Eur Vol

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We report the case of a 31-year-old, right-hand dominant female, who presented with critical ischaemia of the dominant hand following iatrogenic injury to the ulna artery at the wrist, during attempted venepuncture to monitor renal function (after a recent kidney infection). Past medical history included a clinical history of COVID-19 infection 5 months previously and occasional chronic pyelonephritis over 8 years. The patient was taking the combined oral contraceptive pill and her body mass index (BMI) was 25.7.The patient then applied a heartrate/motion tracker band to the wrist and the hand subsequently became cool, swollen, mottled and excruciatingly painful. Removal of the fitness tracker band did not improve matters (Figure 1(a)). She presented to the Emergency Department and a duplex ultrasound scan confirmed occlusion of the ulna artery at the wrist, with no flow through the radial artery and no distal run-off to the digits. Almost 24 hours after the initial venepuncture injury, the patient was referred to the plastic surgery service and underwent emergency exploration of the ulna artery. At operation, the artery was found thrombosed at the site of venepuncture. Thrombus was removed, the damaged segment resected and the artery successfully primarily anastomosed (Figure 1(b)). Despite early improvement and continuing patency of the ulna artery, the hand continued to demonstrate poor perfusion, particularly affecting thumb, index and middle fingers distally -interpreted to be related to distal thrombosis.The next day, an upper limb arteriogram was performed, which revealed absent perfusion of a 4-5 cm distal segment of the radial artery and no distal runoff in the digital vessels (Figure 1(c)). Thrombolysis treatment was commenced with tissue plasminogen activator infusion, through an indwelling brachial artery catheter demonstrating improvement in

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Ischemia of the hand and forearm in a 33-year-old COVID-19 patient: a case report

Cited by 3 publications

References 2 publications

What’s New in Hand and Wrist Surgery

What’s New in Hand and Wrist Surgery

Subclavian Artery Thrombosis in a COVID-19 Patient

Critical ischaemia of the hand and upper limb in a patient with long COVID-19 infection

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