Surgical Treatment of Carpal Tunnel Syndrome and Lymphedema in Advanced-Stage Upper Extremity Lymphedema

Abstract

Background Recent advances in supermicrosurgery have evolved to treat lymphedema surgically. For patients with carpal tunnel syndrome (CTS) and advanced-stage lymphedema, lymphovenous anastomosis (LVA) may effectively improve lymphedema after carpal tunnel release in patients with CTS and advanced stage lymphedema. However, no studies have reported simultaneous carpal tunnel release and LVA surgeries for patients with CTS and advanced-stage lymphedema.Case Presentation A 60-year-old female with carpal tunnel syndrome and International Society of Lymphology late stage 2 right upper extremity lymphedema following right mastectomy and axillary lymph node dissection and adjuvant chemoradiotherapy for treating breast cancer was admitted to our lymphedema clinic. She developed carpal tunnel syndrome four years after breast cancer surgery. She underwent release of the transverse carpal ligament, followed by four lymphovenous anastomoses at the wrist, forearm, and antecubital area. After two simultaneous surgeries, she had less neuropathic pain and volume reduction in her hand.Conclusion The authors recommend simultaneous LVA and release of the transverse carpal ligament as the first treatment option for patients with advanced-stage lymphedema and concurrent CTS.