Two Cases of Acute Carpal Tunnel Syndrome in Classic Haemophilia

Abstract

We present two cases of acute carpal tunnel syndrome in patients with haemophilia A. There have been only a few cases reported and controversy exists as to whether conservative or surgical treatment should be given in the acute phase. We successfully decompressed the carpal tunnel in both cases. The numbers reported are small, however, and a combination of conservative and surgical treatment remains acceptable in the early phase of this syndrome.

Management of Acute Carpal Tunnel Syndrome: A Systematic Review

“…The 86 selected articles included 69 case reports, 13 case series, two retrospective, and two prospective studies. 2 , 3 , 4 , 7 , 13 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , …”

Case report: Acute cubital tunnel syndrome in a hemophiliac patient

“…While accurately diagnosing acute cubital tunnel syndrome or other acute compressive neuropathies in the hemophiliac patient may seem clinically apparent, determining the optimal treatment requires incorporating multiple variables and is not always straightforward. 4,5,7–10 Historically, treatment has been largely conservative: administration of coagulation factors, limb elevation, and joint immobilization. 5–7,10 Patients refractory to conservative management eventually have undergone surgical decompression with nerve transposition, ultimately yielding clinical improvement, but not always with complete resolution of their symtpoms.…”

“…5–7,10 Patients refractory to conservative management eventually have undergone surgical decompression with nerve transposition, ultimately yielding clinical improvement, but not always with complete resolution of their symtpoms. 5–9…”

Acute carpal tunnel syndrome due to a hemangioma of the median nerve

“…Hamartomas involving the peripheral nerves were first described in 1953 by Mason,1 mostly involving the median nerve in the forearm and wrist and usually presenting as chronic CTS. Acute CTS may occur consecutive to hamate and triquetral fractures,2 acute metacarpal osteomyelitis3 compression by anomalous flexor digitorum superficialis,4 after internal fixation of scaphoid,4 secondary to pyogenic infections,5 classical hemophilia,6 von Willebrand's disease7 oral anticoagulant therapy,8 distal radial fractures,9 filarial infections,10 thrombosed persistent median artery,11 idiopathic tumoral calcinosis,12 decompression sickness,13 Hansen's disease,14 peritendinitis calcarea,15 pseudogout,16 scaphoid pseudoarthroses 17. Bilateral cases may occur due to human parvovirus B19 infection 18…”