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Unilateral carpal tunnel syndrome caused by an occult ganglion in the carpal tunnel: a report of two cases.

Yalcinkaya M, Akman YE, Bagatur AE - Case Rep Orthop (2014)

Bottom Line: It is easy to detect a mass when it is palpable; however, occult lesions are usually overlooked.This study presents two cases with an occult ganglion in the carpal tunnel compressing the median nerve and causing unilateral symptoms of CTS.We stress on the importance of imaging studies in patients with unilateral symptoms that are usually not used in CTS.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery and Traumatology, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Rumeli Hisari Cad. No. 62, Baltalimani, Sariyer, 34470 Istanbul, Turkey.

ABSTRACT
Carpal tunnel syndrome (CTS) usually presents bilaterally and a secondary nature should be suspected in patients with unilateral symptoms, especially those with a long-standing history, and when the symptomatic hand shows severe neurophysiologic impairment, while the contralateral hand is neurophysiologically intact. Space-occupying lesions are known to cause CTS and the incidence of space-occupying lesions in unilateral CTS is higher than that of bilateral CTS. It is easy to detect a mass when it is palpable; however, occult lesions are usually overlooked. Whenever a patient presents with unilateral symptoms and unilateral neurophysiologic impairment, the possibility of a space-occupying lesion compressing the median nerve should be kept in mind in the differential diagnosis. This study presents two cases with an occult ganglion in the carpal tunnel compressing the median nerve and causing unilateral symptoms of CTS. We stress on the importance of imaging studies in patients with unilateral symptoms that are usually not used in CTS. The reported patients were evaluated and magnetic resonance images revealed an intratunnel space-occupying lesion.

No MeSH data available.


Related in: MedlinePlus

MRI revealed a space-occupying lesion (arrow) in the carpal tunnel and the median nerve (arrowhead) with high signal intensity on fat-suppressed proton density axial images of the wrist.
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fig1: MRI revealed a space-occupying lesion (arrow) in the carpal tunnel and the median nerve (arrowhead) with high signal intensity on fat-suppressed proton density axial images of the wrist.

Mentions: Both clinical symptoms and signs and the neurophysiological tests showed severe [5] CTS in one hand while the contralateral hand was completely healthy, implying a secondary disease. No external signs or palpable masses were present. Magnetic resonance imaging (MRI) showed a 12 × 10 × 6 mm cystic space-occupying lesion with well-defined margins resembling a ganglion, originating from the posterior wall of the carpal tunnel and compressing the flexor tendons. MRI also showed flattening of the median nerve at the hamate level, palmar bowing of the flexor retinaculum, and increased signal intensity of the median nerve (Figure 1). Open carpal tunnel release and mass excision were performed through a palmar incision (Figure 2). Histological examination revealed thin connective tissue capsule made up of compressed collagen fibers lined with flattened cells without a synovial or epithelial lining, consistent with a ganglion. The patient reported relief of all symptoms postoperatively, and no recurrence had occurred at 1-year follow-up.


Unilateral carpal tunnel syndrome caused by an occult ganglion in the carpal tunnel: a report of two cases.

Yalcinkaya M, Akman YE, Bagatur AE - Case Rep Orthop (2014)

MRI revealed a space-occupying lesion (arrow) in the carpal tunnel and the median nerve (arrowhead) with high signal intensity on fat-suppressed proton density axial images of the wrist.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4109127&req=5

fig1: MRI revealed a space-occupying lesion (arrow) in the carpal tunnel and the median nerve (arrowhead) with high signal intensity on fat-suppressed proton density axial images of the wrist.
Mentions: Both clinical symptoms and signs and the neurophysiological tests showed severe [5] CTS in one hand while the contralateral hand was completely healthy, implying a secondary disease. No external signs or palpable masses were present. Magnetic resonance imaging (MRI) showed a 12 × 10 × 6 mm cystic space-occupying lesion with well-defined margins resembling a ganglion, originating from the posterior wall of the carpal tunnel and compressing the flexor tendons. MRI also showed flattening of the median nerve at the hamate level, palmar bowing of the flexor retinaculum, and increased signal intensity of the median nerve (Figure 1). Open carpal tunnel release and mass excision were performed through a palmar incision (Figure 2). Histological examination revealed thin connective tissue capsule made up of compressed collagen fibers lined with flattened cells without a synovial or epithelial lining, consistent with a ganglion. The patient reported relief of all symptoms postoperatively, and no recurrence had occurred at 1-year follow-up.

Bottom Line: It is easy to detect a mass when it is palpable; however, occult lesions are usually overlooked.This study presents two cases with an occult ganglion in the carpal tunnel compressing the median nerve and causing unilateral symptoms of CTS.We stress on the importance of imaging studies in patients with unilateral symptoms that are usually not used in CTS.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery and Traumatology, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Rumeli Hisari Cad. No. 62, Baltalimani, Sariyer, 34470 Istanbul, Turkey.

ABSTRACT
Carpal tunnel syndrome (CTS) usually presents bilaterally and a secondary nature should be suspected in patients with unilateral symptoms, especially those with a long-standing history, and when the symptomatic hand shows severe neurophysiologic impairment, while the contralateral hand is neurophysiologically intact. Space-occupying lesions are known to cause CTS and the incidence of space-occupying lesions in unilateral CTS is higher than that of bilateral CTS. It is easy to detect a mass when it is palpable; however, occult lesions are usually overlooked. Whenever a patient presents with unilateral symptoms and unilateral neurophysiologic impairment, the possibility of a space-occupying lesion compressing the median nerve should be kept in mind in the differential diagnosis. This study presents two cases with an occult ganglion in the carpal tunnel compressing the median nerve and causing unilateral symptoms of CTS. We stress on the importance of imaging studies in patients with unilateral symptoms that are usually not used in CTS. The reported patients were evaluated and magnetic resonance images revealed an intratunnel space-occupying lesion.

No MeSH data available.


Related in: MedlinePlus