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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

Intraoperative photograph shows the ganglion in the carpal tunnel.
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fig4: Intraoperative photograph shows the ganglion in the carpal tunnel.

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. MRI showed a 10 × 9 × 6 mm cystic space-occupying lesion with well-defined margins resembling a ganglion, originating from the posterior wall of the carpal tunnel, and flattening of the median nerve at the hamate level, palmar bowing of the flexor retinaculum, increased signal intensity of the median nerve, and acute denervation of the thenar muscles (Figure 3). Open carpal tunnel release and mass excision were performed through a palmar incision (Figure 4). Histological examination revealed findings consistent with a ganglion. The patient reported relief of all symptoms postoperatively, and no recurrence had occurred at 14-month 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)

Intraoperative photograph shows the ganglion in the carpal tunnel.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig4: Intraoperative photograph shows the ganglion in the carpal tunnel.
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. MRI showed a 10 × 9 × 6 mm cystic space-occupying lesion with well-defined margins resembling a ganglion, originating from the posterior wall of the carpal tunnel, and flattening of the median nerve at the hamate level, palmar bowing of the flexor retinaculum, increased signal intensity of the median nerve, and acute denervation of the thenar muscles (Figure 3). Open carpal tunnel release and mass excision were performed through a palmar incision (Figure 4). Histological examination revealed findings consistent with a ganglion. The patient reported relief of all symptoms postoperatively, and no recurrence had occurred at 14-month 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