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Archives of Orthopaedic and Trauma Surgery

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01-01-2014 | Handsurgery

Tumors and tumor-like lesions mimicking carpal tunnel syndrome

Authors: Zoe H. Dailiana, Sofia Bougioukli, Socratis Varitimidis, Vasileios Kontogeorgakos, Euthimia Togia, Marianna Vlychou, Konstantinos N. Malizos

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2014

Abstract

Introduction

Tumors and tumor-like lesions in or around the median nerve are uncommon causes of carpal tunnel syndrome (CTS). The purpose of the present study is to highlight the diagnostic approach and point out the profile of patients with CTS and potential underlying pathology.

Materials and methods

Twenty-eight patients with 32 affected hands had CTS correlated to a mass in or around the nerve. In 20 hands a palpable mass was present. Diagnostic workup included nerve conduction studies, ultrasound and/or MRI. Pre- and postoperative examination included two-point discrimination (2PD), grip strength, visual analogue scale (for pain) (VAS) and disabilities of the arm, shoulder and hand (DASH) scores.

Results

Twelve of 28 patients were young (range 9–38 years) and 10 were male. Nerve compression was due to 27 extraneural lesions (8 abnormal muscles, 5 lipomas, 7 tenosynovitis, 4 vascular tumors, 2 ganglia, 1 Dupuytren’s fibromatosis) and five intraneural tumors (three schwannomas, one neurofibroma, one sarcoma). Nerve decompression and excision of extraneural lesions were performed in all cases whereas in intraneural tumors, decompression was followed by excision in most cases and nerve grafting in one. Mean follow-up was 22 months (12–105 months). Extraneural masses were associated with a better outcome than nerve tumors. The mean postoperative VAS/DASH scores were 0.3/16.2 in extraneural lesions and 2.5/22 in intraneural lesions. The 2PD improved gradually in all patients (mean pre- and postoperative 12 and 5 mm). The mean grip strength increased from 28 to 31.3 kg postoperatively.

Conclusions

Although rare, the surgeon should include in the differential diagnosis of CTS the unusual cause of tumors and tumor-like lesions, especially when the patients’ profile is not typical (young, male, no repetitive stress or manual labor). In addition, the presence of a palpable mass at the distal forearm or palm dictates the need for imaging studies. The extent, location and aggressiveness of the mass will determine the approach and type of procedure.

Dawson DM (1993) Entrapment neuropathies of the upper extremities. N Engl J Med 329:2013–2018PubMedCrossRef

Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I (1999) Prevalence of carpal tunnel syndrome in a general population. JAMA 282:153–158PubMedCrossRef

de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F (1992) Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 45:373–376PubMedCrossRef

von Schroeder HP, Botte MJ (1996) Carpal tunnel syndrome. Hand Clin 2:643–655

Solomon DH, Katz JN, Bohn R, Mogun H, Avorn J (1999) Nonoccupational risk factors for carpal tunnel syndrome. J Gen Intern Med 14:310–314PubMedCentralPubMedCrossRef

Shiri R, Miranda H, Heliovaara M, Viikari-Juntura E (2009) Physical work load factors and carpal tunnel syndrome: a population-based study. Occup Environ Med 66:368–373. doi:10.1136/oem.2008.039719 PubMedCrossRef

Uchiyama S, Itsubo T, Nakamura K, Kato H, Yasutomi T, Momose T (2010) Current concepts of carpal tunnel syndrome: pathophysiology, treatment, and evaluation. J Orthop Sci 15:1–13. doi:10.1007/s00776-009-1416-x PubMedCrossRef

Vlychou M, Dailiana ZH (2011) Ancient schwannoma of the hand. J Hand Surg Am 36:2030–2033. doi:10.1016/j.jhsa.2011.08.009 PubMedCrossRef

Amirfeyz R, Clark D, Parsons B, Melotti R, Bhatia R, Leslie I, Bannister G (2011) Clinical tests for carpal tunnel syndrome in contemporary practice. Arch Orthop Trauma Surg 131:471–474. doi:10.1007/s00402-010-1150-z PubMedCrossRef

10.

Lange J (2013) Carpal tunnel syndrome diagnosed using ultrasound as a first-line exam by the surgeon. J Hand Surg Eur 38:627–632. doi:10.1177/1753193412469581 CrossRef

11.

Horng YS, Chang HC, Lin KE, Guo YL, Liu DH, Wang JD (2012) Accuracy of ultrasonography and magnetic resonance imaging in diagnosing carpal tunnel syndrome using rest and grasp positions of the hands. J Hand Surg Am 37:1591–1598PubMedCrossRef

12.

Kang HJ, Jung SH, Yoon HK, Hahn SB, Kim SJ (2009) Carpal tunnel syndrome caused by space occupying lesions. Yonsei Med J 50:257–261. doi:10.3349/ymj.2009.50.2.257 PubMedCentralPubMedCrossRef

13.

Barber K, Bianco A, Sole E, McCarty C (1962) Benign extra-neural soft tissue tumors of the extremities causing compression of nerves. J Bone Joint Surg Am 44:98–104

14.

Oster LH, Blair WF, Steyers CM (1989) Large lipomas in the deep palmar space. J Hand Surg Am 14:700–704PubMedCrossRef

15.

Mohamed A, Rosalie S, Taylor K, Fink M, Coombs C, Ryan M, Kornberg A (2011) Carpal tunnel syndrome secondary to ganglion cyst in a child. J Child Neurol 26:630–633. doi:10.1177/0883073810387299 PubMedCrossRef

16.

Nakamichi K, Tachibana S (1993) Ultrasonography in the diagnosis of carpal tunnel syndrome caused by an occult ganglion. J Hand Surg Br 18:174–175PubMedCrossRef

17.

Kim JY, Sung JH, Lee S (2010) A haemangioma of the flexor tendon sheath causing carpal tunnel syndrome. J Hand Surg Eur 35:73–74. doi:10.1177/1753193409347688 CrossRef

18.

Schön R, Kraus E, Boller O, Kampe A (1992) Anomalous muscle belly of the flexor digitorum superficialis associated with carpal tunnel syndrome: case report. Neurosurgery 31:969–970PubMedCrossRef

19.

Sánchez Lorenzo J, Cañada M, Díaz L, Sarasúa G (1996) Compression of the median nerve by an anomalous palmaris longus tendon: a case report. J Hand Surg Am 21:858–860PubMedCrossRef

20.

Mathoulin C, Dailiana Z (1998) Palmaris profundus associé a un syndrome du canal carpien. A propos d’un cas et revue de la bibliographie. La Main 3:261–265

21.

Froimson AI (1987) Benign solid tumors. Hand Clin 3:213–217PubMed

22.

Nilsson J, Sandberg K, Dahlin LB, Vendel N, Balslev E, Larsen L, Nielsen NS (2010) Fibrolipomatous hamartoma in the median nerve in the arm—an unusual location but with MR imaging characteristics: a case report. J Brachial Plex Peripher Nerve Inj 5:1. doi:10.1186/1749-7221-5-1 PubMedCentralPubMedCrossRef

23.

Louis DS (1987) Peripheral nerve tumors in the upper extremity. Hand Clin 3:311–318PubMed

24.

Sughrue ME, Levine J, Barbaro NM (2008) Pain as a symptom of peripheral nerve sheath tumors: clinical significance and future therapeutic directions. J Brachial Plex Peripher Nerve Inj 3:6. doi:10.1186/1749-7221-3-6 PubMedCentralPubMedCrossRef

25.

Valeyrie-Allanore L, Ismaïli N, Bastuji-Garin S, Zeller J, Wechsler J, Revuz J, Wolkenstein P (2005) Symptoms associated with malignancy of peripheral nerve sheath tumours: a retrospective study of 69 patients with neurofibromatosis I. Br J Dermatol 153:79–82PubMedCrossRef

26.

Padua L, Padua R, Aprile, Tonali P (1999) Italian multicentre study of carpal tunnel syndrome Differences in the clinical and neurophysiological features between male and female patients. J Hand Surg Br 24:579–582PubMedCrossRef

27.

Höglund M, Muren C, Engkvist O (1997) Ultrasound characteristics of five common soft tissue tumors in the hand and forearm. Acta Radiol 38:348–354PubMed

28.

Gielen J, Ceulemans R, van Holsbeeck M (2006) Ultrasound of soft tissue tumors. In: De Schepper AM (ed) Imaging of soft tissue tumors, 3rd edn. Springer, Germany, pp 3–18CrossRef

29.

Peh WC, Truong NP, Totty WG, Gilula LA (1995) Pictorial review: magnetic resonance imaging of benign soft tissue masses of the hand and wrist. Clin Radiol 50:519–525PubMedCrossRef

30.

Hsu CS, Hentz VR, Yao J (2007) Tumours of the hand. Lancet Oncol 8:157–166PubMedCrossRef

31.

Russell SM (2007) Preserve the nerve: microsurgical resection of peripheral nerve sheath tumors. Neurosurgery 61:113–117PubMedCrossRef

Title: Tumors and tumor-like lesions mimicking carpal tunnel syndrome
Authors: Zoe H. Dailiana
Sofia Bougioukli
Socratis Varitimidis
Vasileios Kontogeorgakos
Euthimia Togia
Marianna Vlychou
Konstantinos N. Malizos
Publication date: 01-01-2014
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 1/2014
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-013-1901-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Tumors and tumor-like lesions mimicking carpal tunnel syndrome

Abstract

Introduction

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

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