Self-mutilation in a patient with mucolipidosis III

Missed childhood-onset carpal tunnel syndrome diagnosed as chronic pain: case report

We report the case of a 15-year-old girl with a red, swollen, and painful right hand. She first developed symptoms when she was 7 years old. Numerous physicians evaluated her at various institutions but were able to classify her only with chronic pain syndrome. She continued with regular occupational therapy and had to use special aids to compensate throughout school. After 8 years of treatment with no improvement, she presented to our office, where we diagnosed carpal tunnel syndrome. Intraoperative findings revealed a large proximal muscle belly of the index lumbrical, a thickened transverse carpal ligament, and marked compression of the median nerve. Two weeks after the surgery, her symptoms cleared; at 5 months, she remained symptom free.

Carpal tunnel syndrome secondary to ganglion cyst in a child

Carpal tunnel syndrome is uncommon in children and is associated with an underlying etiology in the majority of cases. The diagnosis of the condition in childhood is dependent on a high degree of clinical suspicion, careful clinical examination, and judicious use of confirmatory investigations. The authors report a novel cause of carpal tunnel syndrome in a child, and discuss the investigation and management strategies in childhood carpal tunnel syndrome.

Carpal tunnel syndrome in children

Carpal tunnel syndrome is a condition rarely encountered in infants. We describe five patients with nine involved hands. One was reported earlier. In three cases the cause of carpal tunnel syndrome is a storage disease: one girl with mucolipidosis type III and a boy and a girl with mucopolysaccharidosis type I. The fourth case is a girl presenting with unilateral macrodactyly of the right third and fourth digits. The last case involves a boy with familial carpal tunnel syndrome. We briefly discuss these patients and review the literature since 1989.

Carpal tunnel syndrome in a 28-month-old child

We report a 28-month-old male child, known to have Maroteaux-Lamy syndrome (mucopolysaccharidosis type VI), who presented with inconsistent right hand discomfort. Clinical suspicion of right carpal tunnel syndrome was confirmed by nerve conduction and electromyographic studies, and a decompressive procedure was done with uneventful recovery. Carpal tunnel syndrome in mucopolysaccharidosis patients should be suspected, diagnosed and treated early for better outcome.

Mutilating hand syndrome in an infant with familial carpal tunnel syndrome

A 7-month-old infant, son of consanguinous Indian parents, presented with recurrent chewing of his digits in a median nerve distribution as the primary manifestation of carpal tunnel syndrome, in conjunction with features consistent with congenital insensitivity to pain. Electromyography (EMG) demonstrated severe median nerve entrapment at the wrist bilaterally, but other nerves were normal. In spite of clinical evidence of diffuse pain insensitivity, sural nerve and skin biopsies were normal, and he had no evidence of autonomic dysfunction. Hand findings evolved with scarring and infection of median innervated digits and loss of fine motor skills. Carpal tunnel release resulted in complete clinical resolution and significant EMG improvement. Milder symptoms and EMG evidence of median nerve entrapment were demonstrated in both parents, paternal grandparents, and several of his father's siblings. We hypothesize this child may be homozygous for a mutant allele that in its heterozygous state predisposes to familial autosomal dominant carpal tunnel syndrome. Homozygosity for this or another mutant allele may be responsible for his congenital insensitivity to pain.