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Zbeda RM, Rabinovich RV, Vialonga M, Seigerman DA. Acute Septic Carpal Tunnel Syndrome in a Rock Climber. J Orthop Case Rep 2021; 11:100-103. [PMID: 34327176 PMCID: PMC8310637 DOI: 10.13107/jocr.2021.v11.i04.2170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Rock climbing is an increasingly popular sport in the United States. Acute and chronic upper extremity injuries related to rock climbing are frequently reported and include flexor pulley ruptures and hamate stress fractures. Deep space hand infections after indoor rock climbing are a sport-related pathology that has yet to be reported. Our purpose is to describe an acute septic carpal tunnel syndrome following rock climbing at an indoor climbing gym in a patient who required urgent irrigation and debridement. Case Report: A 33-year-old Caucasian male presented with an acute septic carpal tunnel syndrome 4 days after rock climbing at an indoor gym. On physical examination, he exhibited numbness over the fingers, significant tenderness to palpation, and pain with passive range of motion. His inflammatory markers were markedly elevated and deep space hand infection was confirmed with computed tomography scans. The patient was taken for urgent exploration, irrigation and debridement, and carpal tunnel release. Conclusion: We theorize that the patient had an abrasion on the finger or palm that created an entryway for a pathogen. We are unaware of another report of a deep space hand infection associated with rock climbing activities. This case report will hopefully spread awareness of this clinical entity to improve evaluation and prevention of hand infections in rock climbers, as well as providing guidelines for appropriate and timely treatment of the condition.
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Affiliation(s)
- Robert M Zbeda
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, United States
| | - Remy V Rabinovich
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, United States
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Okuma K, Furuhata R, Kiyota Y, Kono A, Hayashi T, Kamata Y, Morioka H. Acute progressive bilateral carpal tunnel syndrome associated with remitting seronegative symmetrical synovitis with pitting edema syndrome: A case report. J Orthop Surg (Hong Kong) 2020; 28:2309499019893079. [PMID: 31876228 DOI: 10.1177/2309499019893079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The association between carpal tunnel syndrome (CTS) and remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome, an elderly onset rheumatic disease, is not fully understood. Here, we describe a case of acute CTS caused by RS3PE syndrome. An 84-year-old man visited the hospital with sudden onset of severe neuralgia in the median nerve and pitting edema in both hands. Computed tomography showed low-density areas around the flexor tendons and median nerve compression in the carpal tunnel. Rapidly progressing intolerable neuralgia and paralysis required urgent carpal tunnel release in the left hand. After surgery, we considered the possibility of RS3PE syndrome and started the administration of prednisolone. The pitting edema and neuralgia improved. In this case, imaging and intraoperative findings suggest that the effusion generated from flexor tenosynovitis associated with RS3PE syndrome increased the internal pressure in the carpal tunnel rapidly, which led to acute CTS and urgent surgery.
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Affiliation(s)
- Kentaro Okuma
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Ryogo Furuhata
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yasuhiro Kiyota
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Aki Kono
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Teppei Hayashi
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yusaku Kamata
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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Loizides A, Gruber L, Peer S, Plaikner M, Gruber H. [Ultrasound-guided interventions on the peripheral nervous system]. Radiologe 2018; 57:166-175. [PMID: 28054138 DOI: 10.1007/s00117-016-0203-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CLINICAL/METHODICAL ISSUE Up to the advent of high-resolution ultrasound, interventions on the peripheral nervous system, including local anesthesia and pain treatment were performed without visual guidance, which in some cases led to treatment failure or local tissue and nerve damage. METHODICAL INNOVATIONS Progress in the field of ultrasound has enabled the functional visualization, anesthesia and anti-inflammatory or neurolytic treatment of many peripheral nerves, such as the brachial plexus, nerves of the upper and lower extremities and various nerves of the trunk. Contrast medium-guided biopsies have also become feasible. ACHIEVEMENTS This article discusses the general prerequisites for such interventions and details the visualization and the interventional algorithms for interventions on the brachial plexus, on large nerves often affected by compression neuropathies, such as the median, ulnar, sciatic and femoral nerves and small nerves, such as the lateral cutaneous nerves of the thigh. Furthermore, contrast medium-aided biopsies of intraneural and perineural masses are discussed. Finally, the treatment of stump neuromas via phenol instillation is described. PRACTICAL RECOMMENDATIONS Innovations in high-resolution ultrasound allow the reliable and safe diagnosis and treatment of various pathologies of the peripheral nervous system with few side effects. Compared to older methods, which did not use visual guidance ultrasound provides higher success rates and lower adverse event rates in many instances.
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Affiliation(s)
- A Loizides
- Department Radiologie, Medizinische Universität Innsbruck, 6020, Innsbruck, Österreich.
| | - L Gruber
- Department Radiologie, Medizinische Universität Innsbruck, 6020, Innsbruck, Österreich
| | - S Peer
- CTI GesmbH und Roentgeninstitut B7, 6020, Innsbruck, Österreich
| | - M Plaikner
- Department Radiologie, Medizinische Universität Innsbruck, 6020, Innsbruck, Österreich
| | - H Gruber
- Department Radiologie, Medizinische Universität Innsbruck, 6020, Innsbruck, Österreich
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Yoshida H, Imura H, Goto T, Nakamata T, Daya MR, Kamiya T. Acute Carpal Tunnel Syndrome Due to Pyogenic Flexor Tenosynovitis without Any Antecedent Injury. Intern Med 2017; 56:1439-1442. [PMID: 28566613 PMCID: PMC5498214 DOI: 10.2169/internalmedicine.56.7584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of acute carpal tunnel syndrome due to pyogenic flexor tenosynovitis in the absence of any antecedent injury whose rapid progression and course was similar to that seen with necrotizing fasciitis. This potentially disastrous clinical condition must be promptly recognized, since it needs early surgical management to prevent morbidity.
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Affiliation(s)
- Hirofumi Yoshida
- Department of General Internal Medicine, Rakuwakai Otowa Hospital, Japan
| | - Haruki Imura
- Department of Infectious Diseases, Rakuwakai Otowa Hospital, Japan
| | - Taiga Goto
- Department of Orthopedics, Rakuwakai Otowa Hospital, Japan
| | | | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health and Science University, USA
| | - Toru Kamiya
- Department of General Internal Medicine, Rakuwakai Otowa Hospital, Japan
- Department of Infectious Diseases, Rakuwakai Otowa Hospital, Japan
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NOURISSAT G, FOURNIER E, WERTHER JR, DUMONTIER C, DOURSOUNIAN L. Acute Carpal Tunnel Syndrome Secondary to Pyogenic Tenosynovitis. ACTA ACUST UNITED AC 2016; 31:687-8. [DOI: 10.1016/j.jhsb.2006.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Revised: 05/18/2006] [Accepted: 05/23/2006] [Indexed: 10/24/2022]
Abstract
We report a case of acute carpal tunnel syndrome related to a spontaneous pyogenic tenosynovitis and a review of this clinical condition.
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Affiliation(s)
- G. NOURISSAT
- From the SOS Main, Service de Chirurgie Orthopedique et Traumatologique, Hôpital Saint Antoine, Université Pierre et Marie Curie-Paris, Paris, France
| | - E. FOURNIER
- From the SOS Main, Service de Chirurgie Orthopedique et Traumatologique, Hôpital Saint Antoine, Université Pierre et Marie Curie-Paris, Paris, France
| | - J. R. WERTHER
- From the SOS Main, Service de Chirurgie Orthopedique et Traumatologique, Hôpital Saint Antoine, Université Pierre et Marie Curie-Paris, Paris, France
| | - C. DUMONTIER
- From the SOS Main, Service de Chirurgie Orthopedique et Traumatologique, Hôpital Saint Antoine, Université Pierre et Marie Curie-Paris, Paris, France
| | - L. DOURSOUNIAN
- From the SOS Main, Service de Chirurgie Orthopedique et Traumatologique, Hôpital Saint Antoine, Université Pierre et Marie Curie-Paris, Paris, France
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Abstract
Acute carpal tunnel syndrome is characterized by rapid onset of median neuropathy caused by sudden increases in carpal tunnel pressures, which leads to ischemia of the median nerve. The most common cause is traumatic injury, although atraumatic sources should also be recognized. Patients generally complain of pain, lose two-point discrimination, and may demonstrate elevated compartment pressure on measurement. Prompt recognition and surgical decompression are imperative to spare median nerve viability.
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Charalambous CP, Zipitis CS, Kumar R, Paul AS. Acute carpal tunnel syndrome: two rare cases. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2003; 8:117-8. [PMID: 12923946 DOI: 10.1142/s0218810403001455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2002] [Accepted: 04/10/2003] [Indexed: 11/18/2022]
Abstract
Acute carpal tunnel syndrome is an orthopaedic emergency that requires prompt surgical treatment. We describe two rare cases of this condition, one secondary to pyogenic infection and one secondary to prolonged pressure on the upper limb brought on by overdose.
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Affiliation(s)
- C P Charalambous
- University Department of Trauma and Orthopaedics, Manchester Royal Infirmary, Manchester, UK.
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Abstract
A case of acute carpal tunnel syndrome (CTS) due to filarial infection is reported in a resident of Newfoundland, Canada. The patient presented with classical symptoms and signs of acute CTS and a filarial worm was identified in synovial tissue removed during surgery that was morphologically consistent with the genus Brugia. Antifilarial antibodies were present in serum. Surgical removal of the infected tissue, without administration of antifilarial drugs, proved adequate in eradicating the infection and a subsequent serum sample was negative for antifilarial antibodies. The patient remains asymptomatic more than two years after surgery. This case is unusual in its clinical presentation and geographic location.
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Affiliation(s)
- Barry Gallagher
- Departments of Pathology, James Paton Memorial Hospital, Gander, Newfoundland, Canada
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Abstract
The anatomical configuration of the carpal tunnel is that of an inelastic channel. Consequently, any increase in its volume or alteration in shape will usually result in a significant increase in interstitial pressure. At a pressure threshold of 20 mm Hg to 30 mm Hg, epineurial blood flow is compromised. When that pressure is sustained, the symptoms and physical findings associated with CTS appear. Typically, patients present with intermittent pain and paresthesias in all or part of the median nerve distribution of their hand(s). As weeks and months pass, symptoms progressively increase in frequency and severity. Eventually, thenar muscle weakness develops that initially manifests itself as "fatigue," or "tiredness." The progressive increase in symptoms and physical findings, usually accompanied by a progressive deterioration in electrodiagnostic studies, facilitates the classification of the condition into early, intermediate, and advanced stages. The increase in interstitial pressure in the carpal tunnel is in the vast majority of cases idiopathic (spontaneous). It can also be caused by a myriad of other conditions that can be classified into three other categories: intrinsic factors that increase the volume of the tunnel (outside and inside the nerve), extrinsic factors that alter the contour of the tunnel, and repetitive/overuse conditions. In addition, there is another category of neuropathic factors that affect the nerve without increasing interstitial pressure. In rare situations CTS can present as an acute problem. Far less common than the chronic form of the condition, it can follow acute wrist trauma, rheumatologic disorders, hemorrhagic problems, vascular disorders affecting a patent median artery, and high pressure injection injuries. Prompt recognition is important, followed in most cases by urgent surgical decompression of the median nerve.
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Affiliation(s)
- Heidi Michelsen
- Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases, New York, NY 10128, USA
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