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Natroshvili T, Peperkamp K, Malyar MA, Wijnberg D, Heine EP, Walbeehm ET. Rare Tumors Causing Median Nerve Compression in Adults-A Narrative Review. Arch Plast Surg 2022; 49:656-662. [PMID: 36159378 PMCID: PMC9507571 DOI: 10.1055/s-0042-1756345] [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] [Received: 04/28/2021] [Accepted: 07/11/2022] [Indexed: 11/01/2022] Open
Abstract
The median nerve can be compressed due to a tumor along the course of the median nerve, causing typical compression symptoms or even persistence or recurrence after an operation. The aim of this review is to provide a comprehensive overview of rare tumors described in recent publications that cause median nerve compression and to evaluate treatment options. The PubMed, Embase, and Web of Science databases were searched for studies describing median nerve compression due to a tumor in adults, published from the year 2000 and written in English. From 94 studies, information of approximately 100 patients have been obtained. Results The rare tumors causing compression were in 32 patients located at the carpal tunnel, in 21 cases in the palm of the hand, and 28 proximal from the carpal tunnel. In the other cases the compression site extended over a longer trajectory. There were 37 different histological types of lesions. Complete resection of the tumor was possible in 58 cases. A total of 8 patients presented for the second time after receiving initial therapy. During follow-up, three cases of recurrence were reported with a mean follow-up period of 11 months. The most common published cause of median nerve compression is the lipofibromatous hamartoma. Besides the typical sensory and motor symptoms of median nerve compression, a thorough physical examination of the complete upper extremity is necessary to find any swelling or triggering that might raise suspicion of the presence of a tumor.
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Affiliation(s)
- Tinatin Natroshvili
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Kirsten Peperkamp
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Masoud A Malyar
- Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - David Wijnberg
- Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Erwin P Heine
- Department of Plastic and Reconstructive Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Erik T Walbeehm
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Chouhan D, Ansari MT, Goyal D, Mridha AR. Unilateral carpal tunnel syndrome: an unusual presentation of nodular fasciitis. BMJ Case Rep 2020; 13:13/11/e236142. [PMID: 33257360 PMCID: PMC7705373 DOI: 10.1136/bcr-2020-236142] [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: 11/04/2022] Open
Abstract
Nodular fasciitis is a benign, self-limiting proliferative disorder of fibroblast of uncertain aetiology, occurs frequently in the forearm. Nodular fasciitis in hand inducing carpal tunnel syndrome is exceptional. There are four cases of non-intraneural nodular fasciitis causing peripheral neuropathy that has been reported previously. We present the case of a 38-year-old man with features of unilateral carpal tunnel syndrome. Decompression of the median nerve performed subsequently along with excision of the lesion in a piecemeal fashion. Histopathological and immunohistochemical findings were consistent with nodular fasciitis. There were complete resolution of symptoms and no sign of recurrence at the end of 1 year after surgery.
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Affiliation(s)
- Deepak Chouhan
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Devansh Goyal
- Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Asit Ranjan Mridha
- Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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3
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Is the Recurrence of Fibroma of the Tendon Sheath Underestimated? An Instructive Case Report and a Review of the Literature. Case Rep Orthop 2020; 2020:5357329. [PMID: 32047687 PMCID: PMC7007948 DOI: 10.1155/2020/5357329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/18/2020] [Indexed: 01/04/2023] Open
Abstract
We report a case of a 21-year-old healthy woman with a history of a painful growing mass in the palm of the right hand, with a trigger finger phenomenon. The mass was surgically entirely excised, and the histological findings of the tumor were those of a fibroma of the tendon sheath (FTS) starting from the flexor tendons. Although the initial outcome was good, the patient experienced the same symptoms at the same location 4.5 years later. The MRI demonstrated a 50 × 10 × 5 mm mass of low intensity on T1-weighted images and high intensity on T2-weighted images and gadolinium enhancement. A second complete excision of the tumor was performed by the same senior surgeon, and the histology confirmed the recurrence of the FTS. We also reviewed the scientific literature about FTS in the hand. Most recent studies show a low rate or no recurrence at all. We hypothesize that a lot of recurrences are missed because of a short follow-up and that the recurrence rate may be higher than thought.
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4
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A Case of 14-Year-Old Male with Fibroma of Tendon Sheath of the Hand with Novel Chromosomal Translocation 4;10. Case Rep Orthop 2019; 2019:3514013. [PMID: 31637074 PMCID: PMC6766145 DOI: 10.1155/2019/3514013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/21/2019] [Indexed: 11/21/2022] Open
Abstract
Fibroma of tendon sheath (FTS) is an uncommonly encountered soft tissue mass, which is morphologically distinct from the more commonly seen giant cell tumor of tendon sheath (GCTTS). Initially described in 1936, FTS is typically a slow growing, painless, firm mass with a predilection for the upper extremity, frequently involving the hand. Cases of associated triggering or compression neuropathies have been described when underlying tendons or nerves are affected. Currently, the literature on FTS is sparse and largely limited to case reports. More recently, few reports of cytogenetic analysis on FTS have been reported in the literature. Cellular and chromosomal analysis of FTS tissue revealed chromosomal translocations with yet unknown clinical significance. Here, we present a case report of FTS in a 14-year-old male with a painless enlarging mass on the palmar side of the left hand treated by excision. Subsequent karyotypic analysis revealed a chromosomal translocation t(4;10) (p16;q24), add (10)(q22)[24]. To our knowledge, this is the first description of this chromosomal aberration in the literature.
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Superficial radial nerve compression due to fibroma of the brachioradialis tendon sheath: A case report. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:394-396. [PMID: 31031130 PMCID: PMC6819761 DOI: 10.1016/j.aott.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/25/2019] [Accepted: 04/07/2019] [Indexed: 11/24/2022]
Abstract
Fibroma of the tendon sheath (FTS) is a rare benign tumour that usually develops in the upper extremity, particularly in the fingers, hands and wrists. Herein, we present the case of a patient with an unusually localised FTS compressing the superficial branch of the radial nerve. A 62-year-old woman presented with a superficial radial nerve compression due to FTS of the brachioradialis. Histopathological diagnosis was confirmed as a FTS after marginal excision. The patient who had compression-related symptoms in the superficial branch of the radial nerve recovered completely at one month after surgery. One year later, the patient remained free of symptoms and no recurrence was observed.
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Thoma A, Rao J, Salama S. Fibroma of Tendon Sheath of the Hand: Clinical and Pathological Study. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2017. [DOI: 10.1177/229255030000800603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Presented are seven cases of the rare tumour known as fibroma of tendon sheath of the hand. Diagnosis was uncertain before surgery. When the lesions were removed, they resembled schwannomas. Immunohistochemistry helped distinguish these tumours from giant cell tumours of the flexor sheath and schwannomas. The authors recommend that fibroma of the tendon sheath be included in the differential diagnosis of soft tissue neoplasms of the hand.
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Affiliation(s)
- Achilleas Thoma
- Department of Surgery, Division of Plastic and Reconstructive Surgery, St Joseph's Hospital and McMaster University, Hamilton, Ontario
| | - Jaggi Rao
- Department of Dermatology, University of Alberta, Calgary, Alberta
| | - Samih Salama
- Department of Pathology, St Joseph's Hospital and McMaster University, Hamilton, Ontario
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7
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Paredes-Carnero X, Vidal B, Delgado P. Fibroma sinovial como causa atípica de síndrome de túnel del carpo: presentación de 2 casos clínicos. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2016. [DOI: 10.1016/j.ricma.2016.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
El fibroma sinovial (FS) es una tumoración benigna que puede encontrarse en la mano, teniendo predilección por las vainas flexoras. Esta lesión puede comportarse como una lesión ocupante de espacio (LOE), la cual puede llegar a comprimir nervios, como en el túnel del carpo, provocando un síndrome del túnel del carpo (STC). Este hecho solo ha sido descrito en 9 ocasiones. Cuando el STC se presenta de manera unilateral debemos descartar una LOE, entre las cuales el FS debería ser considerado como diagnóstico diferencial, especialmente frente al tumor de células gigantes, del cual solo es diferenciable microscópicamente, por lo que la resección de la masa es imprescindible. Los 2 casos aquí descritos tuvieron diferentes presentaciones clínicas pero sin complicaciones tras la resección.
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Affiliation(s)
- X. Paredes-Carnero
- Servizo de Cirurxía Ortopédica e Traumatoloxía, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - B. Vidal
- Servizo de Cirurxía Plástica e Queimados, Hospital Povisa, Vigo, España
| | - P.J. Delgado
- Unidad de Cirugía de la Mano y Miembro Superior, Hospital Montepríncipe, Boadilla del Monte, Madrid, España
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8
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Tiong WHC, Ismael TS, Regan PJ. Fibroma of Tendon Sheath: a Rare Cause of Carpal Tunnel Syndrome. ACTA ACUST UNITED AC 2016; 31:579-80. [PMID: 16828943 DOI: 10.1016/j.jhsb.2006.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2005] [Revised: 05/01/2006] [Accepted: 05/08/2006] [Indexed: 11/29/2022]
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Abstract
Fibroma of tendon sheath is an uncommon fibrous tumour that has a predilection for the hand. Large series from Histopathological Units report a local recurrence rate of 24% after surgical excision. In the hand/orthopaedic surgery literature, fibroma of tendon sheath was generally reported as isolated case reports with unusual presentations, such as triggering and carpal tunnel syndrome. The current article reports on a series of 23 tumours of the hands of 20 patients. These were all adults (mean age of 36 years) with a male to female ratio of 3:1. The thumb and index were the most common sites. A slow-growing painless mass was the clinical presentation in every case. Total surgical excision was ensured by excision of part of flexor sheath/palmar fascia to which the tumour was attached. Diagnosis was confirmed by the classic histological features of fibroma of tendon sheath. There were no recurrences at final follow-up 2-5 years after surgery.
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Affiliation(s)
- M M Al-Qattan
- Division of Plastic and Hand Surgery, King Saud University, Riyadh, Saudi Arabia
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10
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Syndrome du canal carpien et poignet à ressaut révélant un fibrome de la gaine des fléchisseurs. ACTA ACUST UNITED AC 2014; 33:59-62. [DOI: 10.1016/j.main.2013.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/08/2013] [Accepted: 11/11/2013] [Indexed: 11/23/2022]
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11
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Intraneural fibroma of the median nerve at the wrist. J Clin Neurosci 2013; 21:1054-6. [PMID: 24291475 DOI: 10.1016/j.jocn.2013.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/09/2013] [Indexed: 11/22/2022]
Abstract
Distal median neuropathy from carpal tunnel syndrome is the most well known lesion affecting the median nerve. Mass lesions may affect the nerve at the wrist. We present to our knowledge the first histologically confirmed case of an intraneural fibroma.
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12
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Chen CH, Wu T, Sun JS, Lin WH, Chen CY. Unusual causes of carpal tunnel syndrome: space occupying lesions. J Hand Surg Eur Vol 2012; 37:14-9. [PMID: 21825010 DOI: 10.1177/1753193411414352] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Space occupying lesions found at surgery caused or contributed to carpal tunnel syndrome in 23 of 779 patients operated for carpal tunnel syndrome from January 1999 to December 2008. The mean age of these 23 patients was 52.9 years, and in patients who had a local swelling or palpable mass, ultrasonography or magnetic resonance imaging (MRI) was done. All had open release of the transverse carpal ligament and lesions were removed. Histopathology showed tophaceous gout in 10 men, tenosynovitis in seven patients and tumors in eight. The tumors included ganglion cysts in two, lipoma in three and fibroma of the tendon sheath in one. The neurological symptoms subsided after surgery in all. In patients with gout, one had an infected wound and another had recurrence of symptoms 1 year after later. Carpal tunnel syndrome caused by a space occupying lesion is rare and more complicated than idiopathic carpal tunnel syndrome.
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Affiliation(s)
- C-H Chen
- Department of Orthopedic Surgery, National Taiwan University & Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan
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13
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Clark JC, Galloway SJ, Schlicht SM, McKellar RP, Choong PF. Myoepithelioma within the carpal tunnel: a case report and review of the literature. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2009; 6:15. [PMID: 19740441 PMCID: PMC2748076 DOI: 10.1186/1477-7800-6-15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 09/09/2009] [Indexed: 11/10/2022]
Abstract
Myoepitheliomas of the extremity are rare and usually benign, while a minority display malignant features. This case demonstrates the diagnosis and management of myoepithelioma within the carpal tunnel. Clinical and radiological tumour features were evaluated. Hematoxylin and eosin stained tumour sections were examined, and immunohistochemistry was performed. Histology revealed a nodular mass of epithelioid cells in clusters within a myxoid/chondroid stroma. No mitoses were noted. Cytokeratins, neuron-specific enolase, synaptophysin, glial fibrillary acidic protein, and S100 were positive on immunohistochemistry. A literature review revealed very few prior reports of myoepithelioma in the wrist, and limited data concerning any relationship between recurrence and quality of surgical margins. In this case, wide local excision would have significantly compromised dominant hand function, and therefore a marginal excision was deemed appropriate in the context of bland histological features. Surgical margins noted in future case reports will aid clinical decision making.
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Affiliation(s)
- Jonathan Cm Clark
- Department of Orthopaedics and Department of Surgery, University of Melbourne, St Vincent's Hospital, Melbourne, Australia.
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14
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Kang HJ, Jung SH, Yoon HK, Hahn SB, Kim SJ. Carpal tunnel syndrome caused by space occupying lesions. Yonsei Med J 2009; 50:257-61. [PMID: 19430560 PMCID: PMC2678702 DOI: 10.3349/ymj.2009.50.2.257] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 06/14/2008] [Accepted: 06/14/2008] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the diagnosis and treatment of the carpal tunnel syndrome (CTS) due to space occupying lesions (SOL). MATERIALS AND METHODS Eleven patients and 12 cases that underwent surgery for CTS due to SOL were studied retrospectively. We excluded SOL caused by bony lesions, such as malunion of distal radius fracture, volar lunate dislocation, etc. The average age was 51 years. There were 3 men and 8 women. Follow-up period was 12 to 40 months with an average of 18 months. The diagnosis of CTS was made clinically and electrophysiologically. In patients with swelling or tenderness on the area of wrist flexion creases, magnetic resonance imaging (MRI) and/or computed tomogram (CT) were additionally taken as well as the carpal tunnel view. We performed conventional open transverse carpal ligament release and removal of SOL. RESULTS The types of lesion confirmed by pathologic examination were; tuberculosis tenosynovitis in 3 cases, nonspecific tenosynovitis in 2 cases, and gout in one case. Other SOLs were tumorous condition in five cases, and abnormal palmaris longus hypertrophy in 1 case. Tumorous conditions were due to calcifying mass in 4 cases and ganglion in 1 case. Following surgery, all cases showed alleviation of symptom without recurrence or complications. CONCLUSION In cases with swelling or tenderness on the area of wrist flexion creases, it is important to obtain a carpal tunnel view, and MRI and/or CT should be supplemented in order to rule out SOLs around the carpal tunnel, if necessary.
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Affiliation(s)
- Ho Jung Kang
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Jung
- Department of Orthopaedic Surgery, Kwangmyung Sung-Ae General Hospital, Gwangmyeong, Korea
| | - Hong Ki Yoon
- Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Soo Bong Hahn
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Jae Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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Musso M, Schilton I, Pallotti F. Fibrome de la gaine tendineuse occasionnant un « poignet à ressaut » et un syndrome du canal carpien. ACTA ACUST UNITED AC 2006; 25:89-91. [PMID: 16841770 DOI: 10.1016/j.main.2006.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There are few cases described of fibroma of tendon sheath located to the hand and the wrist. A case of fibroma of tendon sheath of lumbrical muscle of the index finger has been described. The tumor was responsible of a peculiar phenomenon of "triggering" of the wrist during the movements of flexion and extension of the index finger, and caused compression of the median nerve at the carpal tunnel. The intervention has brought to an early and long lasting relief of symptoms. Moreover, the histological aspect has been described and the relatively high possibility of recurrence of this lesion is underlined.
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Affiliation(s)
- M Musso
- U.O. Chirurgia della Mano, Istituti Clinici di Perfezionamento, P.O. CTO, via Bignami, 1, 20126 Milano, Italie.
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Abstract
This article presents the current understanding of soft tissue hand tumors and the best options for treating them. The majority of soft tissue hand tumors are benign. Discussion includes hand tumors of fibrous and adipose tissue origin, determining the diagnostic and therapeutic pathways for these tumors, and controversial treatment issues.
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Affiliation(s)
- John V Ingari
- Department of Orthopaedic Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859, USA.
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17
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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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Rao J, Thoma A, Salama S. Fibroma of Tendon Sheath as a Cause of Carpal Tunnel Syndrome. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 1997. [DOI: 10.1177/229255039700500304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This report describes a 28-year-old male with a fibrovascular tumour of the left midpalm, extending into the carpal tunnel. It compressed the median nerve, producing carpal tunnel syndrome. Upon carpal tunnel decompression and local excision, the symptoms were relieved. Histopathological study of the tumour revealed characteristics suggestive of fibroma of tendon sheath, an uncommon tumour of the hand and rare cause of carpal tunnel syndrome.
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Affiliation(s)
- Jaggi Rao
- Department of Surgery, Division of Plastic and Reconstructive Surgery, and Department of Pathology, St Joseph's Hospital, McMaster University, Hamilton, Ontario
| | - Achilleas Thoma
- Department of Surgery, Division of Plastic and Reconstructive Surgery, and Department of Pathology, St Joseph's Hospital, McMaster University, Hamilton, Ontario
| | - Sam Salama
- Department of Surgery, Division of Plastic and Reconstructive Surgery, and Department of Pathology, St Joseph's Hospital, McMaster University, Hamilton, Ontario
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Bertolotto M, Rosenberg I, Parodi RC, Perrone R, Gentile S, Rollandi GA, Succi S. Case report: Fibroma of tendon sheath in the distal forearm with associated median nerve neuropathy: US, CT and MR appearances. Clin Radiol 1996; 51:370-2. [PMID: 8641105 DOI: 10.1016/s0009-9260(96)80120-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- M Bertolotto
- Servizio di Ecografia, Istituto di Radiologia, Università di Genova, Italy
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20
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Pinar H, Ozkan M, Ozaksoy D, Pabuççuoğlu U, Akseki D, Karaoğlan O. Intraarticular fibroma of the tendon sheath of the knee. Arthroscopy 1995; 11:608-11. [PMID: 8534305 DOI: 10.1016/0749-8063(95)90140-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fibroma of the tendon sheath is an uncommon soft-tissue tumor. Intraarticular localization has not been previously reported. The patient presented with unexplained recurrent swelling of the knee not associated with recent trauma. The soft-tissue tumor was identified by magnetic resonance imaging. Arthroscopy confirmed the diagnosis. Arthrotomy was performed because of the large size of the lesion.
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Affiliation(s)
- H Pinar
- Department of Orthopaedics, Dokuz Eylül University School of Medicine, Izmir, Turkey
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21
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Abstract
Seven cases of fibroma of tendon sheath in the hand are reviewed. These tumors are common enough to be considered in the differential diagnosis of a soft tissue tumor in the hand, as they comprised 7 of our series of 208 soft tissue hand tumors excised over a 15-year period. A marginal excision was performed in each case, and no tumor recurred after a mean follow-up interval of 8 years. The fibromas were adherent to tendons, tendon sheaths, and neurovascular structures, and thus were more difficult to excise without morbidity than other soft tissue hand tumors.
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Affiliation(s)
- S J Millon
- Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA 17822-2130
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Nakamichi K, Tachibana S. Unilateral carpal tunnel syndrome and space-occupying lesions. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1993; 18:748-9. [PMID: 8308434 DOI: 10.1016/0266-7681(93)90236-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To assess the association between unilateral carpal tunnel syndrome and space-occupying lesions, 128 patients have been reviewed. They were divided into bilateral, subclinical (unilateral signs and symptoms, and bilateral slowing in the median nerve conduction) and unilateral carpal tunnel syndrome. Space-occupying lesions were investigated on the basis of physical examination and wrist imaging using plain radiographs and ultrasonograms. Of 20 patients with unilateral carpal tunnel syndrome, space-occupying lesions were found in seven (occult ganglion in five and occult calcified mass in two). In contrast, none of 89 patients with bilateral carpal tunnel syndrome and 19 with subclinical carpal tunnel syndrome had space-occupying lesions. We conclude that careful examination and wrist imaging on suspicion of local pathology, especially a space-occupying lesion, are needed when the condition is unilateral and the aetiology is not clear from the history and on physical examination.
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Affiliation(s)
- K Nakamichi
- Department of Orthopaedic Surgery, Torano-mon Hospital, Tokyo, Japan
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