1/48. carpal tunnel syndrome caused by an idiopathic calcified mass.This is a case report of carpal tunnel syndrome caused by an idiopathic calcareous lesion within the carpal canal. The median nerve was trapped between the transverse carpal ligament and the calcified mass. The mass was predominantly composed of calcium phosphate. Surgical release of the transverse carpal ligament and removal of the calcareous mass relieved the symptoms.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/48. ulnar nerve compression by an anomalous muscle following carpal tunnel release: a case report.We describe the acute development of ulnar nerve compression following carpal tunnel release in a patient with an accessory palmaris longus muscle. Although anomalous muscles in the wrist are relatively common and may produce ulnar nerve compression, this particular occurrence following carpal tunnel release has not been previously described in the literature. We theorize that the compression of the ulnar nerve proximal to Guyon's canal was caused by increased tension along the long axis of the anomalous accessory palmaris longus muscle as a consequence of transverse carpal ligament division.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
3/48. Bipartite median nerve with a double compartment within the transverse carpal canal.An anomaly of the median nerve in which there is a division into two branches at the level of the distal third of the forearm is reported. This case was unique in that the ulnar branch of the median nerve passed through a separate compartment within the transverse carpal ligament. It was necessary to decompress both branches of the nerve when releasing the carpal canal.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
4/48. Arthroscopic repair of dorsal radiocarpal ligament tears.Various authors have highlighted the importance of the dorsal radiocarpal (DRC) ligament in normal carpal kinematics. It is a secondary stabilizer of the lunate and has a role in midcarpal stability. Disruption of the DRC ligament has been implicated in the development of static VISI and DISI deformities, prompting some authors to perform an open reattachment of the dorsal capsule if there is an associated scapholunate ligament tear. The management of these tears is still evolving. The contribution of a DRC ligament tear to the development of wrist pain remains uncertain when combined with additional wrist pathology. An isolated DRC ligament tear was responsible for chronic dorsal wrist pain in 2 patients. A previously undescribed inside-out repair method of the DRC ligament using a volar wrist portal was successful in relieving the pain. Recognition of this condition and further research into treatment methods is needed.- - - - - - - - - - ranking = 5keywords = ligament (Clic here for more details about this article) |
5/48. The distally-based radial fasciosubcutaneous flap for soft tissue cover of the flexor aspect of the wrist.The distally-based radial forearm fasciosubcutaneous flap is based on the distal perforators of the radial artery. We used it in a particularly difficult case involving loss of soft tissue at the wrist with exposure of tendons and nerves after an operation to section the transverse carpal ligament for carpal tunnel syndrome complicated by a chronic fistula.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
6/48. Bilateral carpal tunnel syndrome after abductor digiti minimi opposition transfer: a case report.We present a case of bilateral, delayed-onset, median nerve compression at the wrist after abductor digiti minimi opposition transfer for thumb hypoplasia. The symptoms resolved on each side after transverse carpal ligament release without disruption of the opposition transfers.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
7/48. A potential complication of endoscopic carpal tunnel release.Complications of carpal tunnel release have been well documented in the literature. Recently, a procedure for endoscopic release of the transverse carpal ligament has been described. This case report demonstrates a potential complication of endoscopic carpal tunnel release, in which the flexor digitorum superficialis tendon to the ring finger was nearly cut when the arthroscopic trocar passed beneath it. The procedure was converted to an open carpal tunnel release when the transverse fibers of the carpal ligament were not seen after several passes of the trocar. This complication was related to the inability to fully extend the wrist and metacarpophalangeal joints because of arthritic contractures. This case underscores the need for accurate identification of endoscopic anatomy prior to release of the carpal tunnel. The surgeon should not hesitate to convert to open technique if it becomes necessary.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
8/48. Transverse carpal ligament reconstruction with polyesterurethane patch for prevention of recurrence in therapy of failed primary carpal tunnel surgery.A small group of patients with carpal tunnel syndrome (CTS) can present recurrences and persistent symptoms of CTS after its surgical release. If recurrence is due to scarring between median nerve and surrounding tissue (true recurrence of CTS, transverse carpal ligament [TCL] reconstruction with transposition flap technique is available but it presents poor results: This 48-year-old woman presented a recurrence of CTS 3 months after open standard incision. At operation, a scar was detected that did not permit normal median nerve gliding during wrist movements. External neurolysis restored normal gliding and non-absorbable polyesterurethane patch was used to reconstruct TCL. At 2-year follow-up the patient was in good health and returned to her manual usual job without pain and sensitive and motor deficits. Implantation of unresorbable poliesterurethane patch for TCL reconstruction after external neurolysis appears to be more advantageous than TCL reconstruction with transposition flap technique because it takes little time, causes minimal adhesion formation, does not need of wide incision and provides the same favourable conditions of the transposition flap as mechanical stabilization of the tranverse carpal arch, prevention of bowstringing of the flexor tendons, increase of postoperative grip strength and good protection of the median nerve. However, more cases should be studied before considering TCL reconstruction with poliesterurethane patch as a useful option in secondary surgery of true recurrence of CTS.- - - - - - - - - - ranking = 2.5keywords = ligament (Clic here for more details about this article) |
9/48. carpal tunnel syndrome in children.carpal tunnel syndrome (CTS) is rarely seen in children. A literature search in 1989 revealed 52 published cases. The authors review 163 additional cases that were published since that date. The majority of these cases were related with a genetic condition. The most common aetiology was lysosomal storage disease: mucopolysaccharidoses (MPS) in 95 and mucolipidoses (ML) in 22. In CTS secondary to MPS, clinical signs typical of adult CTS are rarely seen, and difficulty with fine motor tasks is the most frequent finding. CTS in MPS does not seem to be prevented by bone marrow transplantation, the usual treatment for the condition. CTS is probably due to a combination of excessive lysosomal storage in the connective tissue of the flexor retinaculum and a distorted anatomy because of underlying bone dysplasia. mucolipidoses come next in the aetiology, with essentially similar symptoms. The authors found in the literature 11 cases of primary familial CTS, a condition which presents as an inheritable disorder of connective tissue mediated by an autosomal dominant gene; the symptoms may be more typical in some cases, but are more similar to MPS in others. A case with self-mutilation has been reported. Hereditary neuropathy with liability to pressure palsies (HNPP) is a rare autosomal dominant condition characterised by episodes of decreased sensation or palsies after slight traction or pressure on peripheral nerves; it may also give symptoms of CTS. Schwartz-Jampel syndrome (SJS), another genetic disorder with autosomal recessive skeletal dysplasia, is characterised by varying degrees of myotonia and chondrodysplasia; it has also been noted associated with CTS in a child. Melorrheostosis and Leri's syndrome have also been noted in children with CTS, as well as Dejerine-Sottas syndrome and weill-marchesani syndrome. Among non-genetic causes of CTS in children, idiopathic cases with children onset have been reported, usually but not always related with thickening of the transverse carpal ligament. Intensive sports practice has been reported as an aetiological factor in several cases of childhood CTS. Nerve territory oriented macrodactily, a benign localised form of gigantism, is another unusual cause of CTS in children, as are fibrolipomas of the median nerve or intraneural perineuroma or haemangioma of the median nerve. Acute cases have been reported in children with haemophilia, secondary to local bleeding. Another local cause is a musculotendinous malformation of the palmaris longus, the flexor digitorum superficialis, the flexor carpi radialis brevis (a supernumerary muscle), the first lumbricalis or the palmaris brevis. Isolated cases of childhood CTS have also been reported in Klippel-Trenaunay syndrome, in poland's syndrome and in scleroderma. Finally, several cases have been noted following trauma, most often related with epiphysiolysis of the distal radius. Immediate reduction has cleared the problem in most cases, but exploration of the median nerve should be considered otherwise, and also in cases with delayed occurrence of symptoms. overall 145 of the 163 reviewed cases have undergone open carpal tunnel release. Childhood CTS often has an unusual presentation, with modest complaints and children are often too young to communicate their problem. In CTS with specific aetiologies such as storage disease, the symptoms may be masked by the skeletal dysplasia and joint stiffness. Every child with even mild symptoms must be thoroughly examined and a family history must be taken. Children with storage disease may benefit from early clinical and electrophysiological screening before they develop obvious clinical signs.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
10/48. Transverse carpal muscle in association with carpal tunnel syndrome: report of three cases.Anomalous muscles of the upper extremity are common, however, symptomatic anomalies causing CTS are rare. Three cases of CTS that are believed to be caused by an anomalous muscle located palmar to the transverse carpal ligament with transversely oriented muscle bundles is presented. Despite the arguments in literature, this is certainly an anomalous muscle that can be encountered during carpal tunnel release and be problematic to manipulate when minimally invasive approaches are chosen.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
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