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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Clinical case 1&#46; A&#58;</span> Swelling of the forearm &#40;circle&#41;&#59; <span class="elsevierStyleBold">B&#58;</span> Magnetic resonance imaging showing a muscle mass&#44; which may correspond to the anatomical variant &#40;arrow&#41;&#59; <span class="elsevierStyleBold">C&#58;</span> Ultrasound of normal forearm&#59; <span class="elsevierStyleBold">D&#58;</span> Ultrasound of accessory flexor digitorum superficialis indicis muscle &#40;arrow&#41;&#46; <span class="elsevierStyleBold">Clinical case 2&#46; E&#58;</span> Swelling of the forearm &#40;circle&#41;&#59; <span class="elsevierStyleBold">F&#58;</span> Magnetic resonance imaging showing mild hypersignal of the pronator quadratus &#40;arrow&#41;&#59; <span class="elsevierStyleBold">G&#58;</span> Ultrasound showing a hypoechoic mass &#40;arrow&#41;&#59; <span class="elsevierStyleBold">H&#58;</span> Ultrasound of normal forearm&#59; <span class="elsevierStyleBold">I&#58;</span> Surgical exploration that revealed a lipoma&#46; <span class="elsevierStyleBold">Clinical case 3&#46; J&#58;</span> Swelling of the forearm &#40;circle&#41;&#59; <span class="elsevierStyleBold">K&#58;</span> Ultrasound of normal forearm&#59; <span class="elsevierStyleBold">L&#58;</span> Ultrasound of a hypoechoic mass that compressed the median nerve&#44; suggestive of lipoma or muscle mass &#40;arrow&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Symptomatic compression neuropathy of the median nerve is a frequent entity&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The most common cause of the median nerve compression is carpal tunnel syndrome &#40;CTS&#41; due to thickening of the anterior annular ligament&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Nerve compression by anomalous masses located at the wrist and distal forearm is an infrequent condition&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Accessory muscles and other masses&#44; like lipomas&#44; may compress underlying structures in the carpal tunnel region&#44; causing pain and paresthesias&#44; leading to the diagnosis of CTS&#44; which can mislead to a wrong diagnosis of thickening of the anterior annular ligament&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Clinical cases</span><p id="par0015" class="elsevierStylePara elsevierViewall">We present three cases of patients with symptoms and clinical tests &#40;Tinel&#39;s and Phalen&#39;s&#41; compatible with compression of the median nerve in the carpal tunnel who showed&#44; on clinical examination&#44; a soft tissue mass in the distal region of the forearm&#46; The ultrasound &#40;US&#41; evaluation revealed a mass&#44; of different aethiologies&#44; compressing the median nerve&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Clinical case 1</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 31-year-old woman&#44; whose electromyogram revealed a sensory latency of the left median nerve in the wrist&#44; compatible with mild CTS&#44; presented a soft tissue mass that&#44; on US&#44; corresponded to an accessory muscle&#46; A wrist MRI showed a &#8220;muscle mass&#44; which may correspond to an anatomical variant at this level and the median nerve shows a hypersignal proximal to the carpal tunnel&#46;&#8221; A surgical exploration of the carpal tunnel was performed&#44; allowing the identification and release of the median nerve and the excision of an exuberant muscular mass that corresponded to an accessory <span class="elsevierStyleItalic">flexor digitorum superficialis indicis</span>&#46; After two months of follow-up&#44; the patient referred total resolution of the complaints of paresthesia and neuropathic pain &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#8211;D&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Clinical case 2</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 43-year-old woman&#44; with an unremarkable electromyogram&#44; was submitted to an US evaluation of the wrist&#44; which revealed that the mass on the dorsal flexor surface corresponded to an hyperechoic mass compared to the surrounding hypoechoic fat&#44; with fibrous capsule and no posterior acoustic enhancement&#46; The MRI revealed &#8220;muscular groups of the volar surface of the distal forearm with mild hypersignal of the <span class="elsevierStyleItalic">pronator quadratus</span>&#44; which may be due to overuse or translate innervation interfere&#8221;&#46; The surgical exploration revealed a lipoma which was surgically extracted &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>E&#8211;I&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Clinical case 3</span><p id="par0030" class="elsevierStylePara elsevierViewall">A 45-year-old woman&#44; with a normal electromyogram&#44; whose soft tissue mass on the forearm corresponded&#44; on US evaluation&#44; to a muscle mass that was compressing the median nerve&#46; The patient is currently waiting for surgical releasing of the median nerve &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>J&#8211;L&#41;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">CTS is one of the most common peripheral neuropathies in the upper extremity&#46; It is defined as an entrapment syndrome of the median nerve at the level of the distal forearm&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Median nerve compression at the wrist can also result from accessory flexor tendons or hypertrophic muscles&#46; Although rare&#44; these anatomic variances need to be considered&#44; especially in the presence of a mass in the distal region of the forearm&#44; such as in the reported cases&#46; Lipomas are the most frequent human tumors and are generally asymptomatic&#46; However&#44; as in the clinical case 2&#44; they can compress some structures&#44; including nerves&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> In literature&#44; the reported cases of accessory muscles and other masses causing median nerve compression are mainly described in patients with residual symptoms after the surgical decompression of the carpal tunnel&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusion</span><p id="par0040" class="elsevierStylePara elsevierViewall">US evaluation prior to the median nerve decompression surgery is of upmost importance since it allows an adequate differential diagnosis&#44; helping identifying these cases and planning surgical approach&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Authors&#8217; statement</span><p id="par0045" class="elsevierStylePara elsevierViewall">Authors declare that the manuscript has not been submitted or published elsewhere with the exception of abstracts published with scientific meetings</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Compliance with ethical standards</span><p id="par0050" class="elsevierStylePara elsevierViewall">These patients gave your informed consent in accordance with the 1964 Helsinki declaration&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interests</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "sec0015"
          "titulo" => "Clinical case 1"
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          "titulo" => "Clinical case 2"
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          "titulo" => "Clinical case 3"
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          "titulo" => "Discussion"
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          "titulo" => "Conclusion"
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          "titulo" => "Compliance with ethical standards"
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        13 => array:2 [
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          "titulo" => "Conflict of interests"
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        14 => array:1 [
          "titulo" => "References"
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    ]
    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2020-04-18"
    "fechaAceptado" => "2020-06-10"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1401633"
          "palabras" => array:5 [
            0 => "Median nerve compression"
            1 => "Carpal tunnel"
            2 => "Abnormal mass"
            3 => "Lipoma"
            4 => "Accessory muscle"
          ]
        ]
      ]
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          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1401632"
          "palabras" => array:5 [
            0 => "Compresi&#243;n del nervio mediano"
            1 => "T&#250;nel carpiano"
            2 => "Masa anormal"
            3 => "Lipoma"
            4 => "M&#250;sculo accesorio"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nerve compression by anomalous masses located at the wrist and distal forearm is an infrequent condition&#46; They may compress underlying structures in the carpal tunnel region&#44; causing pain and paresthesias&#44; which leads to the wrong diagnosis of carpal tunnel syndrome&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Clinical cases</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present three cases of patients with symptomatology and clinical tests compatible with compression of the median nerve in the carpal tunnel but whose physical examination showed a soft mass in the distal region of the forearm which was compressing the median nerve&#44; as demonstrated by ultrasound evaluation&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The reported cases of accessory muscles or lipomas described in the literature as causes of median nerve compression clinic are mainly described only after the surgical decompression of the carpal tunnel&#44; due to the maintenance of residual symptoms&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Careful examination with an ultrasound evaluation prior to surgery may help to identify these cases and help planning surgical treatment&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
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            "titulo" => "Clinical cases"
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          2 => array:2 [
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            "titulo" => "Discussion"
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            "titulo" => "Conclusion"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La compresi&#243;n del nervio mediano por masas an&#243;malas localizadas en la mu&#241;eca y en el antebrazo distal es una condici&#243;n infrecuente&#46; Las estructuras subyacentes en la regi&#243;n del t&#250;nel carpiano pueden ser comprimidas&#44; causando dolor y parestesias&#44; pudiendo llevar al diagn&#243;stico err&#243;neo de s&#237;ndrome del t&#250;nel carpiano&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Casos cl&#237;nicos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se presentan 3 casos de pacientes con sintomatolog&#237;a y pruebas cl&#237;nicas compatibles con compresi&#243;n del nervio mediano en el t&#250;nel carpiano&#46; Sin embargo&#44; a la inspecci&#243;n presentaban leve edema en la regi&#243;n proximal del canal&#44; y en la evaluaci&#243;n por ultrasonido se detect&#243; sendas tumoraciones que comprim&#237;an el nervio mediano previo a su ingreso en el canal carpiano&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discusi&#243;n</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En la literatura&#44; los casos de m&#250;sculos accesorios o lipomas como causas de compresi&#243;n del nervio mediano son las causas m&#225;s probables de persistencia de los s&#237;ntomas tras la descompresi&#243;n quir&#250;rgica del canal carpiano&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La exploraci&#243;n cl&#237;nica detallada junto con la evaluaci&#243;n ultrasonogr&#225;fica antes de la cirug&#237;a pueden ayudar a identificar estos casos y planificar un mejor abordaje quir&#250;rgico&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Clinical case 1&#46; A&#58;</span> Swelling of the forearm &#40;circle&#41;&#59; <span class="elsevierStyleBold">B&#58;</span> Magnetic resonance imaging showing a muscle mass&#44; which may correspond to the anatomical variant &#40;arrow&#41;&#59; <span class="elsevierStyleBold">C&#58;</span> Ultrasound of normal forearm&#59; <span class="elsevierStyleBold">D&#58;</span> Ultrasound of accessory flexor digitorum superficialis indicis muscle &#40;arrow&#41;&#46; <span class="elsevierStyleBold">Clinical case 2&#46; E&#58;</span> Swelling of the forearm &#40;circle&#41;&#59; <span class="elsevierStyleBold">F&#58;</span> Magnetic resonance imaging showing mild hypersignal of the pronator quadratus &#40;arrow&#41;&#59; <span class="elsevierStyleBold">G&#58;</span> Ultrasound showing a hypoechoic mass &#40;arrow&#41;&#59; <span class="elsevierStyleBold">H&#58;</span> Ultrasound of normal forearm&#59; <span class="elsevierStyleBold">I&#58;</span> Surgical exploration that revealed a lipoma&#46; <span class="elsevierStyleBold">Clinical case 3&#46; J&#58;</span> Swelling of the forearm &#40;circle&#41;&#59; <span class="elsevierStyleBold">K&#58;</span> Ultrasound of normal forearm&#59; <span class="elsevierStyleBold">L&#58;</span> Ultrasound of a hypoechoic mass that compressed the median nerve&#44; suggestive of lipoma or muscle mass &#40;arrow&#41;&#46;</p>"
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            0 => "B&#46; Graham"
                            1 => "A&#46;E&#46; Peljovich"
                            2 => "R&#46; Afra"
                            3 => "M&#46;S&#46; Cho"
                            4 => "R&#46; Gray"
                            5 => "J&#46; Stephenson"
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                      "doi" => "10.2106/JBJS.16.00719"
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                      "titulo" => "Unusual compression neuropathies of the forearm&#44; part II&#58; median nerve"
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                        0 => array:2 [
                          "etal" => false
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                            0 => "A&#46;C&#46; Dang"
                            1 => "C&#46;M&#46; Rodner"
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                      "titulo" => "Compression of the median nerve in the proximal forearm by a giant lipoma&#58; a case report"
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                          "etal" => false
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                            0 => "S&#46;E&#46; Valbuena"
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                          "etal" => false
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