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Vol. 17. Issue 7.
Pages 422-424 (August - September 2021)
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Vol. 17. Issue 7.
Pages 422-424 (August - September 2021)
Case Report
DOI: 10.1016/j.reumae.2020.06.013
Uncommon causes of nerve compression in the distal forearm
Causas poco frecuentes de compresión nerviosa en el antebrazo distal
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Soraia Azevedoa,
Corresponding author
, Francisca Guimarãesa, Joana Ramos Rodriguesa, Ricardo Brancob, Elisa Rodriguesb, Filipa Teixeiraa
a Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
b Orthopedic Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
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Abstract
Introduction

Nerve compression by anomalous masses located at the wrist and distal forearm is an infrequent condition. They may compress underlying structures in the carpal tunnel region, causing pain and paresthesias, which leads to the wrong diagnosis of carpal tunnel syndrome.

Clinical cases

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, as demonstrated by ultrasound evaluation.

Discussion

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, due to the maintenance of residual symptoms.

Conclusion

Careful examination with an ultrasound evaluation prior to surgery may help to identify these cases and help planning surgical treatment.

Keywords:
Median nerve compression
Carpal tunnel
Abnormal mass
Lipoma
Accessory muscle
Resumen
Introducción

La compresión del nervio mediano por masas anómalas localizadas en la muñeca y en el antebrazo distal es una condición infrecuente. Las estructuras subyacentes en la región del túnel carpiano pueden ser comprimidas, causando dolor y parestesias, pudiendo llevar al diagnóstico erróneo de síndrome del túnel carpiano.

Casos clínicos

Se presentan 3 casos de pacientes con sintomatología y pruebas clínicas compatibles con compresión del nervio mediano en el túnel carpiano. Sin embargo, a la inspección presentaban leve edema en la región proximal del canal, y en la evaluación por ultrasonido se detectó sendas tumoraciones que comprimían el nervio mediano previo a su ingreso en el canal carpiano.

Discusión

En la literatura, los casos de músculos accesorios o lipomas como causas de compresión del nervio mediano son las causas más probables de persistencia de los síntomas tras la descompresión quirúrgica del canal carpiano.

Conclusión

La exploración clínica detallada junto con la evaluación ultrasonográfica antes de la cirugía pueden ayudar a identificar estos casos y planificar un mejor abordaje quirúrgico.

Palabras clave:
Compresión del nervio mediano
Túnel carpiano
Masa anormal
Lipoma
Músculo accesorio

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