J Korean Orthop Assoc JKOA Journal of the Korean Orthopaedic Association 1226-2102 The Korean Orthopaedic Association 10.4055/jkoa.2007.42.5.616 Original Article Carpal Tunnel Syndrome Caused by Space Occupying Lesions Kang Ho-Jung M.D. Jung Sung-Hoon M.D. Choi Chong-Hyuk M.D. Choi Woo-Jin M.D. Kim Sung-Jae M.D. Hahn Soo-Bong M.D. Department of Orthopaedic Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. Address reprint requests to Chong-Hyuk Choi, M.D Department of Orthopaedic Surgery, Yongdong Severance Hospital, 146-92, Dogok-dong, Gangnam-gu, Seoul 135-720, Korea. Tel: +82.2-2019-3410, Fax: +82.2-573-5393, choi8422@yumc.yonsei.ac.kr 10 2007 31 10 2007 42 5 616 622 Copyright © 2007 The Korean Orthopaedic Association 2007 Purpose

To evaluate the diagnosis and treatment of the carpal tunnel syndrome (CTS) due to space occupying lesion (SOL)s.

 Materials and Methods

14 patients (15 cases) that underwent surgery from 1992 to 2002 for CTS due to SOL were studied. The average age was 51 years. There were 6 men and 8 women. Mean follow up period was 16 months. In patients with swelling or tenderness on the area of wrist flexion creases, MRI and/or CT scan 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 were, in three cases tuberculosis tenosynovitis, nonspecific tenosynovitis in three cases, gout in one case, mass in four cases, and abnormal palmaris longus hypertrophy in one case. Bony lesions were, in one case Kienböck's disease (stage III), neglected volar dislocation of lunate in two cases. Following surgery, all cases showed alleviation of symptoms.

 Conclusion

In cases with swelling or tenderness on the area of wrist flexion creases, it is important to obtain a carpal tunnel view, and if necessary, MRI and/or CT should be supplemented in order to rule out SOLs.

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(A) MRI shows hypertrophied flexor digitorum profundus tenosynovium in carpal tunnel (Black arrow: hypertrophied tenosynovium). (B) Pathologic findings were compatible with tuberculosis tenosynovitis. There were caseous necrosis and granuloma with Langerhan's giant cell (black arrow) and lymphocytic infiltration (H-E stain, ×200).

(A) MRI shows tophi infiltration between flexor digitorum profundus tenosynovium and carpal bones (white arrow: tophi infiltration). (B) Urate crystal and lymphocyte infiltration show chronic tophaceous arthritis (H-E stain, ×200). (C) When examined with a polarizing filter, negative birefringence was noted.

(A) MRI shows hypertrophied palmaris longus is compressing median nerve in carpal tunnel (white arrow: hypertrophied palmaris longus muscle). (B) Open transverse carpal ligament release and hypertrophied palmaris longus excision was performed.

Carpal tunnel view (A) and CT scan (B) shows that calcifying mass is located just above the capitate.

Summary of Cases

D, Dominant hand; N, Non-dominant hand; B, Both hand; NS, Nonspecific.