掌侧月骨脱位引起继发性腕管综合征1例

Pub Date : 2023-10-09 DOI:10.1055/s-0043-1774774
Andrew M. Gabig, Hayden L. Cooke, Robert Roundy, Michael B. Gottschalk
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After failed conservative treatment and multiple ultrasound-guided corticosteroid injections, the patient was successfully treated surgically with carpal tunnel release, tenosynovectomy, and lunate excision. Literature Review Volar lunate dislocation without a traumatic mechanism is rare. Progressive carpal destabilization and volar subluxation is not a commonly reported cause of secondary carpal tunnel symptoms. Isolated reports in the literature have been published with nearly identical presentations. Kamihata et al reported a patient, with a history of carpal tunnel decompression, presenting with numbness and tingling in her right hand without traumatic injury. A displaced lunate was found to abut the flexor tendons and median nerve. Ott et al further reported an atraumatic lunate dislocation and palmar swelling 4 weeks after a carpal tunnel release. 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引用次数: 0

摘要

摘要背景腕管释放失败是一种罕见的疾病,其独特的病理特征可能会阻碍正确的诊断和治疗。症状通常是由于腕横韧带释放不足或初次减压引起的病理性瘢痕组织。病例描述在这篇报告中,我们描述了一个79岁男性的病例,他有舟状骨月骨晚期塌陷史和先前的腕管减压,表现为右腕功能恶化和新的右掌肿块。患者没有明显的先前创伤,临床检查显示掌侧月骨脱位。在保守治疗和多次超声引导皮质类固醇注射失败后,患者成功接受手术治疗,包括腕管松解、腱鞘切除术和月骨切除术。无创伤机制的掌侧月骨脱位是罕见的。进行性腕失稳和掌侧半脱位并不是继发性腕管症状的常见原因。文献中发表的孤立报告几乎都是相同的。Kamihata等人报道了一名患者,有腕管减压史,表现为右手麻木和刺痛,无外伤性损伤。移位的月骨位于屈肌腱和正中神经附近。Ott等人进一步报道了腕管解除术后4周发生的非外伤性月骨脱位和掌肿胀。在已有关节炎退行性变的情况下,腕管松解可能使腕骨失稳,使患者易发生腕关节脱位。需要进一步的研究来了解这种不稳定导致继发于腕管释放的月骨脱位的风险。
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Volar Lunate Dislocation Causing Secondary Carpal Tunnel Syndrome: A Case Report
Abstract Background Failure of carpal tunnel release is an uncommon occurrence with unique pathologies that may impede proper diagnosis and treatment. Symptoms are most often attributed to an inadequate release of the transverse carpal ligament or pathologic scar tissue resultant of the primary decompression. Case Description In this report, we describe the case of a 79-year-old male with a history of scaphoid lunate advanced collapse and a prior carpal tunnel decompression presenting with worsening right wrist function and new right palmar mass. The patient had no significant antecedent trauma, and clinical workup revealed volar dislocation of the lunate. After failed conservative treatment and multiple ultrasound-guided corticosteroid injections, the patient was successfully treated surgically with carpal tunnel release, tenosynovectomy, and lunate excision. Literature Review Volar lunate dislocation without a traumatic mechanism is rare. Progressive carpal destabilization and volar subluxation is not a commonly reported cause of secondary carpal tunnel symptoms. Isolated reports in the literature have been published with nearly identical presentations. Kamihata et al reported a patient, with a history of carpal tunnel decompression, presenting with numbness and tingling in her right hand without traumatic injury. A displaced lunate was found to abut the flexor tendons and median nerve. Ott et al further reported an atraumatic lunate dislocation and palmar swelling 4 weeks after a carpal tunnel release. Clinical Relevance In the setting of existing arthritic degeneration, carpal tunnel release may destabilize the carpus and predispose patients to carpal dislocation. Further research is required to understand the risks associated with this instability leading to lunate dislocations secondary to carpal tunnel release.
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