Jalan Divesh, Garg Bhavuk, Marimuthu Kanniraj, Kotwal Prakash
All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Pan Afr Med J. 2011;9:29. doi: 10.4314/pamj.v9i1.71205. Epub 2011 Jul 18.
Carpal tunnel syndrome, in its idiopathic form, is an extremely common entrapment neuropathy in the clinical practice however secondary compressive causes are rare. Among secondary causes, tumors are even rarer. Although lipomas are the most common soft tissue tumor in the body, <5% of the benign tumors of the hand are lipomas. A 48-year old manual laborer man presented to us with a two-year history of numbness, tingling and burning pain in the palmar surface of the left hand and fingers along with a progressively increasing swelling in the hand and wrist. His medical history was unremarkable and no trauma episode was reported. According to the clinical examination and the result of median nerve conduction study (NCS) the diagnosis of carpal tunnel syndrome was established. Operative release of the transverse carpal ligament was subsequently performed along with excision of the lipoma using extensile open approach. Intraoperatively, median nerve and its digital branches were found to be stretched over the giant lipoma causing substantial compression to median nerve. Histopathological findings of the resected mass were consistent with lipoma. After two years the patient was pain-free without any sign of tumor recurrence. Lipomas are infrequently seen in hand and wrist, however giant lipoma as a cause of secondary carpal tunnel syndrome is even more rare, which makes this case interesting.
特发性腕管综合征是临床实践中极为常见的一种卡压性神经病，然而继发性压迫原因却很罕见。在继发性原因中，肿瘤更为罕见。尽管脂肪瘤是体内最常见的软组织肿瘤，但手部良性肿瘤中脂肪瘤占比不到5%。一名48岁的男性体力劳动者前来就诊，他左手手掌和手指掌面有两年的麻木、刺痛和灼痛病史，同时手部和手腕肿胀逐渐加重。他的病史无异常，也未报告有外伤史。根据临床检查和正中神经传导研究（NCS）结果，确诊为腕管综合征。随后采用扩展性开放手术方法，松解腕横韧带并切除脂肪瘤。术中发现正中神经及其指支被巨大脂肪瘤牵拉，导致正中神经受到严重压迫。切除肿块的组织病理学检查结果与脂肪瘤相符。两年后患者无痛，无肿瘤复发迹象。脂肪瘤在手部和腕部并不常见，然而巨大脂肪瘤作为继发性腕管综合征的病因更为罕见，这使得该病例颇具看点。
