Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessalia, Biopolis, 41110, Larissa, Greece,
Arch Orthop Trauma Surg. 2014 Jan;134(1):139-44. doi: 10.1007/s00402-013-1901-8. Epub 2013 Dec 11.
Tumors and tumor-like lesions in or around the median nerve are uncommon causes of carpal tunnel syndrome (CTS). The purpose of the present study is to highlight the diagnostic approach and point out the profile of patients with CTS and potential underlying pathology.
Twenty-eight patients with 32 affected hands had CTS correlated to a mass in or around the nerve. In 20 hands a palpable mass was present. Diagnostic workup included nerve conduction studies, ultrasound and/or MRI. Pre- and postoperative examination included two-point discrimination (2PD), grip strength, visual analogue scale (for pain) (VAS) and disabilities of the arm, shoulder and hand (DASH) scores.
Twelve of 28 patients were young (range 9-38 years) and 10 were male. Nerve compression was due to 27 extraneural lesions (8 abnormal muscles, 5 lipomas, 7 tenosynovitis, 4 vascular tumors, 2 ganglia, 1 Dupuytren's fibromatosis) and five intraneural tumors (three schwannomas, one neurofibroma, one sarcoma). Nerve decompression and excision of extraneural lesions were performed in all cases whereas in intraneural tumors, decompression was followed by excision in most cases and nerve grafting in one. Mean follow-up was 22 months (12-105 months). Extraneural masses were associated with a better outcome than nerve tumors. The mean postoperative VAS/DASH scores were 0.3/16.2 in extraneural lesions and 2.5/22 in intraneural lesions. The 2PD improved gradually in all patients (mean pre- and postoperative 12 and 5 mm). The mean grip strength increased from 28 to 31.3 kg postoperatively.
Although rare, the surgeon should include in the differential diagnosis of CTS the unusual cause of tumors and tumor-like lesions, especially when the patients' profile is not typical (young, male, no repetitive stress or manual labor). In addition, the presence of a palpable mass at the distal forearm or palm dictates the need for imaging studies. The extent, location and aggressiveness of the mass will determine the approach and type of procedure.
正中神经及其周围的肿瘤和类肿瘤病变是腕管综合征（CTS）的罕见病因。本研究的目的是强调诊断方法，并指出 CTS 患者和潜在潜在病理学的特征。
28 名患者的 32 只受累手存在与神经内或周围肿块相关的 CTS。20 只手上可触及肿块。诊断性研究包括神经传导研究、超声和/或 MRI。术前和术后检查包括两点辨别觉（2PD）、握力、视觉模拟量表（疼痛）（VAS）和手臂、肩部和手部残疾（DASH）评分。
28 名患者中有 12 名年轻（年龄 9-38 岁），10 名男性。神经受压是由 27 个神经外病变（8 个异常肌肉、5 个脂肪瘤、7 个腱鞘炎、4 个血管肿瘤、2 个神经节、1 个杜普伊特伦氏纤维瘤）和 5 个神经内肿瘤（3 个神经鞘瘤、1 个神经纤维瘤、1 个肉瘤）引起的。所有病例均行神经减压和神经外病变切除术，而在神经内肿瘤中，大多数病例行减压后切除，1 例行神经移植。平均随访时间为 22 个月（12-105 个月）。神经外肿块的结果优于神经肿瘤。神经外病变的术后平均 VAS/DASH 评分分别为 0.3/16.2，神经内病变为 2.5/22。所有患者的 2PD 逐渐改善（平均术前和术后分别为 12 和 5mm）。术后平均握力从 28 增加到 31.3kg。
尽管罕见，但外科医生应将肿瘤和类肿瘤病变这一不常见的病因纳入 CTS 的鉴别诊断，特别是当患者的情况不典型时（年轻、男性、无重复劳损或体力劳动）。此外，在远端前臂或手掌处触及肿块需要进行影像学检查。肿块的范围、位置和侵袭性将决定手术方式和手术类型。
