Singh Simranjit, Sanna Fnu, Singh Natasha, Adhikari Ramesh, Kumar Vinod
Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, USA.
Hospital Medicine, Franciscan Health, Lafayette, USA.
Cureus. 2021 Dec 31;13(12):e20852. doi: 10.7759/cureus.20852. eCollection 2021 Dec.
Acute atraumatic carpal tunnel syndrome (CTS) that results from a hematoma as a complication of oral anticoagulation use is a highly uncommon presentation. CTS is a common type of peripheral compression neuropathy, with CTS's acute presentation being less common than chronic. The acute type is commonly caused either by recent trauma, including fractures of the distal radius and carpal dislocations, atraumatic etiologies like infections, or inflammatory conditions that increase the pressure in the carpal tunnel. Timely diagnosis of acute CTS is essential, as often surgical decompression is required if symptoms do not improve within hours. A 79-year-old female presented to the ED with a past medical history significant for stroke, paroxysmal atrial fibrillation on rivaroxaban, and hypertension. She complained of a one-day history of left wrist pain, swelling, and restricted range of motion, associated with numbness in the median nerve distribution and weakening of the handgrip. The patient denied any trauma or unusual physical activity. CCT imaging of the left upper extremity showed soft tissue expansion around the flexor pollicis longus proximal to and just distal to the carpal tunnel consistent with dissecting hematoma within the flexor compartment. The orthopedics hand team evaluated the patient. Her rivaroxaban was held, and she was monitored for 24 hours in the hospital. The next day, she almost had a complete resolution of her symptoms. She was discharged home with a close follow-up. There are various atraumatic causes of acute CTS. Spontaneous atraumatic hematoma occurring in the forearm's flexor compartment and resulting in acute CTS is extremely uncommon. In contrast to chronic CTS, acute CTS requires urgent carpal tunnel release to prevent irreversible median nerve damage. Anticoagulants in such cases increase the bleeding risk. This case highlights the importance of considering CTS into the differential diagnosis of someone on an anticoagulant and presenting with acute wrist swelling and pain. Despite the absence of any direct trauma, timely diagnosis of this condition is prudent and greatly affects the outcomes.
作为口服抗凝治疗并发症的血肿导致的急性非创伤性腕管综合征（CTS）是一种极为罕见的表现。CTS是周围压迫性神经病变的常见类型，其急性表现比慢性表现少见。急性型通常由近期创伤引起，包括桡骨远端骨折和腕骨脱位，也可由感染等非创伤性病因或增加腕管压力的炎症性疾病导致。及时诊断急性CTS至关重要，因为如果症状在数小时内没有改善，通常需要进行手术减压。一名79岁女性因有中风、正在服用利伐沙班治疗阵发性心房颤动以及高血压的病史而就诊于急诊科。她主诉有一天的左腕疼痛、肿胀和活动范围受限病史，伴有正中神经分布区域麻木和握力减弱。患者否认有任何创伤或异常体力活动。左上肢的计算机断层扫描（CT）成像显示，在腕管近端和远端的拇长屈肌周围软组织扩张，符合屈肌间隙内的夹层血肿。骨科手部团队对患者进行了评估。停用了她的利伐沙班，并在医院对她进行了24小时监测。第二天，她的症状几乎完全缓解。她出院回家并接受密切随访。急性CTS有多种非创伤性病因。在前臂屈肌间隙发生的自发性非创伤性血肿并导致急性CTS极为罕见。与慢性CTS不同，急性CTS需要紧急进行腕管松解术以防止正中神经不可逆损伤。在此类病例中，抗凝剂会增加出血风险。本病例强调了在对抗凝剂使用者出现急性腕部肿胀和疼痛进行鉴别诊断时考虑CTS的重要性。尽管没有任何直接创伤，但对这种情况进行及时诊断是谨慎的，并且会极大地影响治疗结果。
