Acute Carpal Tunnel Syndrome Due to Excessive Blood-Pressure-Measurement at the WristAkutes Karpal-Tunnel-Syndrom verursacht durch exzessives Blutdruckmessen am Handgelenk
04 June 2012
07 September 2012
05 November 2012 (eFirst)
Carpal tunnel syndrome (CTS) represents a compression of the median nerve within the carpal tunnel and is, with an incidence of 1 – 3 subjects per thousand, the most frequent entrapment mononeuropathy.
It typically develops in individuals of 45 – 60 years of age and is more frequently observed in women. Patients with carpal tunnel syndrome (CTS) experience pain and weakness in the hand and numbness and paresthesias in the three radial digits. Secondary causes must be differentiated from the idiopathic CTS form: swelling of flexor tendons in tenosynovitis, ganglia or other tumors, accessory muscle tissue and even vascular anomalies (as e. g. a persistent median artery, aneurysms, vascular malformations) may result in space reduction of the carpal tunnel and lead to symptoms similar to those of idiopathic CTS. These secondary causes must and can be excluded easily by means of sonography. Within the last decade high resolution ultrasonography (HRUS) has become the first line imaging-modality for small soft tissue structures such as peripheral nerves: by high-frequency broadband transducers even tiny peripheral nerve branches may be visualized in an unrivalled manner (Kopf H et al. Ultraschall in Med 2011; 32: 242 – 266).
In acute CTS (ACTS), interstitial sudden pressure increase reaches a critical threshold where capillary blood flow is substantially reduced as is the perfusion required for median nerve viability (Szabo RM. Hand Clin 1998; 14: 419 – 429). This results above all in nerve ischemia, which leads to a sudden and typical clinical situation. ACTS mostly results from trauma above all in patients with coagulant disorders or receiving anticoagulation therapy. However, ACTS secondary to intraneural hemorrhage of the median nerve is very unusual and often associated with classic forms of hemophilia.
We present such a case of ACTS due to intraneural hematoma after excessive blood-pressure-measurements at the wrist by a subject without coagulant disorder.