Surgical Release of the Carpal Tunnel in a Patient with Compressive Median Neuropathy: A Case Report
Main Article Content
Abstract
Carpal tunnel syndrome (CTS) is the most common compressive neuropathy of the upper extremity and frequently coexists with other fibroproliferative disorders of the hand, particularly in patients with metabolic conditions such as diabetes mellitus. Trigger finger, a stenosing tenosynovitis caused by thickening of the A1 pulley, shares pathophysiological mechanisms with CTS, including collagen glycosylation and connective tissue alterations. We report the case of a 52-year-old right-handed woman with poorly controlled type 2 diabetes mellitus who presented with an 18-month history of progressive paresthesias in the median nerve distribution of the right hand, nocturnal pain, and decreased grip strength, associated with symptomatic triggering of the fifth digit. Physical examination and nerve conduction studies confirmed moderate to severe median nerve compression at the carpal tunnel. The patient underwent open carpal tunnel release combined with A1 pulley release of the fifth digit in a single operative session under regional anesthesia. Intraoperative findings included a thickened transverse carpal ligament and a flattened median nerve without structural disruption, as well as a fibrotic A1 pulley. Postoperatively, the patient experienced complete resolution of nocturnal pain and triggering, with progressive sensory recovery and restoration of thumb opposition strength at six-week follow-up. No complications were observed. This case highlights the frequent coexistence of CTS and trigger finger in diabetic patients and supports the safety and effectiveness of combined surgical management in a single procedure. Early recognition and comprehensive treatment of associated hand pathologies may improve functional outcomes and patient satisfaction.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Aroori, S., & Spence, R. A. J. (2008). Carpal tunnel syndrome. Ulster Medical Journal, 77(1), 6–17.
II. Atroshi, I., Gummesson, C., Johnsson, R., Ornstein, E., Ranstam, J., & Rosén, I. (1999). Prevalence of carpal tunnel syndrome in a general population. JAMA, 282(2), 153–158. https://doi.org/10.1001/jama.282.2.153
III. Chammas, M., Boretto, J., Burmann, L. M., Ramos, R. M., Neto, F. S., & Silva, J. B. (2014). Carpal tunnel syndrome – Part I: Anatomy, physiology, etiology, and diagnosis. Revista Brasileira de Ortopedia, 49(5), 429–436. https://doi.org/10.1016/j.rboe.2014.08.001
IV. Chammas, M., Boretto, J., Burmann, L. M., Ramos, R. M., Neto, F. S., & Silva, J. B. (2014). Carpal tunnel syndrome – Part II: Treatment. Revista Brasileira de Ortopedia, 49(5), 437–445. https://doi.org/10.1016/j.rboe.2014.08.002
V. Green, D. P., Wolfe, S. W., Pederson, W. C., Kozin, S. H., & Cohen, M. S. (Eds.). (2017). Green’s operative hand surgery (7th ed.). Elsevier.
VI. Lundborg, G., & Dahlin, L. B. (1996). The pathophysiology of nerve compression. Hand Clinics, 12(2), 215–227.
VII. Phalen, G. S. (1966). The carpal-tunnel syndrome: Clinical evaluation of 598 hands. Clinical Orthopaedics and Related Research, 45, 29–40.
VIII. Ring, D., Lozano-Calderón, S., Shin, R., & Jupiter, J. B. (2008). Trigger finger following carpal tunnel release. The Journal of Hand Surgery, 33(2), 185–189. https://doi.org/10.1016/j.jhsa.2007.10.008
IX. Ryzewicz, M., & Wolf, J. M. (2006). Trigger digits: Principles, management, and complications. The Journal of Hand Surgery, 31(1), 135–146. https://doi.org/10.1016/j.jhsa.2005.10.013
X. Saldana, M. J. (2001). Trigger digits: Diagnosis and treatment. Journal of the American Academy of Orthopaedic Surgeons, 9(4), 246–252.
XI. American Diabetes Association. (2023). Standards of care in diabetes—2023. Diabetes Care, 46(Supplement 1), S1–S291. https://doi.org/10.2337/dc23-SINT
XII. Papanicolaou, G. D., McCabe, S. J., & Firrell, J. (2001). The prevalence and characteristics of nerve compression symptoms in the general population. The Journal of Hand Surgery, 26(3), 460–466.
XIII. Kerrigan, C. L., & Stanwix, M. G. (2009). Using evidence to minimize the cost of trigger finger care. The Journal of Hand Surgery, 34(6), 997–1005. https://doi.org/10.1016/j.jhsa.2009.03.008
XIV. Palmer, D. H., & Hanrahan, L. P. (1995). Social and economic costs of carpal tunnel surgery. Instructional Course Lectures, 44, 167–172.
XV. Wolfe, S. W., Hotchkiss, R. N., Pederson, W. C., Kozin, S. H., & Cohen, M. S. (Eds.). (2021). Green’s operative hand surgery (8th ed.). Elsevier.