Carpal tunnel syndrome associated with chronic bursitis: A case report

Abstract

This current report presents a rare case of carpal tunnel syndrome with chronic bursitis that was treated successfully by open surgery. A 53-year-old female patient that had begun to experience swelling, pain and limited flexion activity of the left wrist 1 year previously presented because of a deterioration in her condition and numbness of the thumb, index finger and middle finger in the previous 2 months without any treatment. The diagnosis of bursitis should be based on clinical symptoms and signs, combined with colour ultrasonography, magnetic resonance imaging, arthroscopy and arthrography. Bursitis should be differentiated from arthritis, tendonitis, fracture and neoplasm, but complete exclusion depends on the postoperative pathological results. In this current case, the histopathological findings were consistent with bursitis without malignancy. After surgery, the patient was instructed to perform rehabilitation exercises for the wrist joint. These exercises included passive activity 3 days after surgery and active activity 1 week after surgery. There was also regular follow-up every 3 months. The patient recovered well and reported that the pain and numbness that she described preoperatively had been resolved.

Keywords: Carpal tunnel syndrome; chronic bursitis; surgical excision.

Figure 1.

Magnetic resonance images of a 53-year-old female patient that had experienced swelling, pain and limited flexion activity of the left wrist for 1 year previously. She presented because of a deterioration in her condition and numbness of the thumb, index finger and middle finger in the previous 2 months without any treatment. The images show chronic bursitis with effusion and degenerative changes in the left wrist: (a) intraarticular synovial thickening with multiple patchy and cystic hypersignal foci in the T2 lipid compression sequence and (b) thickening of the synovial membrane in the coronal position of the T2 lipid compression sequence, patchy hypersignal shadow and an unclear boundary.

Figure 2.

Surgical procedures undertake on a 53-year-old female patient admitted because of symptoms of swelling, pain and limited flexion activity of the left wrist and numbness of the thumb, index finger and middle finger: (a) an S-shaped incision on the metacarpal surface of the wrist (b) these bursa abnormalities were wrapped around the median nerve and flexor tendon, while the aponeurosis and epineurium were eroded; (c) the lesion was completely removed and the transverse carpal ligament was incised to release the flexor tendons, median nerve and its returning branches and (d) the wound was closed and a negative pressure drainage tube was placed. The colour version of this figure is available at: http://imr.sagepub.com.

Figure 3.

Representative postoperative histopathological photomicrographs show an uneven thickness of the bursa wall, myxoid fluid, hyperplasia of synovial cells, dilatation and hyperaemia of interstitial blood vessels, infiltration of lymphocytes and plasma cells. Haematoxylin and eosin; scale bar 200 µm (a) and scale bar 100 µm (b). The colour version of this figure is available at: http://imr.sagepub.com.

Figure 4.

Photographs of the hands of a 53-year-old female patient admitted because of symptoms of swelling, pain and limited flexion activity of the left wrist and numbness of the thumb, index finger and middle finger at 3 months after surgery: (a) good flexion activity in the left hand compared with the right hand and (b) good extension activity in the left hand compared with the right hand.