Vasculitis presenting as carpal tunnel syndrome: a case report
Abstract Background Carpal tunnel syndrome is the most common focal mononeuropathy which presents with pain in the wrist and hand, paresthesia, loss of sensation in the distribution of the median nerve, and in more severe cases, weakness and atrophy of the thenar muscles. Meanwhile, carpal tunnel sy...
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13256-023-03801-8 |
| _version_ | 1797864658568216576 |
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| author | Mohammad Rahbar Neda Dolatkhah |
| author_facet | Mohammad Rahbar Neda Dolatkhah |
| author_sort | Mohammad Rahbar |
| collection | DOAJ |
| description | Abstract Background Carpal tunnel syndrome is the most common focal mononeuropathy which presents with pain in the wrist and hand, paresthesia, loss of sensation in the distribution of the median nerve, and in more severe cases, weakness and atrophy of the thenar muscles. Meanwhile, carpal tunnel syndrome can present as an initial manifestation of underlying systemic vasculitis disorder and result in severe physical disabilities. Case presentation A 27-year-old Iranian man was referred to our electrodiagnosis center with a clinical diagnosis of carpal tunnel syndrome in April 2020. Surgical intervention had been taken into account for him because of unsuccessful conservative therapies. On admission, thenar eminence was reduced. Electrodiagnostic findings were not compatible with median nerve entrapment at the wrist. All sensory modalities in the distribution of the right median nerve were decreased. Additionally, a mild increase in erythrocyte sedimentation rate was noted in laboratory tests. Because of the high vasculitis suspicion, we recommended the nerve biopsy and/or starting a high-dose corticosteroid. However, the surgery release was performed. After 6 months, the patient was referred for progressive weakness and numbness in the upper and lower limbs. After documentation of vasculitis neuropathy by biopsy, a diagnosis of non-systemic vasculitic neuropathy was confirmed. A rehabilitation program started immediately. Rehabilitation led to gradual improvement and recovery of function and muscle strength, and no complications remained, except mild leg paralysis. Conclusions Physicians should be suspicious of the median nerve vasculitis mononeuropathy in a patient with carpal tunnel syndrome-like symptoms. Median nerve vasculitis mononeuropathy as an initial presenting feature of vasculitis neuropathy can further result in severe physical impairments and disabilities. |
| first_indexed | 2024-04-09T22:55:27Z |
| format | Article |
| id | doaj.art-ce3a8c565e92488e950cd0d5f62d8583 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-04-09T22:55:27Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-ce3a8c565e92488e950cd0d5f62d85832023-03-22T11:19:17ZengBMCJournal of Medical Case Reports1752-19472023-03-011711510.1186/s13256-023-03801-8Vasculitis presenting as carpal tunnel syndrome: a case reportMohammad Rahbar0Neda Dolatkhah1Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical SciencesPhysical Medicine and Rehabilitation Research Center, Tabriz University of Medical SciencesAbstract Background Carpal tunnel syndrome is the most common focal mononeuropathy which presents with pain in the wrist and hand, paresthesia, loss of sensation in the distribution of the median nerve, and in more severe cases, weakness and atrophy of the thenar muscles. Meanwhile, carpal tunnel syndrome can present as an initial manifestation of underlying systemic vasculitis disorder and result in severe physical disabilities. Case presentation A 27-year-old Iranian man was referred to our electrodiagnosis center with a clinical diagnosis of carpal tunnel syndrome in April 2020. Surgical intervention had been taken into account for him because of unsuccessful conservative therapies. On admission, thenar eminence was reduced. Electrodiagnostic findings were not compatible with median nerve entrapment at the wrist. All sensory modalities in the distribution of the right median nerve were decreased. Additionally, a mild increase in erythrocyte sedimentation rate was noted in laboratory tests. Because of the high vasculitis suspicion, we recommended the nerve biopsy and/or starting a high-dose corticosteroid. However, the surgery release was performed. After 6 months, the patient was referred for progressive weakness and numbness in the upper and lower limbs. After documentation of vasculitis neuropathy by biopsy, a diagnosis of non-systemic vasculitic neuropathy was confirmed. A rehabilitation program started immediately. Rehabilitation led to gradual improvement and recovery of function and muscle strength, and no complications remained, except mild leg paralysis. Conclusions Physicians should be suspicious of the median nerve vasculitis mononeuropathy in a patient with carpal tunnel syndrome-like symptoms. Median nerve vasculitis mononeuropathy as an initial presenting feature of vasculitis neuropathy can further result in severe physical impairments and disabilities.https://doi.org/10.1186/s13256-023-03801-8Carpal tunnel syndromeVasculitic neuropathyElectrodiagnosisRehabilitation |
| spellingShingle | Mohammad Rahbar Neda Dolatkhah Vasculitis presenting as carpal tunnel syndrome: a case report Journal of Medical Case Reports Carpal tunnel syndrome Vasculitic neuropathy Electrodiagnosis Rehabilitation |
| title | Vasculitis presenting as carpal tunnel syndrome: a case report |
| title_full | Vasculitis presenting as carpal tunnel syndrome: a case report |
| title_fullStr | Vasculitis presenting as carpal tunnel syndrome: a case report |
| title_full_unstemmed | Vasculitis presenting as carpal tunnel syndrome: a case report |
| title_short | Vasculitis presenting as carpal tunnel syndrome: a case report |
| title_sort | vasculitis presenting as carpal tunnel syndrome a case report |
| topic | Carpal tunnel syndrome Vasculitic neuropathy Electrodiagnosis Rehabilitation |
| url | https://doi.org/10.1186/s13256-023-03801-8 |
| work_keys_str_mv | AT mohammadrahbar vasculitispresentingascarpaltunnelsyndromeacasereport AT nedadolatkhah vasculitispresentingascarpaltunnelsyndromeacasereport |