A rare cause of median nerve compression: A fibroma originating from the tendon sheath in the carpal tunnel

Abstract

Abstract. Carpal tunnel syndrome is a widespread clinical condition, the cause of which is compression of the median nerve in the tunnel. For a large proportion of patients, the surgical release of the median nerve in the carpal tunnel is sufficient treatment.  In some cases, the cause of this condition may be due to a mass along the median nerve path. These could be lipomas, ganglia, rarely tendon sheath origin fibromas. In such conditions, the symptoms are not alleviated by a simple release of the transverse carpal ligament; an excision of the mass may be required.

Fibromas originating from the tendon sheath are rare benign tumors. When this causes compression of the median nerve, the presentation is similar to carpal tunnel syndrome. In our study, a patient developing median nerve compression due to a fibroma stemming from the tendon sheath has been presented and mass-presenting cases in literature have been reviewed.

Key words: Fibroma stemming from tendon sheath, carpal tunnel syndrome, median nerve

Keywords

• Fibroma stemming from tendon sheath, carpal tunnel syndrome, median nerve

Kaynakça

1. Garrido A, Lam WL, Stanley PR. Fibroma of a tendon sheath the wrist: a rare cause of compression of the median nerve. Scand J Plast Reconstr Surg Hand Surg 2004; 38: 314-316.
2. Vekris MD, Lykissas MG, Beris AE. Median nerve compression secondary to lipoma arising from flexor tenosynovium: a case report. Hand Surg 2007; 12: 83Misawa A, Okada K, Hirano Y, Sageshima M. Fibroma of tendon sheath arising from the radioulnar joint. Pathol Int 1999 ; 49: 1089-1092. Fox MG, Kransdorf MJ, Bancroft LW, Peterson JJ, Flemming DJ. MR imaging of fibroma of the tendon sheath. AJR Am J Roentgenol 2003; 180: 144914
3. Evangelisti S, Reale VF. Fibroma of tendon sheath as a cause of carpal tunnel syndrome. J Hand Surg Am 1992; 17: 1026-1027.
4. Millon SJ, Bush DC, Garbes AD. Fibroma of tendon sheath in the hand. J Hand Surg Am 1994; 19: 7887
5. Sarma DP, Weilbaecher TG, Rodriguez FH Jr. Fibroma of tendon sheath. J Surg Oncol 1986; 32: 230-2
6. Kim DH, Hwang M, Lee JI, Park JW. Acute median nerve compression caused by calcifying aponeurotic fibroma. Am J Phys Med Rehabil 2006; 85: 101710
7. Babins DM, Lubahn JD. Palmar lipomas associated with compression of the median nerve. J Bone Joint Surg Am 1994; 76: 1360-1362.
8. Imai S, Kodama N, Matsusue Y. Intrasynovial lipoma causing trigger wrist and carpal tunnel syndrome. Scand J Plast Reconstr Surg Hand Surg 2008; 42: 328-330.

9. Ward CM, Lueck NE, Steyers CM. Acute carpal tunnel syndrome caused by diffuse giant cell tumor of tendon sheath: a case report. Iowa Orthop J 2007; 27: 99-103.
10. Chalmers RL, Mandalia M, Contreras R, Schreuder F. Acute trigger wrist and carpal tunnel syndrome due to giant-cell tumour of the flexor sheath. J Plast Reconstr Aesthet Surg 2008; 61: 1557.
11. Bertolotto M, Rosenberg I, Parodi RC, et al. Case report: Fibroma of tendon sheath in the distal forearm with associated median nerve neuropathy: US, CT and MR appearences. Clin Radiol 1996; 51: 370-3