Combined triggering at the wrist and severe carpal tunnel syndrome caused by gouty infiltration of a flexor tendon

Trigger Wrist and Carpal tunnel syndrome caused by a flexor tendon-related ganglion in a teenager: A case report

“…All three cases had tumors related to the flexor tendons within the carpal tunnel: a giant cell tumor of tendon sheath [1], a synovial mass [3], and a fibroma of tendon sheath [4]. None of the pediatric cases had concurrent carpal tunnel syndrome, although it has been reported in adults [5], [6]. In our case, triggering was caused by a ganglion and concurrent carpal tunnel syndrome was present.…”

“…If there was a history of a laceration on the dorsal aspect of the wrist, exploration of the area of laceration and release of the extensor retinaculum should be done [8], [9]. In all other cases, carpal tunnel release is indicated [1], [2], [3], [4], [5], [6], [10], [11]. In neurologically asymptomatic patients, the carpal tunnel release serves to provide access to the pathology within the carpal tunnel rather than to decompress the median nerve.…”

“…During the release of the carpal tunnel, the surgeon should look for the cause of triggering and treat it accordingly. This will include synovectomy, resection of the anomalous muscles, excision of space occupying lesions, and release of tendon adhesions [1], [2], [3], [4], [5], [6], [10], [11]. Triggering related to partial flexor tendon lacerations is usually associated with oblique lacerations and tendon “flap” formation [12].…”

“…The outcome of management is generally good with resolution of triggering [1], [2], [3], [4], [8], [9], [10], [11] and improvement of symptoms related to median nerve compression [5], [6]. Children with juvenile arthritis remain at risk of recurrence and hence control of synovitis by appropriate medications is mandatory.…”

A repeated carpal tunnel syndrome due to tophaceous gout in flexor tendon

“…Rand reported a case of triggered wrist and severe CTS. [10] Hernandez-Cortes et al [13] reported a case of digital flexion contracture and severe CTS. In the above 2 cases because of obvious clinical signs, with imaging characteristics and medical history, the diagnosis was not difficult.…”