Median Nerve Compression in Carpal Tunnel Caused by a Giant Lipoma

Abstract

A lipoma is a common, benign soft-tissue tumor that rarely arises in the upper limb. When one does occur in the hand, the location of the lipoma can cause nerve compression, which can mimic carpal tunnel symptoms. Magnetic resonance imaging is the visualization modality of choice for diagnosis and surgical planning of lipomas. Surgical resection is recommended to relieve the neurological manifestations of this disease. The surgeon should always suspect liposarcoma first before voluminous, atypical, or recurrent tumors are considered.

A hidden etiology in a case of recurrent carpal tunnel syndrome: Giant cell tumor of the tendon sheath

“…Because of the absence of space in the hand compartments, tumor is starting to press to neurovascular endings with rapid growth, and this leads to an atypical clinical presentation imitating the carpal tunnel syndrome [7]. The most common tumors causing carpal tunnel syndrome are lipomas, vascular malformations and ganglions [9].…”

“…It just may be seen as a homogenous opacity in the soft tissue [15]. In this case, direct radiographs did not contribute to reaching the diagnosis.Generally, MR imaging is recommended in patients who have atypical symptoms, sudden onset symptoms or clinical mass lesion or young patients [7]. MRI is useful in many tumors, especially helpful in evaluating malignancy development [16].…”

“…They are almost always benign tumors, but behave similar to some borderline tumors, because of their growth patterns, they have high local recurrence possibility [2,4]. Tenosynovial giant cell tumors are rarely reported as a reason of carpal tunnel syndrome and usually present with swelling at the volar location of the wrist besides carpal tunnel syndrome findings [5][6][7][8][9]. We reported a tenosynovial GCT case located in the carpal tunnel at a patient who has recurrent carpal tunnel syndrome without physical findings of a mass lesion.…”

Carpal Tunnel Syndrome Caused by Bifid Median Nerve in Association with Anomalous Course of the Flexor Digitorum Superficialis Muscle at the Wrist

“…Among the nonneural sheath-origin tumors, lipomas are a very rare cause of peripheral nerve compression 8) . Therefore, peripheral nerve compression by lipoma is infrequently reported in the medical literature, and most reports are restricted to case reports and small series of patients 3,5,6,[9][10][11]13,14,17,18,20,21,[23][24][25]27) . Lipomas are benign fatty tumors that are common in humans; it is a globose or ovoid mass which is mostly localized in the subcutaneous tissue 15) .…”

“…The most reported nerve affected by lipoma is the radial nerve, which is usually affected with subfascial, parosteal lipomas 7,12,16,25) , followed by the median 5,6,8,10,14,18,22,27) and ulnar nerves 9,21) . Involvement of the nerves in the upper extremity is more common than those in the lower extremity and the reports regarding involvement of the median nerve by a lipoma within carpal tunnel are now increasing 5,6,14,18,22) . Although symptomatic involvement of the median nerve in the proximal forearm by a lipoma has been reported twice 13,27) , to our knowledge, the case presented is the first of compression of the median nerve by a lipoma in the distal forearm just proximal to the wrist.…”