Median Nerve Schwannoma of the Hand and Wrist: 3 Cases

Abstract

Tumors of the median nerve are difficult to diagnose and median nerve schwannomas are rare. During a ten-year period, we treated eleven median nerve schwannomas found on the hand (nine) and wrist (two). All the tumors were treated by enucleation under loupe magnification and tourniquet application. All had a favorable result at a mean follow up of five years. We present three of our most typical cases, with schwannomas found on the wrist, palm and thumb. We also review the literature offering a wider view on the pathology, diagnosis and treatment of schwannomas in general.

Schwannoma of the Upper Limb: Retrospective Study of a Rare Tumor with Uncommon Locations

“…Due to the rarity of the tumor, its slow growth and the absence of specific symptoms, diagnosis is often difficult, late or incorrect [ 2 , 9 , 10 , 11 ]. This type of benign tumor of the peripheral nerve is most often located in the large nerve trunks, and in the upper limb is more often located on the anterior aspect, frequently involving the ulnar nerve, in over 75% of cases occurring distal to the elbow [ 2 , 12 ]. In 90% of cases, the schwannoma is a tumor with a single location [ 13 ].…”

“…In 90% of cases, the schwannoma is a tumor with a single location [ 13 ]. The presence of multiple schwannomas is related to neurofibromatosis type 2 (NF2) [ 2 , 12 ]. Its clinical diagnosis is not based on specific signs, although the presence of a slow-growing tumor mass along the course of a nerve, that is mobile in the transverse plane, relatively fixed in the longitudinal plane, and sometimes painful on palpation may suggest a clinical diagnosis of schwannoma [ 12 , 14 ].…”

“…The presence of multiple schwannomas is related to neurofibromatosis type 2 (NF2) [ 2 , 12 ]. Its clinical diagnosis is not based on specific signs, although the presence of a slow-growing tumor mass along the course of a nerve, that is mobile in the transverse plane, relatively fixed in the longitudinal plane, and sometimes painful on palpation may suggest a clinical diagnosis of schwannoma [ 12 , 14 ]. Imaging investigations—ultrasonography (USG) and, first of all, magnetic resonance imaging (MRI) description—have a major role in preoperative diagnosis, being considered helpful for establishing a correct diagnosis in 90% of cases [ 2 , 15 , 16 , 17 ].…”