Trophic ulcers in the carpal tunnel syndrome

Araújo, Abelardo Q.-C.; Barros Neto, Henrique; Bulcão, Henrique; Nascimento, Osvaldo J. M.

doi:10.1590/S0004-282X1993000300017

Abstracts

A patient with carpal tunnel syndrome (CTS) and trophic ulcers is described. Despite the healing of the ulcers after surgery for CTS, the severe sensory deficit and the electrophysiological tests have not shown any significant improvement. We think these findings argue against the hypothesis of the sensory deficit being responsible for the trophic ulcers. We favor a major role for the sympathetic disturbances as the main cause for those lesions.

median nerve; carpal tunnel syndrome; autonomic dysfunction

Relata-se o caso de paciente com sindrome do túnel do carpo (STC) de longa evolução que exibia mal perfurante palmar. Submetida a cirurgia descompressiva (epineurólise microcirúrgica do nervo mediano e tendossinovectomia) houve rápido desaparecimento das lesões cutâneas embora o déficit sensitivo e as alterações aos testes neurofisiológicos não revelassem melhora significativa. Acreditamos que estes achados falem contra a hipótese de que as graves alterações tróficas ocasionalmente encontradas nestes enfermos sejam consequentes ao severo déficit sensitivo. Tais anormalidades devem ser devidas à disfunção das fibras simpáticas do nervo mediano.

nervo mediano; sindrome do túnel do carpo; disfunção antônoma

Abelardo Q.-C. Araújo^I; Henrique Barros Neto^II; Henrique Bulcão^II; Osvaldo J. M. Nascimento^I

^IDepartment of Internal Medicine (Neurology), Universidade Federal Fluminense, Niterói

^IIHand Surgery Unit, Santa Casa de Misericórdia, Rio de Janeiro

SUMMARY

A patient with carpal tunnel syndrome (CTS) and trophic ulcers is described. Despite the healing of the ulcers after surgery for CTS, the severe sensory deficit and the electrophysiological tests have not shown any significant improvement. We think these findings argue against the hypothesis of the sensory deficit being responsible for the trophic ulcers. We favor a major role for the sympathetic disturbances as the main cause for those lesions.

Key words: median nerve, carpal tunnel syndrome, autonomic dysfunction

RESUMO

Relata-se o caso de paciente com sindrome do túnel do carpo (STC) de longa evolução que exibia mal perfurante palmar. Submetida a cirurgia descompressiva (epineurólise microcirúrgica do nervo mediano e tendossinovectomia) houve rápido desaparecimento das lesões cutâneas embora o déficit sensitivo e as alterações aos testes neurofisiológicos não revelassem melhora significativa. Acreditamos que estes achados falem contra a hipótese de que as graves alterações tróficas ocasionalmente encontradas nestes enfermos sejam consequentes ao severo déficit sensitivo. Tais anormalidades devem ser devidas à disfunção das fibras simpáticas do nervo mediano.

Palavras-chave: nervo mediano, sindrome do túnel do carpo, disfunção antônoma.

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Dr. Abelardo de Queiroz-Campos Araújo Rua Gildásio Amado 55/1011 - 22631-020 Rio de Janeiro RJ - Brasil.

1. Adoue D, Arlent Ph, Giraud P. Syndrome du canal carpien avec ulcerations digitales chez un insuffisant renal en hemodialyse periodique. Ann Dermatol Venereol 1984, 111:1019-1021.
2. Amschler A, Hartmann A. Ungewohnlicher Fall von Karpaltunnel Syndrom. Hautarzt 1979, 30:398-399.
3. Bouvier M, Lejeune B, Rouillat M, Marionnet J. Les formes ulcero-mutilantes du syndrome du canal carpien. Rev Rhum 1979, 46:169-176.
4. Dawson DM, Hallett M, Millender LH, Entrapment neuropathies. Boston: Little, Brown & Co, 1983, p 5-59.
5. Geffray L, Leman Ch, Dehais J, David-Chausse J. Deux cas de syndrome du canal carpien avec ulcerations digitales et acro-osteolyse. Rev Rhum 1984, 51:45-47.
6. Neau JPh, Gil R, Boissonnot L. Ulcerations cutanees et Osteolyse dans le syndrome du canal carpien. Rev Neurol (Paris) 1987, 143:303-305.
7. Phalen GS. The carpal-tunnel syndrome: seventeen years' experience in diagnosis and treatment of six hundred fifty four hands. J Bone Joint Surg 1966, 48:211-218.
8. Treves R, Arnauld JP, Benabbou M, Desproges-Gotteron R. Ulserations digitales au cours d'un syndrome du canal carpien avec syndrome de Raynaud. Rev Rhum 1980, 47:578-579.

Trophic ulcers in the carpal tunnel syndrome

Mal perfurante palmar e sindrome do túnel do carpo

Publication Dates

Publication in this collection
19 Jan 2011
Date of issue
Sept 1993

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Adoue D, Arlent Ph, Giraud P. Syndrome du canal carpien avec ulcerations digitales chez un insuffisant renal en hemodialyse periodique. Ann Dermatol Venereol 1984, 111:1019-1021.

[2] 2. Amschler A, Hartmann A. Ungewohnlicher Fall von Karpaltunnel Syndrom. Hautarzt 1979, 30:398-399.

[3] 3. Bouvier M, Lejeune B, Rouillat M, Marionnet J. Les formes ulcero-mutilantes du syndrome du canal carpien. Rev Rhum 1979, 46:169-176.

[4] 4. Dawson DM, Hallett M, Millender LH, Entrapment neuropathies. Boston: Little, Brown & Co, 1983, p 5-59.

[5] 5. Geffray L, Leman Ch, Dehais J, David-Chausse J. Deux cas de syndrome du canal carpien avec ulcerations digitales et acro-osteolyse. Rev Rhum 1984, 51:45-47.

[6] 6. Neau JPh, Gil R, Boissonnot L. Ulcerations cutanees et Osteolyse dans le syndrome du canal carpien. Rev Neurol (Paris) 1987, 143:303-305.

[7] 7. Phalen GS. The carpal-tunnel syndrome: seventeen years' experience in diagnosis and treatment of six hundred fifty four hands. J Bone Joint Surg 1966, 48:211-218.

[8] 8. Treves R, Arnauld JP, Benabbou M, Desproges-Gotteron R. Ulserations digitales au cours d'un syndrome du canal carpien avec syndrome de Raynaud. Rev Rhum 1980, 47:578-579.