Carpal tunnel syndrome due to a small displaced fragment of bone

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THE carpal tunnel syndrome,1, 2 characterized by painful paresthesias in the hand, is associated with burning pain, tingling, or numbness of the thumb, index and long fingers. Thenar atrophy and loss of tactile discrimination may ensue. Symptoms are worst at night or after repetitive motion of the hands. Middle-aged women are most often affected.

A recognized complication of the treatment of Colles’ fracture, the carpal tunnel syndrome usually results from placing the hand in the Cotton-Loder position (acute anterior flexion and ulnar deviation). The anterior border of a fractured radius has resulted in compression of the median nerve at the wrist, but there is no recent report that the carpal tunnel syndrome was associated with a small anteriorly displaced fragment of the radius. Our report concerns such a case.

Report of a Case

On November 24, 1967, a 44-year-old woman was examined by us because she fell at home and injured her right wrist. Examination revealed a closed fracture of the distal right radius and ulnar styloid, with severe posterior displacement of the radial fragment (Fig. 1). There was moderate swelling of the wrist, but no neurovascular abnormalities were found. The fractures were reduced by manipulation after local infiltration of the fracture hematoma with 2 percent mepivacaine hydrochloride, NF. A long arm cast was applied with the patient’s hand in moderate anterior flexion and ulnar deviation. Postreduction roentgenograms demonstrated satisfactory fracture alignment (Fig. 2). The next day the patient had a severe pain in the wrist and hand despite the . . .



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