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Case Report of Carpal Tunnel Syndrome Caused by Hand Aneurysm

In this single case report, hand surgeons describe a false aneurysm in a 38-year-old woman after a hand injury. The diagnosis was delayed because of symptoms of carpal tunnel syndrome (CTS) present at the time. The surgeons found out later the numbness and tingling from CTS was caused by a large mass of blood from the aneurysm stretching the nerve to the fingers.

An aneurysm is a bulge in the blood vessel caused by a weakness in the vessel wall. As the bulge gets larger, the wall gets thinner and can burst. A false aneurysm refers to blood leaking between two layers of the blood vessel wall. False aneurysms are often caused by trauma that punctures the artery.

The patient was initially treated at a local hospital. On two separate occasions, blood pooled in her palm and was removed. The injury was cleaned each time but the mass kept coming back. Her symptoms of pain and finger numbness got worse. Finger range of motion was decreased due to pain.

An MRA (magnetic resonance angiography) was done and showed the false aneurysm in her palm. Surgery to remove the mass showed that it extended into the carpal tunnel area putting pressure on the median nerve.

After surgery, the patient needed wound care and hand therapy. By the end of six months, she was pain free and her fingers were back to normal. Range of motion, strength, and sensation were all restored at the end of one year after surgery.

The authors comment that false aneurysms are very rare in the hand. It's easy to misdiagnose this problem. This is the only reported case of a false aneurysm complicated by carpal tunnel syndrome.

References: Yury A. Slesarenko, MD, et al. False Aneurysm of the Superficial Palmar Arch Causing Acute Carpal Tunnel Syndrome. In Orthopedics. June 2007. Vol. 30. No. 6. Pp. 493-494.

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