摘要
Abstract
Objective To explore the etiology,diagnosis and treatment measures of carpal tunnel syndrome,and analyze the reasons for misdiagnosis and missed diagnosis.Methods A retrospective analysis was conducted on the clinical data of 2 patients with carpal tunnel syndrome caused by wrist masses admitted from January 2019 to January 2025.Results One patient visited the doctor due to numbness in the left fingers for over 10 months.Electromyography examination indicated damage to the left median nerve,especially below the wrist,and the diagnosis was left carpal tunnel syndrome.After admission,based on the past medical history and magnetic resonance imaging(MRI)examination of the wrist joint,gouty tendinitis was considered.Open surgery was performed,including carpal tunnel incision and median nerve release,as well as removal of lesions in the wrist tendons and surrounding tissues.The symptoms were relieved after the operation,and the pathological examination confirmed the diagnosis of gouty tendinitis.The duration of missed diagnosis was 3 h.One patient presented with a gradually increasing mass in the right forearm for six years.Based on physical examination and MRI of the wrist joint at another hospital,it was considered a subcutaneous lipoma on the palmar side of the right wrist.Upon admission,it was misdiagnosed as right forearm lipoma(subcutaneous),and right carpal tunnel syndrome.Surgical resection was performed.During the operation,it was found that the lipoma was located between the membranes of the median nerve fiber bundle,and the median nerve fiber bundle wrapped lipoma in a mesh shape.Pathological examination confirmed it as lipoma,and it was diagnosed as an intraneural lipoma of the median nerve in the right forearm.The duration of misdiagnosis was 21 d.The patient recovered well after the operation,and the incision healed at Grade I/A.The stitches were removed on schedule.Conclusion The causes of carpal tunnel syndrome are complex and diverse,lacking specificity.Therefore,clinicians need to repeatedly inquire about the medical history.A diagnosis should be made based on clinical features and electromyography(EMG)examinations,and the cause should also be determined.If necessary,MRI,color Doppler ultrasound and other examinations should be performed to make a correct diagnosis,thus avoiding misdiagnosis,missed diagnosis and the selection of inappropriate surgical methods.关键词
腕管综合征/痛风性肌腱炎/神经内脂肪瘤/误诊/漏诊/磁共振成像/诊断,鉴别/病理学,临床Key words
carpal tunnel syndrome/gouty tendinitis/intraneural lipoma/misdiagnosis/missed diagnosis/magnetic resonance imaging/diagnosis,differential/pathology,clinical
