Presentation
Fall on the ground resulting in right wrist pain.
Patient Data
Hamate dorsal cortical breach. A linear echogenic focus (4 mm) in the carpal tunnel close to the median nerve. Dynamic scan shows a foreign body between the flexor retinaculum and the median nerve. A linear hypoechoic defect is present in the subcutaneous plane and the flexor retinaculum at the foreign body level. The median nerve itself shows a normal echopattern. Normal tendons in the tunnel. No fracture of the hamate hook/ displaced fracture fragment in the carpal tunnel.
The foreign body (thorn) was located in the carpal tunnel. It was removed. The median nerve was normal.
Case Discussion
The patient fell on the ground while walking resulting in wrist pain. An initial radiograph(no copyright, not uploaded) showed a hamate fracture which was not involving its hook. Clinical examination suggested the post-traumatic onset of carpal tunnel syndrome. The ultrasound shows a foreign body (thorn) in the carpal tunnel which was surgically retrieved.
Intraoperative photos: courtesy of operating surgeon Dr. Nisarg A. Patel.