Presentation
Tingling involves the right hand's first three digits. Small lump on the volar-radial side of the right wrist.
Patient Data
The median nerve maximum cross-sectional area proximal to the carpal tunnel is 12.4 mm2. The maximum cross-sectional area distal to the carpal tunnel is 11.1 mm2. There was no mass lesion involving the median nerve.
A thin-walled anechoic lesion deep to the flexor tendons in the carpal tunnel region. Its bulbous part is outside the distal end of the tunnel. Its neck extends along the carpal tunnel floor and appears to enter the intercarpal joint. The lesion measures 21 (length) x 15 (width) x 7 (anteroposterior) mm.
Normal flexor tendons without tenosynovitis.
A clinically palpable nodule on the volar-radial side of the wrist is a thin-walled anechoic cyst (6 x 6 x 3 mm) outside the carpal tunnel. It abuts the flexor carpi radialis, and its neck is close to the scaphoid-trapezium joint.
There was no other wrist abnormality.
A photo of the drawing was attached to the report. See the proximal narrow part of the ganglia deep in the carpal tunnel and the bulbous part distal to the tunnel.
Skin marking for the ganglia. The intraoperative photo shows the deep location of the ganglia.
Case Discussion
A female presented with clinical signs of right carpal tunnel syndrome along with a palpable nodule on the volar-radial side of the wrist. The ultrasound shows a carpal tunnel ganglion with median nerve compression. The clinically palpable nodule is a scaphoid-trapezium joint region ganglion.
Later, the nerve conduction velocity test revealed carpal tunnel syndrome. Surgical release of the flexor retinaculum was done along with carpal tunnel ganglion excision. The scaphoid-trapezium region ganglion was also excised.
Intraoperative photo courtesy of operating surgeon Dr. Piyush N. Patel.
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