Dados do Trabalho

Título

Development of neuroma secondary to decompressive surgery for carpal tunnel syndrome

RESUMO

Case Presentation
A 42-year-old female with a previous diagnosis of carpal tunnel syndrome and two months of surgical decompression evolution median nerve endoscopically. According to the information collected, during the procedure (CIS) there was a possible cutting injury to the aforementioned nerve. After detecting the lesion, the physician would have made a longitudinal incision in the region for exploration, followed by primary raphy of the nerve. In the late postoperative period, the patient evolved with intense pain and paralysis of the muscles of the median nerve territory.
The physical examination showed limited flexion and abduction of the wrist, weakness in thumb opposition, painful palpation of the region and positive Tinel's sign. A MRI of the wrist was requested, which showed a neuroma on the topography of the median nerve with a probable total lesion. The patient underwent microsurgery to expose the lesion and exeresis of the neuroma, with subsequent sural nerve grafting to try to improve pain and return movement of the muscles innervated by the affected nerve. One year postoperatively, the patient evolved with a functional hand, grade 4 strength in the muscles innervated by the median nerve and significant pain improvement (VAS 1).
Discussion
Intraoperative complications of carpal tunnel syndrome treatment can occur during superficial skin dissection or ligament release. Endoscopic decompression surgeries of the nerve in question, can lead to the development of certain complications. The median nerve, having both motor and sensory fibers can have a variable pattern of deficit. Lesions repaired with neural raphy, can evolve with damage to the internal structure of the nerve fiber, allowing fascicular escape and disorganized nerve repair of axons in the circulating tissue. Added to this, there may be deposition of fibroblasts, schawann cells, which usually evolve with neuroma formation. After neuroma formation internal neurolysis may be indicated, with subsequent nerve autograft to supply the motor and sensory needs related to the median nerve damage.
Final Comments
The case reported and the publications raised bring to light the discussion of the therapy of a complex situation that is postoperative neuroma and show that although adopted in a minority of cases, when well performed and in properly selected patients, internal neurolysis associated with autogenous graft is able to obtain satisfactory and lasting results regarding symptomatic relief.

Palavras Chave

SÍNDROME DO TÚNEL DO CARPO, NEUROMA, NEUROPATIA PERIFÉRICA