A 21 -year-old male presented to Aster Hospital, Qusais with an accidental incised wound over his left wrist which was primarily sutured in his home country three years ago. His wound healed, however, he was experiencing severe pain in the lateral half of his left hand and began losing power in the lateral 3 fingers. He also noticed a swelling at the site of the suture which was painful to touch and felt excruciating pain when he hit his wrist against any hard object.
He was clinically examined by Dr. Hariharan and the findings showed that the mass was subcutaneous, mobile, non pulsatile and appeared firm. A Nerve Conduction Study (NSC) was done which showed Carpal Tunnel Syndrome. Furthermore, an MRI test revealed Lt Median Nerve Neuroma with Carpal Tunnel Compression
“This was a case of Median Nerve injury which had gone for healing with the formation of a local Neuroma. The patient was experiencing more pain as it was under the carpal tunnel”, explained Dr. Hariharan.
In consensus with Dr. Arun Krishnan, Specialist Orthopedician, a combined decision for surgical intervention was made. The patient was planned surgery for Carpal Tunnel release and excision of the Median Nerve Neuroma. The release of the Carpal Tunnel was done under general anesthesia.
The tumor was carefully excised from the surrounding tissue, trying to keep the nerve intact.Intraoperative Neuromonitoring was utilized, therefore, the viable portion of the nerve was left intact and the non-viable portions of the Neuroma were excised. The biopsy report also showed featiures consistent with Neuroma.
Post-op, the patient had a significant positive outcome with disfunctions at the distal region of the injury. He started regaining his muscle power, however, some numbness persisted.
In light of this case, Dr. Hariharan stated, “Hand injuries must be carefully examined, especially when it involves the nerves near the anatomic and neurovascular complexity of the hand. Incised wounds over nerves should be carefully inspected for nerve injuries. It should be noted that primary suturing of such wounds can lead to post traumatic neuromas. These neuromas are a cause of pain and discomfort which may need surgical intervention at later point in time.”