Acute atraumatic carpal tunnel syndrome due to flexor tendon rupture following palmar plate osteosynthesis in a patient taking rivaroxaban
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Few case reports describe the development of a hematoma under oral anticoagulation as the cause of an atraumatic carpal tunnel syndrome.
A 76 years old woman presented an acute atraumatic carpal tunnel syndrome of her left hand under oral anticoagulation with rivaroxaban due to atrial fibrillation. 12 years ago, palmar plate osteosynthesis of a distal radius fracture had been performed on the affected wrist. Open decompression of the carpal canal was performed due to persistent severe pain under intense pain therapy and progressive neurological symptoms. The cause of the pain was a hematoma due to a rupture of the flexor pollicis longus and the second flexor digitorum profundus tendon with concomitant synovitis at the plate’s distal rim. After decompression, pain relieved and neurological deficits improved rapidly.
Ruptures of the flexor tendons occur in palmar plate osteosynthesis in up to 1.5% in the long term postoperative course. Very distal plate positions, like in this case, increase that risk. Under anticoagulation, the rupture induced a hematoma increasing local pressure resulting in an acute carpal tunnel syndrome. Acute nerve compression syndromes should be treated surgically without delay.
Therapy with anticoagulants may increase hematoma after tendon rupture, thus supporting the development of an atraumatic acute carpal tunnel syndrome and complicating the surgical therapy. Hardware removal after fracture healing should be advised in patients with Soong grade 2 plate positions especially those taking anticoagulants.
KeywordsOral anticoagulants Carpal tunnel syndrome Tendon rupture Palmar plate osteosynthesis
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Conflict of interest
Wolfram Weschenfelder, Reinhard Friedel, Gunther O. Hofmann and Mark Lenz declare that they have no conflict of interest.
Research involving human and/or animal participants
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 1.Komura S, Hirakawa A, Masuda T, Ito Y, Akiyama H (2017) Recurrent atraumatic acute carpal tunnel syndrome due to hematoma caused by distal radioulnar joint arthritis during anticoagulant treatment with apixaban. Arch Orthop Trauma Surg 137:1161–1164. https://doi.org/10.1007/s00402-017-2730-y CrossRefGoogle Scholar
- 6.Orbay JL, Touhami A (2006) Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop Relat Res 445:58–67. https://doi.org/10.1097/01.blo.0000205891.96575.0f Google Scholar
- 10.Szabo RM (1998) Acute carpal tunnel syndrome. Hand Clin 14:419–429, ixGoogle Scholar
- 13.Sjogren V, Bystrom B, Renlund H, Svensson PJ, Oldgren J, Norrving B, Sjalander A (2017) Non-vitamin K oral anticoagulants are non-inferior for stroke prevention but cause fewer major bleedings than well-managed warfarin: a retrospective register study. PLoS One 12:e0181000. https://doi.org/10.1371/journal.pone.0181000 CrossRefGoogle Scholar