Many anatomical variations exist in and around the carpal tunnel. However, symptomatic anomalies causing carpal tunnel syndrome is rare. Additionally, carpal tunnel surgery is considered a simple operation commonly done by junior surgeons who are usually unaware of variations resulting in unfavorable surgical outcomes. We highlight a case of lumbrical muscle variation causing carpal tunnel syndrome. A 73-year-old male presented with numbness and pain of both hands associated with abnormal fullness over both wrists and distal forearms. Initially the right hand was numb and subsequently a year later, the left hand became numb. Physical examination was positive for Durkan, Phalen and Tinel signs at the carpal tunnel. Magnetic Resonance Imaging (MRI) showed abnormal muscle tissues in the carpal tunnel. During the carpal tunnel release and exploratory surgery, we noted an abnormally proximal origin of the lumbrical muscles in the forearm rather than the typical palmar origin. He also had lumbrical muscle hypertrophy in the left side. These two factors resulted in overcrowding within the carpal tunnel. Post-operatively the patient recovered well with pain relief and gradual improvement of his numbness. Variations in the anatomy of the lumbrical muscles is not uncommon and may result in carpal tunnel syndrome. Hence, carpal tunnel release surgeries may not be as straight forward as expected and surgeons should be aware of this possibility.
Anatomical Variations of the Lumbrical Muscles Causing Carpal Tunnel Syndrome
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Pelbagai jenis variasi anatomi terdapat di sekeliling terowong karpal namun variasi yang menyebabkan sindrom terowong karpal jarang berlaku. Tambahan pula, pembedahan terowong karpal sering dilakukan oleh pakar bedah yang muda yang seringkali tidak sedar akan variasi anatomi menyebabkan pembedahan yang kurang memuaskan. Kami ingin memberi fokus kepada kes otot lumbrikal penyebab sindrom terowong karpal. Seorang lelaki berumur 73 tahun mempunyai simptom kebas dan sakit di kedua-dua belah tangan bersama dengan bengkak di kawasan pergelangan tangan. Pada mulanya hanya tangan kanannya yang kebas, namun setahun kemudian, tangan kirinya pula kebas. Pemeriksaan fizikal semua positif untuk pemeriksaan Durkan, Phalen dan Tinel di terowong karpal. MRI menunjukkan otot-otot yang tidak normal di dalam terowong karpal. Semasa pembedahan terowong karpal, didapati otot lumbrikal mempunyai asal yang agak proksimal di dalam lengan (forearm) dan bukan di dalam tangan seperti kebiasaannya. Juga, di sebelah kiri, ada tumbesaran otot lumbrikal yang lebih besar dari kebiasaan. Kedua faktor ini menyebabkan tiada cukup ruang di dalam terowong karpal. Selepas pembedahan, pesakit sembuh dengan baik tanpa sakit dan kebas yang berkurangan. Variasi anatomi di terowong karpal tidak jarang dan boleh menyebabkan sindrom terowong karpal. Juga, pembedahan terowong karpal tidak boleh diambil senang dan pakar bedah hendaklah mengetahui tentang kemungkinan variasi begini berlaku.
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