Disclosures: Yingrong Zhu, MD: No financial relationships or conflicts of interest

Case Description: The patient presented with a 3 month history of right wrist mass and discomfort. In the last month, the mass enlarged and became associated with audible popping and progression of symptoms now impairing an ability to write or type. No associated numbness or paresthesia were present. Of note, no symptoms were present with wrist in neutral position and only appeared with wrist flexion greater than 20 degrees.

Setting: Veterans Affairs physiatry clinic

Patient: 64-year-old, otherwise healthy, right-handed male Assessment/

Results: On exam, there were no visible deformities. Palpable soft mass associated with clunk present with right wrist flexion. Full range of motion present in wrist and fingers. Strength and sensation intact. Negative Tinel’s and Phalen’s tests. Ultrasound of right wrist showed a hyperechoic mass in the ulnar aspect abutting flexor digitorum superficialis and flexor digitorum profundus tendons measuring 0.87 cm. MRI corroborated a well-defined, heterogeneous T1 hyperintense mass measuring 1.8×0.8×0.8 cm. Signal lost on fat-suppressed images. Lipoma at carpal tunnel diagnosed. Patient subsequently referred to orthopedic surgery for excision of mass.

Discussion: This case illustrates an instance of functional carpal tunnel syndrome (CTS) as the median nerve did not meet sonographic criteria for CTS. Ultrasound is able to distinguish between solid and cystic masses, as well as presence of vascularity. In this case, it was used to diagnose lipoma rather than ganglion cyst which is a more common cause of CTS. POC ultrasound also provides immediate imaging correlation with physical exam assisting with diagnosis of uncommon presentations.

Conclusion: POC ultrasound is a valuable asset to real time diagnosis in outpatient practice, particularly in unconventional presentations as in this case of a functional CTS.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/lipoma-causing-a-functional-carpal-tunnel-syndrome-a-case-report/