Disclosures: Farah S. Hussain, MD: No financial relationships or conflicts of interest

Case Diagnosis: 58-year-old female with right wrist pain, right hand paresthesia and volar wrist mass.

Case Description: The patient was referred for ultrasound assessment of a suspected ganglion cyst prior to possible aspiration. She reported a progressively enlarging wrist mass present for several months with tingling in the fingers. Her symptoms were worse with activity. She had no prior imaging or electrodiagnostic studies. A wrist brace provided no benefit. Examination revealed a palpable, firm, mobile, mildly tender mass at the volar aspect of the distal forearm with diminished sensation to light touch in the distribution of portions of the median nerve.

Setting: Outpatient PM&R officeAssessment/

Results: High frequency ultrasound of the right wrist demonstrated a hyperechoic 1.1 x 1.3 x 0.4 cm solid tissue mass, with heterogeneous features, compressing the median nerve. The mass was well circumscribed and did not appear continuous with the underlying nerve. Additionally, there was a second region of compression at the carpal tunnel outlet. The median nerve in the proximal forearm measured 5mm2, but measured 9mm2 and 13mm2 just proximal to the area of entrapment at the mass and carpal tunnel inlet respectively. The evaluation also included ultra-high-frequency transducers of 48 and 70 megahertz.

Discussion: Solid tissue tumors and masses are a rare cause of median nerve entrapment, with ganglion cysts being the most common around the hand and wrist. Ultrasound allowed clear visualization of the mass and its characteristics. Furthermore, this case demonstrates the value of high frequency ultrasound when compared to traditional electrophysiologic studies in distinguishing the cause of this patient’s symptoms in the setting of multiple areas of focal nerve entrapment.

Conclusion: Ultrasound is an excellent modality in assessing multifocal nerve entrapment. The imaging provided important information on the mass, as well as its impact on the nerve leading to appropriate management decisions.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-evaluation-of-a-median-nerve-double-crush-from-tumor-and-the-carpal-tunnel-a-case-report/