Abstract A rare case of acute carpal tunnel syndrome
is described. This is the first report of an acute tear
within a lumbrical muscle causing carpal tunnel syn-
drome. A review of related cases in the literature is also
Keywords Carpal · Tunnel · Syndrome · Lumbrical
Acute carpal tunnel syndrome is rare in the absence of
acute wrist trauma. There have been a number of reports
of acute carpal tunnel syndrome secondary to non-trau-
matic causes such as bleeding following anticoagulation
, persistent median artery thrombosis , gout  and
pseudogout . We present what we believe is a unique
cause of acute carpal tunnel syndrome.
A 24-year-old, right hand dominant factory worker, presented with
a history of sudden onset of pain in the dominant palm and wrist.
This had started while operating a machine which involved pulling
down a spring loaded door. The patient presented to the emergen-
cy department complaining of pain in the palm and volar aspect of
the wrist and a swelling in the mid-palm. He was prescribed anal-
gesics and discharged with a high arm sling. His symptoms im-
proved but did not settle entirely and he returned to work 2 days
After 5 weeks the patient presented for the second time. He
described the sudden onset of a similar but more intense pain in
the hand and wrist when pressing a button to operate a machine.
He was referred for further investigation.
Examination revealed a swelling in the palm at the base of the
middle and ring fingers of the right hand and a diffuse swelling
just proximal to the transverse carpal ligament. The resting posi-
tion of the hand was with the metacarpophalangeal (MCP) joints
of the middle and ring fingers flexed to 90 and the proximal inter-
phalangeal (PIP) joints and distal interphalangeal (DIP) joints ful-
ly extended. The patient was in pain when attempting to flex the
fingers. The working diagnosis was rupture of the flexor digito-
rum profundus (FDP) to the middle and ring fingers. After 24 h
high elevation and analgesia, the movements of the fingers had
failed to improve and the patient had now developed paraesthesia
in the distribution of the median nerve and had persistent pain in
the wrist and palm. The patient was taken to the operating room
The palm and carpal tunnel were both explored. The operative
findings were a 30% mid-substance tear of the lumbrical to the
middle finger with fresh blood in the palm, blood in the sheath
of FDP to the ring finger and fresh blood in the carpal tunnel.
The blood was evacuated and the carpal tunnel decompressed.
The patient was discharged home on the second day postopera-
tively. Once the wounds had settled he was treated with physio-
On review in clinic 6 weeks postoperatively, the patient had
normal sensation in the fingers and palm and had regained full
movement in the fingers.
We have been unable to find any published reports of an
acute tear in a lumbrical muscle giving rise to an acute
carpal tunnel syndrome. It is unclear why the patient
should have incurred this unusual injury or whether it
was in some way related to his occupation.
Murphy et al.  report a tear at the insertion of an
anomalous lumbrical muscle causing persistent pain in
the hand. There was a history of 1 month’s duration
although, interestingly, this occurred in a manual worker
who gave a similar history of the pain starting when
pulling a weight with the ring finger in a flexed position.
The patient underwent steroid injection of the flexor
sheath and A1 pulley release before surgical exploration
some 9 months later for presumed scar adhesion revealed
the cause of the pain. Nather and Pho  describe carpal
tunnel syndrome arising secondary to an organising
G.F. Lambe (
3 Gawsworth Close, Oxton CH43 2GS, UK
G.F. Lambe · S. Scott · A. Acharya
Department of Orthopaedic Surgery, Aintree University Hospitals,
Eur J Plast Surg (2002) 25:97–98
G.F. Lambe · S. Scott · A. Acharya
Closed rupture of a lumbrical muscle
Received: 9 October 2001 / Accepted: 18 December 2001 / Published online: 8 March 2002
© Springer-Verlag 2002