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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(06): 750-754
DOI: 10.1055/a-1947-2834
Hand/Peripheral Nerve
Case Report

Trigger Wrist with Carpal Tunnel Syndrome Accompanied with Trifid Median Nerve: A Case Report and Literature Review

Sangho Oh 
1   Department of Plastic and Reconstructive Surgery, Saeson Hospital, Daejeon, Republic of Korea
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Abstract

Trigger wrist, characterized by a clicking or snapping sensation around the wrist joint during finger or wrist motion, and bifid or trifid median nerve, which occurs in carpal tunnel syndrome along with anatomical variation of median nerve, are rare conditions. We report the case of a patient with a thickened tendon caused by severe tenosynovitis and flexor tendon subluxation to the hamate hook due to bowing of the flexor retinaculum, thereby resulting in trigger wrist as well as an anatomical median nerve variation (bifid median nerve in the right wrist and trifid median nerve in the left wrist). A 59-year-old housewife visited our hospital with bilateral fingertip numbness, tingling sensation, and aggravated severe night cramping that began 2 months ago. She also complained about trigger wrist during small finger flexion. Based on magnetic resonance imaging, ultrasonography, and nerve conduction study, trifid median nerve and bilateral severe median nerve neuropathy of the wrist were diagnosed; therefore, transverse carpal tunnel release and exploration under wide-awake anesthesia were planned. Intraoperative findings showed trifid and bifid median nerves in left and right wrists, respectively. Additionally, bowing of flexor retinaculum and severe flexor tendon tenosynovitis were observed. Tenosynovitis with thickened flexor sheath resulted in subluxation of the small finger flexor tendon above the hamate hook. After transverse carpal ligament release with antebrachial fascia release and tenosynovectomy, subluxation of the flexor tendon was resolved. At 6 months postoperatively, the tingling and dullness in fingertips also resolved, and no trigger wrist or any other complications were noted.

Keywords

trigger wrist - carpal tunnel syndrome - trifid median nerve - bifid median nerve - median nerve neuropathy

Ethical Approval

This study was approved by the institutional review board of Korea National Institute for Bioethics Pollicy (IRB No. KoNIBP P01-202203-01-031).


Sources of Support

Nothing to disclose


Patient Consent

Written informed consent was obtained for publication of this article and accompanying images.


Author Contribution

Conceptualization, Data curation, Visualization, Writing -original draft and review, editing: S.H Oh.




Publication History

Received: 06 June 2022

Accepted: 14 September 2022

Accepted Manuscript online:
19 September 2022

Article published online:
13 December 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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