Ultrasound Case Study
Lipoma compressing the median nerve at the wrist
Suresh Sudula, Consultant Physiotherapist/MSK Sonographer
This gentleman, in his late 50’s, presented with a lump over the volar wrist which had been there for a couple of years. He reported that the lump was not getting any bigger in size or painful, however he noticed the development of paraesthesia in the hand over the last 6/12. He had been referred to hand surgeon who asked for an ultrasound scan of the lump. Specifically the nature and anatomical relation to the median nerve.
The report for the ultrasound images in the gallery above was ‘There is a subcutaneous soft tissue mass which measures 1.5 x 0.5cm in diameter noted outside of the flexor retinaculum over the proximal carpal tunnel. There is no evidence of aggressive features or vascularity noted of the soft tissue mass however it is compressing median nerve over the proximal carpal tunnel. Appearances are consistent with subcutaneous lipoma of right volar wrist compressing the median nerve over proximal carpal tunnel.’
This patient is now awaiting surgical removal of the lipoma.
Readers may find this free text article of interest by Valbuena et al (2008) demonstrating a giant lipoma compressing the median nerve at the elbow. Particularly interesting dissection images during surgery, over the altered shape of the median nerve consistent with the images in this case.