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CASE REPORT
A 40-year-old right hand dominant man who works as a professional wrestler was evaluated for intermittent bilateral hand paresthesia and anesthesia in the distribution of the median nerve. The patient's left hand was more symptomatic than the right. The patient's symptoms were present for 4 years and had been treated for the last year with night splints and oral non-steroidal antiinflammatory medication.
Physical examination revealed good intrinsic muscle strength, no atrophy, good thenar and hypothenar muscle strength, and no weakness of wrist extensors. Two-point discrimination over both hands was within normal limits. He had a positive Phalen's test, positive reverse Phalen's, and positive Tinel's sign bilaterally as well as a positive carpal tunnel compression test bilaterally.
The patient had median nerve conduction studies performed in 1 986 which were reported as normal. Repeat median and ulnar nerve conduction studies in 1990 showed normal nerve conduction velocities in the left and right median nerves, at 53 and 54 m/sec. There were normal distal motor latencies in both median nerves, absent distal sensory latency on the left, and prolonged distal sensory latency on the right median nerve. The left ulnar distal motor latency was slightly prolonged at 4.3 milliseconds and there was a normal ulnar distal sensory latency on the left.
A carpal tunnel decompression was performed through a zigzag incision ulnar to die long axis of the ring finger.1 The dissection was deepened along the ulnar border of the palmaris longus tendon. The superficial transverse carpal ligament was incised longitudinally. The median nerve was identified and dissection was extended distally and proximal Iy. The deep volar carpal ligament was transected in the usual fashion and was noted not to be markedly thickened nor compressing the median nerve.
The carpal runnel contained normal appearing flexor superficialis and flexor digitorum profundus tendons in...