The 'Unusual' Distal Median Nerve Neuropathy: new insights in diagnose and treatment.

The ‘Unusual’ Distal Median Nerve Neuropathy: new insights in diagnose and treatment. From diagnose of concomitant pathologies in carpal tunnel disease To treatment possibilities in exceptional cases of distal median nerve neuropathy Concluding into final options with therapy resistent patients Implementing questions from the base into daily practice providing out-of-the-box thoughts to the practitioner. Congenital Carpal tunnel syndrome: de novo FBN-2 gene mutation. Distal non traumatic median nerve neuropathy in children is very rare. We identified a novel fibrillin-2 gene mutation in a family with also brachydactyly and short achilles tendon. Further on facial dysmorphism with nose anomalies and almond-shaped eyes are present. Mental development is normal. The full pedigree of this family is described by analyzing the clinical symptoms, the preoperative investigations and the operative treatment options and flowchart. Meanwhile we search for other families around the world and in the UZ Leuven database, enrolling the cases published before by DeSmet et al. The description and publication of this particular congenital new etiology for carpal tunnel syndrome is really important to emphasize a greater awareness in this very young population. Especially concerning the preservation and follow-up of their future sensory and motor function. 2. Carpal tunnel syndrome & Amyloidosis. Recent literature report bilateral carpal tunnel syndrome complaints as an early symptom in cardiac amyloidosis. Importance of treatment of this cardiac amyloidosis in a non advanced stage is mandatory to prevent complications. Medical treatment can so be started in non symptomatically patients. A new algorithm screening protocol is developed to collect and follow-up this patients in close contact with the cardiology, hematology, nuclear medicine and anatomo pathology departments. Discovering the treatable patient in an early stage is of great value and can prolong their live expectancy in a considerable way. 3. Carpal tunnel syndrome: revision surgery & tumours. The hypothenar fat flap technique is the preferred method for revision surgery. A review of the literature is initiated to reveal the type of this specific operative technique of choice. In the cadaver lab we search for the confirmation of the stated scientific questions. We propose the set-up of a randomized clinical trial with follow-up of the different proposed operative techniques. Postoperative evaluation is done by ultrasonography. We state this non invasive examination to be the better way for long term monitoring. Tumours of the distal median nerve are rather exceptional but are a great challenge for symptomatic patients. We describe some specific benign tumours of the median nerve (fibrolipomatous hamartoma, schwannoma, posttraumatic neurinoma) after their first or secondary interventions and with important residual complaints. Even salvage procedures didn’t solve the symptoms of the patients. In this specific cases peripheral neuromodulation can be a symptomatic treatment option. New peripheral modules are in favor now. As there are no simple diagnoses in medicine, this scientific work explores and assembles specifically the borders of the distal median nerve pathology to collaborate to new insights and treatments.