CARPAL-TUNNEL SYNDROME PRESENTING AS SCLERODACTYLIA, NAIL DYSTROPHY AND ACROOSTEOLYSIS IN A 60-YEAR-OLD WOMAN

Shin changes associated with carpal tunnel syndrome have rarely been r eported. A 60-year-old patient was referred to our Department of Derma tology for evaluation of an aseptic gangrene of the distal phalanx of the third finger of her left hand, progressive nail dystrophy, sclerod actylia and spontaneous ulcerations. These features were seen on the d igits with sensory supply from the median nerve. The patient had hand paresthesias for at least 10 years. No abnormal results were found in biochemical, hematological or immunological determinations. An echo-Do ppler study of the upper limbs was normal. An electromyographic study was consistent with a bilateral carpal tunnel syndrome (CTS). Ulcerati ve and mutilating CTS can occasionally produce sclerodactylia with ulc erative lesions on distal fingers, nail dystrophy and acro-osteolysis as a consequence of mechanical compression of the autonomic fibers of the median nerve. The clinical picture includes Raynaud's phenomenon i n some patients. Correct diagnosis is important, since ulcerative and mutilating CTS is a marker of a severe neural lesion, which is amenabl e to treatment by surgical decompression.