warfarin and Carpal-Tunnel-Syndrome

In the perioperative period, patients who are under anti-thrombotic therapy should be managed with care, although there is no clear consensus on this matter. For hand surgery, several authors have advocated no interruption of the anti-thrombotic therapy, but the choice differs between institutes according to protocols and surgeons' preference. We report a case of massive pulmonary embolism after stopping warfarin for carpal tunnel release in a patient with a previous history of pulmonary embolism. Although the patient recovered after thrombolytic therapy and intensive care unit (ICU) care, this case has struck the authors as a valuable lesson. In managing anti-thrombotic therapy, we should weigh the risks and benefits of the patients carefully before making a decision.

Topics: Anticoagulants; Carpal Tunnel Syndrome; Female; Follow-Up Studies; Heparin; Humans; Middle Aged; Postoperative Complications; Preoperative Care; Pulmonary Embolism; Radiography; Recovery of Function; Recurrence; Retreatment; Thrombolytic Therapy; Warfarin; Withholding Treatment; Wound Healing

Performance of joint and soft tissue injections in patients receiving anticoagulation is subject to different protocols, some of which suggest continuing treatment within the therapeutic range, while others recommend stopping the treatment prior to procedures. The aim of this study was to evaluate the safety of two approaches to the management of patients prescribed warfarin requiring joint or soft tissue injection. A systematic literature review on this subject was undertaken. Our departmental protocol was changed from one where anticoagulation treatment was temporarily stopped prior to joint/soft tissue injection to one where treatment was continued in the context of a therapeutic international normalised ratio (INR) level within 24 h of the procedure. In patients in whom warfarin was withheld, 32 procedures were performed in 18 patients (13 rheumatoid arthritis, 11 osteoarthritis, 5 spondyloarthritis and 1 each of adhesive capsulitis, rotator cuff tendinopathy and trochanteric bursitis). Of these, 30 were joint injections and 2 were soft tissue injections. In patients who continued warfarin, 32 procedures were performed in 21 patients (11 rheumatoid arthritis, 7 osteoarthritis, 6 crystal arthritis, 4 rotator cuff tendinopathy, 2 spondyloarthritis and 1 each of adhesive capsulitis and carpal tunnel syndrome). Of these, 27 were joint injections and 5 were soft tissue injections. There were no clinical hemarthroses or complications in either group. Joint and soft tissue injections appear to be safe in patients receiving warfarin anticoagulation with an INR <3. Continuation of anticoagulants reduces staff workload and patient inconvenience with no evidence of increased risk of complications.

Topics: Aged; Aged, 80 and over; Anticoagulants; Arthritis, Rheumatoid; Bursitis; Carpal Tunnel Syndrome; Cohort Studies; Elbow Joint; Female; Humans; Injections, Intra-Articular; International Normalized Ratio; Knee Joint; Male; Osteoarthritis; Prospective Studies; Rheumatology; Shoulder Joint; Spondylarthritis; Warfarin

Acute carpal tunnel syndrome following anticoagulation is uncommon. We describe a case in which the diagnosis was missed on three previous presentations by several clinicians. Although the presentation is typical, lack of awareness of this complication, inability to notice subtle signs and failure to do INR may lead to missing the diagnosis.

Topics: Aged; Anticoagulants; Carpal Tunnel Syndrome; Hematoma; Humans; International Normalized Ratio; Magnetic Resonance Imaging; Warfarin

We reviewed 22 patients who had undergone either carpal tunnel decompression or release of Dupuytren's contractures while anticoagulated with warfarin. All patients continued with their usual anticoagulant regime over the period of operation, provided that the international normalized ratio (INR) was 3 or less. There was no abnormal intraoperative or postoperative bleeding in any patient. Journal of Hand Surgery (British and European volume, 2004).

Topics: Anticoagulants; Cardiovascular Diseases; Carpal Tunnel Syndrome; Cerebrovascular Disorders; Dupuytren Contracture; Heart Valve Prosthesis; Humans; International Normalized Ratio; Outcome Assessment, Health Care; Warfarin

Acute carpal tunnel syndrome is well recognized in patients with haemophilia and conservative management with factor replacement and temporary splinting is recommended. There have, however, been very few reported cases of acute carpal tunnel syndrome as a complication of oral anticoagulant therapy. We describe such a case in a patient on long-term warfarin anticoagulation, drawing attention to particular features of the history and clinical findings. In contrast to previous reports, we recommend prompt decompression under local anaesthesia and continuation of the anticoagulant therapy.

Topics: Anticoagulants; Aortic Valve; Carpal Tunnel Syndrome; Decompression, Surgical; Heart Valve Prosthesis; Hematoma; Humans; Male; Middle Aged; Postoperative Complications; Warfarin

Acute carpal tunnel syndrome secondary to intraneural hemorrhage of the median nerve is an unusual event. Most reports involve hemophiliacs. Only rarely has this disorder occurred in a patient receiving anticoagulation therapy, and in these cases there is usually a history of trauma. We recently treated a 42-year-old patient receiving Coumadin medication who presented with acute carpal tunnel syndrome and who denied any history of trauma. Following the initial carpal tunnel release and drainage of hematoma, the patient was restarted on anticoagulation therapy and developed recurrent bleeding requiring a second surgical exploration. The patient eventually experienced complete recovery of median nerve and hand function.

Topics: Acute Disease; Adult; Carpal Tunnel Syndrome; Hemorrhage; Humans; Male; Median Nerve; Postoperative Period; Recurrence; Warfarin

The case of a 26-year-old patient who developed acute carpal tunnel syndrome while taking warfarin (Coumadin) is reported. She underwent carpal tunnel release with complete resolution of symptoms. We found reports of two other patients taking Coumadin with acute carpal tunnel syndrome. In all three cases, discontinuation of Coumadin therapy and open surgical release of the carpal tunnel led to a good result.

Topics: Acute Disease; Adult; Carpal Tunnel Syndrome; Female; Hand Injuries; Hematoma; Humans; Warfarin

This is a case report of a 66-year-old female who had been taking coumadin for 4 weeks for deep vein thrombosis. She developed acute carpal tunnel syndrome following minor trauma to her wrist. After conservative therapy failed to relieve her symptoms she underwent release of her carpal tunnel with resolution of her symptoms. While there are many patients taking coumadin, its association with acute carpal tunnel syndrome is quite rare: we were only able to find only one other reported case in the literature. While one is tempted to treat these patients conservatively, operative therapy may be indicated.

Topics: Acute Disease; Aged; Carpal Tunnel Syndrome; Female; Hematoma; Humans; Warfarin

A case of acute compression neuropathy of the median nerve associated with haemorrhage into the carpal tunnel is presented. The condition occurred spontaneously in a patient on Warfarin for previous deep venous thrombosis. The signs and symptoms were those of acute tenosynovitis originating in the common flexor synovial sheath at the wrist with associated paraesthesia in the distribution area of the median nerve in the hand. The patient was afebrile and blood tests were normal.

Topics: Carpal Tunnel Syndrome; Female; Hemorrhage; Humans; Middle Aged; Thrombophlebitis; Warfarin; Wrist