Acral ulcerations: An unusual presentation of carpal tunnel syndrome

A 92 year-old woman with history of carpal tunnel release ten years ago, consulted for 1-year history of painless subungual ulcers on the second and third fingers of the right hand (Figure 1). Physical examination also showed a short distant phalanx on the second right finger. No sclerodactyly, telangiectasias or calcifications were present. Capillaroscopy and blood test showed no abnormalities. A biopsy disclosed epidermal ulceration with mild chronic inflammation without signs of vasculitis or thrombosis. Hand X-rays revealed bone resorption in the distal phalanx of the right index finger (Figure 2). An electroneuromyography disclosed severe median nerve damage. A diagnosis of an ulcerative variant of Carpal Tunnel Syndrome was made and the patient was referred to the traumatologist for a newly surgical decompression of the median nerve.