Painless Ulcers on the Fingers: An Unusual Presentation of Severe Bilateral Carpal Tunnel Syndrome Úlceras digitales indoloras como presentación inusual de síndrome de túnel carpiano bilateral severo

Carpal tunnel syndrome (CTS), the most frequent type of entrapment neuropathy, is caused by compression of the median nerve inside the tunnel formed by the wrist bones and the carpal annular ligament. This condition affects between 1% and 3% of the population, and it is 4 times more common in women than in men. Incidence peaks between the fourth and sixth decade of life, and more than 50% of cases are bilateral. Although most cases are idiopathic, the compression of the nerve is occasionally due to a combination of factors that increase pressure on this nerve. CTS commonly presents with a triad of nocturnal pain, hypoesthesia, and thenar atrophy. We describe a case of CTS that was diagnosed based on the presence of painless cutaneous ulcers with a characteristic location. An 86-year-old male nonsmoker with a history of cardiac arrhythmias and lower urinary tract symptoms was referred to our unit with painless ulcers on both hands that had appeared 1 month earlier. He was on treatment with furosemide, acenocoumarol, dutasteride, and tamsulosin. During the physical examination, we observed lesions on several fingers of both hands, bullous lesions on the thumbs, and ulcers on the tips of the index and middle fingers of the right hand and middle finger of the left hand. In addition, a short distal phalanx and a short, wide fingernail were observed in the right index finger (Figs. 1 and 2). Radial and brachial peripheral pulses were normal.