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First digit macrodactyly and carpal tunnel syndrome caused by giant median nerve with macrodystrophia lipomatosa
  1. Walid Moudrous1,
  2. Jasper van der Ree2,
  3. Fiek van Tilborg2,
  4. Leo H Visser1
  1. 1Department of Neurology, ETZ, locatie St Elisabeth ziekenhuis, Tilburg, The Netherlands
  2. 2Department of Radiology, ETZ, locatie St Elisabeth ziekenhuis, Tilburg, The Netherlands
  1. Correspondence to Dr Walid Moudrous, Department of Neurology, ETZ, location St. Elisabeth Hospital, P.O. Box 90151, Tilburg 5000 LC, The Netherlands; w.moudrous{at}

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A 63-year-old man reported numbness in his left first, second and third digits for 2 years. Initially, he found that ‘shaking out’ his left hand helped, but this benefit did not last. He underwent decompression of left-sided carpal tunnel syndrome 2 years earlier and his symptoms worsened after surgery, with more sensory loss and pain. He worked as a carpenter, and had injured his left thumb with nails on multiple occasions without feeling pain. On examination, he had an enlarged left thumb (figure 1), though he appeared unaware of this; his other digits were normal in size. The median nerve was palpable at the wrist, but Tinel's test was negative. There was a mild weakness of abductor pollicis brevis and opponens brevis, with reduced sensation over the fingertips …

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  • Contributors WM drafting the manuscript, JVdR supplied the radiological images. FvT and LHV revising the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Jane Pritchard, London, UK.

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