A Case of Carpal Tunnel Syndrome Resulting from Interference Screw Malposition after LRTI

Many approaches to CMC arthroplasty have been described for treatment of advanced arthritis, yet there is no consensus on the "best" operation. Implantable hardware is increasingly utilized for metacarpal suspension, but few hardware-mediated complications have been documented. Here we present the case of a 69-year-old man with insidious-onset median neuropathy following ligament reconstruction and tendon interposition for CMC arthritis, utilizing interference screw fixation. After surgery, the patient developed median neuropathy, and his physical examination and MRI demonstrated a mass in the volar wrist. Operative exploration revealed an interference screw that was lodged immediately volar to the transverse carpal ligament, causing median nerve compression. Median neurolysis and screw removal led to symptom resolution. Carpal tunnel syndrome is an unreported complication of interference screw use during thumb CMC arthroplasty, and should be considered in patients with postoperative median neuropathy following ligament reconstruction and tendon interposition.