Bilateral Ulcerative Carpal Tunnel Syndrome: A Case Report

Ulcerative carpal tunnel syndrome (UCTS) is a rare, cutaneous manifestation of severe median neuropathy. We present a woman in her 60s with poorly controlled type 2 diabetes mellitus with an HbA1c of 9.5 who reported painless vesicles and presented with erosions involving bilateral median nerve distribution. Examination showed erosions with re-epithelialization of the phalanges and bilateral thenar atrophy, with associated nocturnal paresthesias. Nerve conduction studies confirmed severe bilateral median neuropathy at the wrists, consistent with carpal tunnel syndrome. Surgical decompression was recommended but deferred pending improved glycemic control, and conservative management was pursued. This case highlights the importance of recognizing UCTS in patients with diabetes and digital ulcerations. Careful assessment of lesion distribution may help distinguish UCTS from more common diabetic neuropathic or microvascular complications and prevent delayed diagnosis.