Spontaneous acute carpal tunnel syndrome in an anticoagulated patient

Acute carpal tunnel syndrome secondary to intraneural hemorrhage of the median nerve is an unusual event. Most reports involve hemophiliacs. Only rarely has this disorder occurred in a patient receiving anticoagulation therapy, and in these cases there is usually a history of trauma. We recently treated a 42-year-old patient receiving Coumadin medication who presented with acute carpal tunnel syndrome and who denied any history of trauma. Following the initial carpal tunnel release and drainage of hematoma, the patient was restarted on anticoagulation therapy and developed recurrent bleeding requiring a second surgical exploration. The patient eventually experienced complete recovery of median nerve and hand function.