Objective: OBJECTIVE: To describe a case of a dystonic tremor improvement following treatment of a peripheral nerve lesion, in this case carpal tunnel release surgery.

Background: BACKGROUND: The pathophysiology of dystonia and dystonic tremors is complex and includes loss of surrounding inhibition in the cerebral cortex and reduced reciprocal inhibition at many levels of the motor system. Previous cases of peripherally induced dystonic tremors exist in the literature, but there are no previous reports of improvement of the tremor following carpal tunnel release surgery.

Methods: METHODS: The patient is a 66 year old right handed Caucasian male who was referred for evaluation of a new onset tremor. The tremor symptoms began 3 months prior to the initial visit and were localized to the left hand. Upon physical examination, he did not have a rest tremor but was found to have a 5 cm large amplitude, 5-6Hz  tremor that appeared when the arm was held flexed at the wrist and at the elbow which was consistent with a dystonic tremor. Brain MRI and workup for Wilson ’s disease was negative. Patient reported symptoms of carpal tunnel syndrome (CTS) and underwent electromyography (EMG) testing, which showed findings consistent with severe CTS in his left wrist with denervation occurring. The patient underwent carpal tunnel release surgery.

Results: RESULTS: One week after the surgery patient started to notice improvement in tremor which continued to improve over the next few weeks. There was marked improvement in the frequency and the amplitude of the tremor.

Conclusions: CONCLUSIONS: The patient’s clinical improvement of the dystonic tremor suggests that his tremor had a peripheral cause secondary to his carpal tunnel syndrome. This finding suggests the importance of consideration of peripheral causes of focal dystonic tremors if central causes have been ruled out. Furthermore, this case suggests that treatment of the peripheral lesion in these cases can lead to improvement of their dystonic tremor.

References: 1: Costa, MD., J. et al. “Upper Limb Tremor Induced by Peripheral Nerve Injury.” Neurology 67 (2006): 1884–1886. Web.

2: Iyer, Vasudeva , and Sunil Thirkannad. “Focal Hand Dystonia in a Patient with Ulnar Nerve Neuropathy at the Elbow.” Hand, American Association for Hand Surgery 2010 (2010): 453–456. Web.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/improvement-in-hand-tremor-following-carpal-tunnel-release-surgery/