Formazioni cistiche subcondrali carpo-metacarpiche in un’operaia calzaturiera [Carpometacarpal subchondral cysts in a shoemaker]

Subchondral carpometacarpal cysts are classic and almost pathognomonic lesions found in workers using vibrating instruments over prolonged periods of time. They have not yet been described in repetitive manual tasks with non-vibrating tools. We present the case of a 53 year-old-woman who worked for 30 years sewing shoe uppers, a task which requires firmly grasping a pear-shaped handle awl and pushing it through the leather upper and the sole of the shoe, with a combined flexion and supination movement of the wrist. After approximately 20 years of working, the patient noted gradual onset of paresthesias in the dominant hand, with increasing difficulty in grasping the awl. Subsequent diagnosis of carpal tunnel syndrome was confirmed by electrophysiologic testing; its surgical release was performed one month later. Nevertheless, hand pain, paresthesias and weakness persisted. Ultrasound of the snuffbox tendons excluded DeQuervain tenosynovitis. Radiographic imaging of the symptomatic hand showed arthrosis at the carpometacarpal joint and degenerative carpal cystic formations. In addition to demonstrating the usefulness of radiographic imaging in patients with persistent hand pain post-carpal release, this case is important in illustrating that repetitive movements with high pressure over the palmar carpal area can cause cysts and rhizarthrosis, even without using vibratory tools.