Carpometacarpal subchondral cysts due to repetitive movements in shoemaker: A case report

Objectives: Subchondral carpometacarpal cysts are classic and almost pathognomonic lesions found in workers using vi-brating instruments over prolonged periods of time. Materials and Methods: We present the case of a 53-year-old woman who worked for 30 years sewing shoe uppers, a task which required grasping firmly a pear-shaped handle awl and pushing it through the leather upper and the sole of the shoe, with combined flexion and supination movement of the wrist. After ap-proximately 20 years of working, the patient noted gradual onset of paresthesias in the dominant (right) hand, with increas-ing difficulty in grasping the awl. Subsequent diagnosis of carpal tunnel syndrome was confirmed by electrophysiologic test-ing and its surgical release was performed. Nevertheless, hand pain, paresthesias and weakness persisted. Results: Ultra-sound of the snuffbox tendons excluded DeQuervain tenosynovitis. Radiographic imaging of the symptomatic hand showed carpometacarpal subchondral cystic formations. Conclusions: 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 move-ments with high pressure over the palmar carpal area may cause bone cysts, even if the subjects do not use vibrating tools.