Case and Research Letters
Painless Ulcers on the Fingers: An Unusual Presentation of Severe Bilateral Carpal Tunnel Syndrome
Úlceras digitales indoloras como presentación inusual de síndrome de túnel carpiano bilateral severo
N. Ormaechea-Pérez
, M.A. Arregui-Murua, J. Zubizarreta-Salvador, A. Tuneu-Valls
Autor para correspondencia
Servicio de Dermatología, Hospital Donostia, San Sebastian, Guipúzcoa, Spain
Leído
16284
Vecesse ha leído el artículo
3000
Total PDF
13284
Total HTML
Compartir estadísticas
array:24 [ "pii" => "S1578219012000698" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.03.006" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "aid" => "460" "copyright" => "Elsevier España, S.L. and AEDV" "copyrightAnyo" => "2010" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2012;103:159-61" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5311 "formatos" => array:3 [ "EPUB" => 50 "HTML" => 4433 "PDF" => 828 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731011003358" "issn" => "00017310" "doi" => "10.1016/j.ad.2010.11.010" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "aid" => "460" "copyright" => "Elsevier España, S.L. y AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2012;103:159-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8738 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 7200 "PDF" => 1537 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Úlceras digitales indoloras como presentación inusual de síndrome de túnel carpiano bilateral severo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "159" "paginaFinal" => "160" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Painless Ulcers on the Fingers: An Unusual Presentation of Severe Bilateral Carpal Tunnel Syndrome" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 590 "Ancho" => 950 "Tamanyo" => 69390 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Detalle de las úlceras en pulpejos de dedos índice y medio de mano derecha.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Ormaechea-Pérez, M.A. Arregui-Murua, J. Zubizarreta-Salvador, A. Tuneu-Valls." "autores" => array:4 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Ormaechea-Pérez" ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "Arregui-Murua" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Zubizarreta-Salvador" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Tuneu-Valls." ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219012000698" "doi" => "10.1016/j.adengl.2012.03.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000698?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011003358?idApp=UINPBA000044" "url" => "/00017310/0000010300000002/v1_201304241353/S0001731011003358/v1_201304241353/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1578219012000704" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.03.007" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "aid" => "462" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2012;103:161-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3768 "formatos" => array:3 [ "EPUB" => 49 "HTML" => 3071 "PDF" => 648 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Localized Primary Cutaneous Nodular Amyloidosis in a Patient With Paraproteinemia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "161" "paginaFinal" => "163" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Amiloidosis nodular primaria cutánea localizada en un paciente con paraproteinemia" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1020 "Ancho" => 1587 "Tamanyo" => 132614 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Well-defined, shiny, reddish-orange plaque with an area of ecchymotic appearance, and 2 firm nodules covered by reddish-orange skin except for one area of ulceration, located in the left lower limb.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Villar, M. Burgués, J.L. Rodríguez-Peralto, R. Rivera, F. Vanaclocha" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Villar" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Burgués" ] 2 => array:2 [ "nombre" => "J.L." "apellidos" => "Rodríguez-Peralto" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Rivera" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Vanaclocha" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731011003371" "doi" => "10.1016/j.ad.2011.05.017" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011003371?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000704?idApp=UINPBA000044" "url" => "/15782190/0000010300000002/v1_201304241253/S1578219012000704/v1_201304241253/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219012000686" "issn" => "15782190" "doi" => "10.1016/j.adengl.2012.03.005" "estado" => "S300" "fechaPublicacion" => "2012-03-01" "aid" => "441" "copyright" => "Elsevier España, S.L. and AEDV" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Actas Dermosifiliogr. 2012;103:157-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4036 "formatos" => array:3 [ "EPUB" => 54 "HTML" => 3186 "PDF" => 796 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Persistent Labial Edema Secondary to Hemifacial Spasm" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "157" "paginaFinal" => "158" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Edema labial persistente secundario a espasmo hemifacial" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2002 "Ancho" => 1500 "Tamanyo" => 466406 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histology revealed labial edema with slight ectasia of the lymphatic vessels in the specimen, with no granulomatous lesions or other inflammatory lesions (hematoxylin–eosin, original magnification ×10).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Bella-Navarro, V. Alonso-Usero, E.M. Gutiérrez Paredes, E. Jordá-Cuevas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Bella-Navarro" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Alonso-Usero" ] 2 => array:2 [ "nombre" => "E.M." "apellidos" => "Gutiérrez Paredes" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Jordá-Cuevas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731011003164" "doi" => "10.1016/j.ad.2011.05.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011003164?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000686?idApp=UINPBA000044" "url" => "/15782190/0000010300000002/v1_201304241253/S1578219012000686/v1_201304241253/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Painless Ulcers on the Fingers: An Unusual Presentation of Severe Bilateral Carpal Tunnel Syndrome" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "159" "paginaFinal" => "161" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "N. Ormaechea-Pérez, M.A. Arregui-Murua, J. Zubizarreta-Salvador, A. Tuneu-Valls" "autores" => array:4 [ 0 => array:4 [ "nombre" => "N." "apellidos" => "Ormaechea-Pérez" "email" => array:1 [ 0 => "nereaorma@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "Arregui-Murua" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Zubizarreta-Salvador" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Tuneu-Valls" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Donostia, San Sebastian, Guipúzcoa, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Úlceras digitales indoloras como presentación inusual de síndrome de túnel carpiano bilateral severo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1872 "Ancho" => 1418 "Tamanyo" => 181526 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bone resorption in the distal phalanx of the right index finger.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Carpal tunnel syndrome (CTS), the most frequent type of entrapment neuropathy, is caused by compression of the median nerve inside the tunnel formed by the wrist bones and the carpal annular ligament. This condition affects between 1% and 3% of the population, and it is 4 times more common in women than in men. Incidence peaks between the fourth and sixth decade of life, and more than 50% of cases are bilateral. Although most cases are idiopathic, the compression of the nerve is occasionally due to a combination of factors that increase pressure on this nerve. CTS commonly presents with a triad of nocturnal pain, hypoesthesia, and thenar atrophy. We describe a case of CTS that was diagnosed based on the presence of painless cutaneous ulcers with a characteristic location.</p><p id="par0010" class="elsevierStylePara elsevierViewall">An 86-year-old male nonsmoker with a history of cardiac arrhythmias and lower urinary tract symptoms was referred to our unit with painless ulcers on both hands that had appeared 1 month earlier. He was on treatment with furosemide, acenocoumarol, dutasteride, and tamsulosin. During the physical examination, we observed lesions on several fingers of both hands, bullous lesions on the thumbs, and ulcers on the tips of the index and middle fingers of the right hand and middle finger of the left hand. In addition, a short distal phalanx and a short, wide fingernail were observed in the right index finger (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). Radial and brachial peripheral pulses were normal.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Based on the loss of sensation to pain and the distribution of the lesions, CTS was suspected and the patient was referred to the neurology department. A neurological examination revealed thenar atrophy and loss of pressure sensation in the median nerve territory, with preserved sensation in the forearms and in the ulnar and radial nerve territories of the hands. Electroneurography showed a bilateral loss of sensory and motor function in the median nerve distal to the carpal tunnel.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Blood tests revealed an elevated erythrocyte sedimentation rate and an immunoglobulin A gammopathy, but further testing by the hematology department ruled out multiple myeloma. Rheumatoid factor, cryoglobulin, cold agglutinin, and autoantibody tests were normal.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Hand radiographs showed bone resorption in the distal phalanx of the right index finger (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The patient was advised to take measures to avoid mechanical and thermal injury, and the skin lesions healed after several weeks with the use of topical treatment. He refused surgical treatment.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Skin ulcers in CTS are rare. They were first described by Bouvier et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in 1979 and few cases have since been published. The ulcerative and disfiguring form of CTS is characterized by the appearance of painless skin ulcers on the fingertips and under the fingernails, sclerodactyly, and acroosteolysis in the sensory hand area innervated by the median nerve.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Skin involvement is observed in 20% of CTS cases<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and is caused by the compression of autonomic fibers in the median nerve. This explains why skin manifestations occur in patients with severe CTS.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Vasomotor dysfunction can lead to Raynaud phenomenon and skin necrosis, and sensory dysfunction can result in mechanical or thermal injury, which may in turn cause necrosis to spread.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Cutaneous lesions include erythema, edema, blisters, painless ulcers on the fingertips and under the fingernails, nail discoloration, onycholysis, gangrene, autoamputation, and acroosteolysis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In most patients, the second and third fingers are involved and the main area affected is the volar side of the distal phalanx.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> These fingers are affected most because the innervation of the fingers is mixed, originating from both median and radial nerve fibers, and because they are more vulnerable to injury.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> Acral ulcerations and osteolysis are frequently unilateral, although some bilateral cases have been described. In lesions of this type, the differential diagnosis should include collagenopathies, autonomic neuropathies, hematologic diseases, injuries due to external trauma, metabolic diseases, and vascular pathologies.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Diagnosing CTS is simple if the classic manifestations are present; physical examination is therefore useful. Phalen and Hoffman-Tinel signs are highly suggestive of CTS. Imaging techniques are used to evaluate the stricture of the carpal tunnel and rule out the presence of fractures. However, to confirm the diagnosis and evaluate the degree of median nerve involvement, a neurophysiological examination is required.</p><p id="par0045" class="elsevierStylePara elsevierViewall">It is important for the dermatologist to correctly evaluate these types of lesions because early diagnosis is essential to preventing bone lesions and irreversible deformities.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Ormaechea-Pérez N, et al. Úlceras digitales indoloras como presentación inusual de síndrome de túnel carpiano bilateral severo. Actas Dermosifiliogr. 2012;103:159–160.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1237 "Ancho" => 2168 "Tamanyo" => 208181 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bilateral ulcers on the fingers located in the median nerve territory. A short right index finger is observed.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 985 "Ancho" => 1585 "Tamanyo" => 95453 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Detail of ulcers on the tips of the index and middle fingers of the right hand.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1872 "Ancho" => 1418 "Tamanyo" => 181526 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bone resorption in the distal phalanx of the right index finger.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Les formes ulcéro-mutilantes du syndrome du canal carpien" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Bouvier" 1 => "E. Lejeune" 2 => "M. Rouillat" 3 => "J. Marionnet" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Rhum" "fecha" => "1979" "volumen" => "46" "paginaInicial" => "169" "paginaFinal" => "176" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/472646" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carpal tunnel syndrome presenting as sclerodactylia, nail distrophy and acro-osteolysis in a 60-year-old-woman" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Romani" 1 => "L. Puig" 2 => "G. de Miguel" 3 => "J.M. de Moragas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "1997" "volumen" => "195" "paginaInicial" => "159" "paginaFinal" => "161" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9310726" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carpal tunnel syndrome appearing with prominente skin symptoms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Aratari" 1 => "G. Regesta" 2 => "A. Rebora" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1984" "volumen" => "120" "paginaInicial" => "517" "paginaFinal" => "519" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6703757" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0010782408004514" "estado" => "S300" "issn" => "00107824" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blisters, ulceration and autonomic neuropathy in carpal tunnel syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.H. Cox" 1 => "D.M. Large" 2 => "W.D. Paterson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1992" "volumen" => "126" "paginaInicial" => "611" "paginaFinal" => "613" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1610713" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lesiones cutáneas en el síndrome del túnel carpiano" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Pont" 1 => "F. Millán" 2 => "E. Gimeno" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Piel" "fecha" => "2007" "volumen" => "22" "paginaInicial" => "72" "paginaFinal" => "77" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carpal tunnel syndrome presenting with ischemic skin lesions, acroosteolysis, and nail changes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Tosti" 1 => "R. Morelli" 2 => "R. D’Alessandro" 3 => "F. Bassi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1993" "volumen" => "29" "paginaInicial" => "287" "paginaFinal" => "290" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8340499" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673600045633" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carpal tunnel syndrome with ulcerous skin lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.M. Fritz" 1 => "G. Burg" 2 => "R. Böni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "18464" "Revista" => array:6 [ "tituloSerie" => "Dermatology" "fecha" => "2000" "volumen" => "201" "paginaInicial" => "165" "paginaFinal" => "167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11053924" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acral ulcerations and osteolysis, a severe form of the carpal tunnel syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Requena" 1 => "L. Requena" 2 => "S. Blanco" 3 => "C. Álvarez" 4 => "C. Galache" 5 => "E. Rodríguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2004" "volumen" => "150" "paginaInicial" => "166" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14746645" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ulcerative and mutilating variant of carpal tunnel syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Natale" 1 => "P. Spennato" 2 => "A. Bocchetti" 3 => "M. Fratta" 4 => "L. Savarese" 5 => "M. Rotondo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00701-004-0478-y" "Revista" => array:6 [ "tituloSerie" => "Acta Neurochir" "fecha" => "2005" "volumen" => "147" "paginaInicial" => "905" "paginaFinal" => "908" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15696265" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedad de Buerger (tromboangeítis obliterante)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Goiriz" 1 => "J. Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Dermosifilográficas" "fecha" => "2005" "volumen" => "96" "paginaInicial" => "553" "paginaFinal" => "562" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000002/v1_201304241253/S1578219012000698/v1_201304241253/en/main.assets" "Apartado" => array:4 [ "identificador" => "6169" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000002/v1_201304241253/S1578219012000698/v1_201304241253/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000698?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 3 | 3 | 6 |
| 2024 Octubre | 183 | 51 | 234 |
| 2024 Septiembre | 157 | 29 | 186 |
| 2024 Agosto | 214 | 71 | 285 |
| 2024 Julio | 260 | 62 | 322 |
| 2024 Junio | 189 | 50 | 239 |
| 2024 Mayo | 149 | 66 | 215 |
| 2024 Abril | 146 | 28 | 174 |
| 2024 Marzo | 202 | 32 | 234 |
| 2024 Febrero | 239 | 37 | 276 |
| 2024 Enero | 282 | 51 | 333 |
| 2023 Diciembre | 341 | 26 | 367 |
| 2023 Noviembre | 306 | 52 | 358 |
| 2023 Octubre | 253 | 30 | 283 |
| 2023 Septiembre | 215 | 32 | 247 |
| 2023 Agosto | 135 | 21 | 156 |
| 2023 Julio | 139 | 44 | 183 |
| 2023 Junio | 146 | 34 | 180 |
| 2023 Mayo | 229 | 44 | 273 |
| 2023 Abril | 233 | 24 | 257 |
| 2023 Marzo | 163 | 41 | 204 |
| 2023 Febrero | 181 | 32 | 213 |
| 2023 Enero | 120 | 33 | 153 |
| 2022 Diciembre | 126 | 55 | 181 |
| 2022 Noviembre | 105 | 23 | 128 |
| 2022 Octubre | 110 | 33 | 143 |
| 2022 Septiembre | 66 | 46 | 112 |
| 2022 Agosto | 91 | 46 | 137 |
| 2022 Julio | 93 | 37 | 130 |
| 2022 Junio | 70 | 41 | 111 |
| 2022 Mayo | 156 | 40 | 196 |
| 2022 Abril | 192 | 38 | 230 |
| 2022 Marzo | 171 | 74 | 245 |
| 2022 Febrero | 223 | 37 | 260 |
| 2022 Enero | 271 | 48 | 319 |
| 2021 Diciembre | 200 | 48 | 248 |
| 2021 Noviembre | 197 | 40 | 237 |
| 2021 Octubre | 187 | 58 | 245 |
| 2021 Septiembre | 155 | 47 | 202 |
| 2021 Agosto | 147 | 61 | 208 |
| 2021 Julio | 141 | 40 | 181 |
| 2021 Junio | 177 | 31 | 208 |
| 2021 Mayo | 178 | 54 | 232 |
| 2021 Abril | 342 | 94 | 436 |
| 2021 Marzo | 197 | 25 | 222 |
| 2021 Febrero | 121 | 36 | 157 |
| 2021 Enero | 97 | 22 | 119 |
| 2020 Diciembre | 84 | 29 | 113 |
| 2020 Noviembre | 88 | 21 | 109 |
| 2020 Octubre | 68 | 18 | 86 |
| 2020 Septiembre | 50 | 15 | 65 |
| 2020 Agosto | 55 | 21 | 76 |
| 2020 Julio | 43 | 18 | 61 |
| 2020 Junio | 42 | 25 | 67 |
| 2020 Mayo | 36 | 20 | 56 |
| 2020 Abril | 50 | 20 | 70 |
| 2020 Marzo | 33 | 17 | 50 |
| 2020 Febrero | 4 | 1 | 5 |
| 2019 Diciembre | 4 | 0 | 4 |
| 2019 Noviembre | 0 | 4 | 4 |
| 2019 Octubre | 0 | 2 | 2 |
| 2019 Septiembre | 4 | 5 | 9 |
| 2019 Julio | 0 | 4 | 4 |
| 2019 Junio | 2 | 8 | 10 |
| 2019 Mayo | 0 | 31 | 31 |
| 2019 Abril | 0 | 3 | 3 |
| 2019 Marzo | 2 | 9 | 11 |
| 2019 Febrero | 1 | 1 | 2 |
| 2019 Enero | 1 | 1 | 2 |
| 2018 Diciembre | 2 | 1 | 3 |
| 2018 Noviembre | 1 | 12 | 13 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 1 | 0 | 1 |
| 2018 Mayo | 0 | 6 | 6 |
| 2018 Abril | 0 | 14 | 14 |
| 2018 Marzo | 22 | 12 | 34 |
| 2018 Febrero | 156 | 10 | 166 |
| 2018 Enero | 134 | 13 | 147 |
| 2017 Diciembre | 140 | 7 | 147 |
| 2017 Noviembre | 95 | 9 | 104 |
| 2017 Octubre | 72 | 12 | 84 |
| 2017 Septiembre | 122 | 14 | 136 |
| 2017 Agosto | 142 | 16 | 158 |
| 2017 Julio | 122 | 23 | 145 |
| 2017 Junio | 118 | 23 | 141 |
| 2017 Mayo | 123 | 21 | 144 |
| 2017 Abril | 97 | 16 | 113 |
| 2017 Marzo | 90 | 13 | 103 |
| 2017 Febrero | 98 | 13 | 111 |
| 2017 Enero | 62 | 21 | 83 |
| 2016 Diciembre | 111 | 7 | 118 |
| 2016 Noviembre | 138 | 14 | 152 |
| 2016 Octubre | 158 | 16 | 174 |
| 2016 Septiembre | 229 | 19 | 248 |
| 2016 Agosto | 148 | 12 | 160 |
| 2016 Julio | 60 | 5 | 65 |
| 2016 Junio | 13 | 7 | 20 |
| 2016 Mayo | 9 | 6 | 15 |
| 2016 Abril | 15 | 15 | 30 |
| 2016 Marzo | 7 | 18 | 25 |
| 2016 Febrero | 7 | 16 | 23 |
| 2016 Enero | 15 | 15 | 30 |
| 2015 Diciembre | 16 | 9 | 25 |
| 2015 Noviembre | 16 | 1 | 17 |
| 2015 Octubre | 15 | 12 | 27 |
| 2015 Septiembre | 15 | 2 | 17 |
| 2015 Agosto | 14 | 8 | 22 |
| 2015 Julio | 114 | 1 | 115 |
| 2015 Junio | 51 | 3 | 54 |
| 2015 Mayo | 110 | 13 | 123 |
| 2015 Abril | 86 | 7 | 93 |
| 2015 Marzo | 84 | 9 | 93 |
| 2015 Febrero | 56 | 11 | 67 |
| 2015 Enero | 73 | 11 | 84 |
| 2014 Diciembre | 71 | 7 | 78 |
| 2014 Noviembre | 64 | 10 | 74 |
| 2014 Octubre | 93 | 12 | 105 |
| 2014 Septiembre | 68 | 9 | 77 |
| 2014 Agosto | 79 | 13 | 92 |
| 2014 Julio | 83 | 17 | 100 |
| 2014 Junio | 127 | 9 | 136 |
| 2014 Mayo | 138 | 17 | 155 |
| 2014 Abril | 98 | 13 | 111 |
| 2014 Marzo | 83 | 12 | 95 |
| 2014 Febrero | 28 | 11 | 39 |
| 2014 Enero | 28 | 6 | 34 |
| 2013 Diciembre | 24 | 6 | 30 |
| 2013 Noviembre | 22 | 11 | 33 |
| 2013 Octubre | 6 | 10 | 16 |
| 2013 Septiembre | 10 | 3 | 13 |
| 2013 Agosto | 11 | 10 | 21 |
| 2013 Julio | 11 | 8 | 19 |
| 2013 Junio | 9 | 21 | 30 |
| 2013 Mayo | 14 | 11 | 25 |
| 2013 Abril | 23 | 16 | 39 |
| 2013 Marzo | 19 | 13 | 32 |
| 2013 Febrero | 35 | 7 | 42 |
| 2013 Enero | 72 | 4 | 76 |
| 2012 Diciembre | 42 | 11 | 53 |
| 2012 Octubre | 1 | 0 | 1 |
Mostrar todo
