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Institute of Anaesthesia; Kantonsspital; Lucerne, Switzerland; wruppen{at}freesurf.ch
To the Editor:
Multiple studies in patients with osteoarthritis, rheumatoid arthritis, and acute pain have now confirmed that the clinical efficacy of COX-2-specific inhibitors is similar to that of conventional NSAIDs (1–3). We treated a 40-year-old patient with knee contusion with 40 mg valdecoxib once a day. Twenty-four hours after beginning therapy, the patient developed a massive exacerbation of a preexisting carpal tunnel syndrome (CTS) with the typical signs (4) previously known by the patient.
Because of suspicion of developing a valdecoxib-associated edema in the carpal arch, the therapy was replaced with ibuprofen 400 mg three times a day. No conservative management with splinting was initiated. Within another 12 hours the CTS signs and symptoms disappeared and the patient's knee remained pain free.
This case raises the suspicion that a COX-2 inhibitor (valdecoxib) treatment- associated edema may have aggravated a preexisting condition of CTS. The withdrawal of the COX-2 inhibitor was probably relevant for the relief of the CTS.
The effect of nonsteroidal antiinflammatory medications on carpal tunnel syndrome have not been well studied (5), but a trial of these drugs is suggested.
References
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