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Abstract

Carpal tunnel syndrome (CTS) is the most common nerve entrapment disorder, affecting 1% to 5% of adults, primarily women aged 40-60. It results from median nerve compression, causing pain, numbness, and reduced grip strength. Risk factors include rheumatoid arthritis, pregnancy, and hypertension. Advanced cases may present with painless skin ulcers, suggesting an ulceromutilating variant. An 83-year-old retired seamstress with hypertension, rheumatoid arthritis, and bilateral CTS, diagnosed nine years ago, developed progressive sensory-motor deficits and painless ulcers on her left hand despite successful right-hand surgery. Electromyography confirmed severe left CTS and the clinical presentation suggested an ulceromutilating variant. She was referred for corrective surgery. Painless ulcers in CTS are rare but have been reported since 1979, resulting from prolonged nerve compression and skin necrosis. Early diagnosis and surgery are crucial to prevent irreversible damage, like bone resorption. This case emphasizes the need to consider this variant in advanced CTS.