Imaging Findings

The patient is a 30-year-old male, presenting with a soft tissue mass in the palmar region accompanied by symptoms of carpal tunnel syndrome. Based on the provided X-ray and MRI images, the following observations are noted:

• There is a marked soft tissue thickening in the palm and carpal tunnel area, with an irregular widening appearance.
• X-ray shows essentially normal bone morphology, with no clear evidence of bone destruction or fracture, but there is increased soft tissue density and a local protrusion.
• On MRI sequences (T1, PD, and T2-weighted images), in the region of the median nerve, adipose signal infiltration is visible, appearing as high signal, with the nerve fascicle tissue appearing as thin or "thread-like" low signal within the fatty tissue. This interweaving of fibrous and fatty components creates a characteristic "cable-like" appearance.
• The lesion is primarily confined to the median nerve and its surrounding sheath, with limited proximal or distal extension.

Potential Diagnoses

Based on the patient's age, symptoms, and imaging changes, potential diagnoses or differential diagnoses include:

1. Fibrolipomatous hamartoma (fibrofatty lesion): Also known as a median nerve lipomatous lesion. This condition commonly involves the median nerve, and MRI typically shows a mixture of nerve fascicles and fatty tissue, a highly consistent finding.
2. Intraneural lipoma: A lipoma confined within the nerve, usually lacking significant fibrotic components, which differs from the typical "cable-like" imaging appearance in this case.
3. Ganglion cyst: May appear in the carpal tunnel or hand soft tissue. However, on MRI, it generally presents as a cystic high signal with distinct boundaries, unlike the adipose infiltration seen here.
4. Traumatic neuroma: Often has a history of trauma, and MRI does not typically show fatty infiltration. The lesion is usually small and located at the nerve stump.
5. Vascular lesion (vascular malformation): May show vascular channel signals but rarely such prominent fatty components.

Final Diagnosis

Based on these imaging characteristics (i.e., “cable-like” fatty infiltration of the median nerve), as well as the patient’s chronic slow-growing soft tissue mass and signs of carpal tunnel syndrome, the most likely diagnosis is Fibrolipomatous Hamartoma of the Median Nerve.

Further confirmation may require histopathological examination, but the combination of clinical and imaging data usually allows for a relatively accurate diagnosis.

Treatment Plan and Rehabilitation

For confirmed fibrolipomatous hamartoma, the main treatment goal is to relieve local pressure and improve function. Possible strategies include:

1. Conservative Treatment:
   • Symptomatic management, such as wearing a brace or immobilizing the area to reduce repetitive irritation and stress.
   • For early or mild symptoms, oral or local anti-inflammatory medications may be used to alleviate nerve inflammation.
2. Surgical Intervention:
   • In cases with evident carpal tunnel syndrome or significant nerve dysfunction, carpal tunnel release is often required to alleviate pressure on the median nerve.
   • When the tumor is large and impacts quality of life, microsurgical resection may be considered, weighing the potential risk of nerve function damage.

Regarding rehabilitation and exercise prescriptions, a gradual and individualized approach is recommended (following the FITT-VP principle: frequency, intensity, time, type, volume progression, and personalization).

• Early Stage: After surgery or during conservative treatment, begin with gentle fist clenching, finger extension, and wrist flexion/extension exercises, 2–3 times a day, 5–10 minutes each time, ensuring pain-free intensity.
• Intermediate Stage: Gradually add strength exercises such as using a resistance band or soft grip ball for finger gripping. Perform these 3–5 times a week, 10–15 minutes each session, with moderate intensity, avoiding fatigue-related pain.
• Late Stage: Once recovery is good, incorporate exercises to improve finger dexterity and fine motor skills, such as "piano-playing" joint mobilization and precise grasp training. Also add forearm and wrist muscle strengthening exercises, such as light dumbbell wrist flexion/extension, 3–4 times weekly, 15–20 minutes per session.
• Individual Adjustments: If swelling, significant pain, or worsening nerve symptoms occur, reduce or pause the exercise intensity and seek advice from a professional rehabilitation therapist or hand surgeon.

Disclaimer

This report is a reference analysis based on current clinical and imaging information and does not replace in-person diagnosis by a professional medical institution. If you have any concerns or if symptoms worsen, please seek medical attention promptly for further evaluation and treatment.