Repair of a median nerve transection injury using multiple nerve transfers, with long-term functional recovery

Case report

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Complete loss of median nerve motor function is a rare but devastating injury. Loss of median motor hand function and upper-extremity pronation can significantly impact a patient's ability to perform many activities of daily living independently. The authors report the long-term follow-up in a case of median nerve motor fiber transection that occurred during an arthroscopic elbow procedure, which was then treated with multiple nerve transfers. Motor reconstruction used the nerves to the supinator and extensor carpi radialis brevis to transfer to the anterior interosseous nerve and pronator. Sensory sensation was restored using the lateral antebrachial cutaneous (LABC) nerve to transfer to a portion of the sensory component of the median nerve, and a second cable of LABC nerve as a direct median nerve sensory graft. The patient ultimately recovered near normal motor function of the median nerve, but had persistent pain symptoms 4 years postinjury.

Abbreviations used in this paper:AIN = anterior interosseous nerve; ECRB = extensor carpi radialis brevis; FDP = flexor digitorum profundus; FPL = flexor pollicis longus; IP = interphalangeal; LABC = lateral antebrachial cutaneous; PT = pronator teres.

Article Information

Address correspondence to: Susan E. Mackinnon, M.D., Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110. email: mackinnons@wustl.edu.

Please include this information when citing this paper: published online September 14, 2012; DOI: 10.3171/2012.8.JNS111356.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Intraoperative photograph and drawing (inset) showing that the median nerve is injured at 3 levels along its course. FCR = flexor carpi radialis; PL = palmaris longus.

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    Intraoperative photograph and drawing (inset) showing components of the radial nerve, the posterior interosseous nerve (PIN), the nerve to the supinator, the radial sensory nerve, and the nerve to the ECRB.

  • View in gallery

    Intraoperative photograph and drawing (inset) showing a branch of the nerve to the ECRB repaired to the pronator nerve, and the nerve to the ECRB and the supinator repaired to the AIN.

  • View in gallery

    Intraoperative photograph showing the LABC nerve transferred to the sensory component of the median nerve. A graft from the more distal component of the LABC nerve was used for an 8-cm graft from the sensory component of the median nerve proximally to its remainder distally.

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