American Society for Peripheral Nerve

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Sensory Recovery Following Delayed Median Nerve Reconstruction at the Wrist Level
Ke Nan Huang, MD; Jenny C. Lin, MD, PhD
University of Montreal, Montreal, QC, Canada

Introduction: Median nerve injuries have a significant impact on quality of life due to loss of essential sensation in the hand. Despite microsurgical treatment, recovery after median nerve repair is often suboptimal. Unfortunately, some patients may have a nerve injury that goes undiagnosed for weeks or months following the initial trauma, and other patients have very poor sensory recovery after an initial median nerve repair. The treatment of patients presenting with poor sensation months or years after initial median nerve injury represents a difficult clinical problem as the potential for sensory recovery after delayed median nerve reconstruction has not been well documented. This is particularly difficult in those patients who have already undergone microsurgical median nerve repair yet continue to complain of poor sensory recovery. The goal of this retrospective study is to examine the sensory recovery of patients who underwent median nerve reconstruction at the wrist level that was delayed for several weeks to many years after the initial trauma.

Materials & Methods: All patients seen at our Peripheral Nerve Surgery Clinic between 2007 and 2016 with complete or partial median nerve injury at the wrist level were identified. Patients who underwent median nerve reconstruction were included in this retrospective study. Post-operative sensory function was compared to pre-operative sensory function using Semmes-Weinstein testing data obtained from the clinical chart.

Results: 24 patients treated with median nerve reconstruction by neuroma excision and nerve grafting were identified. 13 patients (14 median nerves) with at least 3 months post-operative follow-up were included in this study. Age range was 13 to 67; 12 males and 1 female. Pre- and post-operative Semmes-Weinstein monofilament testing was done for all patients. All 13 patients included in the study presented with loss of protective sensation or no sensation. Follow-up ranged from 3 to 87 months. 9 of 14 hands showed improvement in sensation at the last follow-up (range 13 to 87 months post-op) when compared to pre-operative function. No improvement was seen in patients with less than 13 months of follow-up. Post-operative Semmes-Weinstein testing in most fingers was in the blue to purple range (diminished protective sensation).

Conclusions: Recovery of sensory function after median nerve laceration is possible even if surgical reconstruction is delayed many years after the initial trauma. Although recovery is incomplete, patients can regain diminished protective sensation. More than one year of follow-up is needed to see improvement in sensory function following surgery.

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