Surgical treatment of the consequences of the computed damage of the median nerve in the proximal part of the upper limb
Aim of the study – to assess the efficacy of surgical reconstruction of the combined proximal median nerve injuries, to evaluate the efficacy of the staged orthopedic reconstruction of the thumb opposition. The retrospective analysis of the reconstruction of 14 proximal median nerve injuries was conducted. 11 men and 3 women were enrolled into the study, mean age of participants was 42,3 years. In all cases proximal median nerve injury was accompanied by either axillary (4 cases) or brachial artery (10 cases) injury. 5 patients received direct repair of the median nerve. 9 patients received autologous grafting of the median nerve with mean gap between the stumps 7,5 cm. Both motor and sensory components of recovery were evaluated with MRC Scale and Seddon Scale respectively. Each patient evaluated the recovered median nerve mediated functions with Brief Michigan Hand Questionnaire. 14 cases with poor or no recovery of thenar muscles required tendon transfer (Bunne’sl transfer) to restore thumb opposition in later terms. Mean terms of recovery of the entire muscle-complex of the anterior surface of the forearm in all 14 patients with proximal median nerve injury was 12,9 months (with no reliable dependence on method of reconstruction). Mean MRC Scale score among all 14 patients was: 3,8 points for m. flexor pollicis longus, 4,4 points for mm. flexores digitorum and 4,4 points for m. flexor carpi radialis respectively. The median nerve mediated sensation recovered to 2,8 points on Seddon scale. Not a single patient showed effective recovery of the thenar muscles. Mean Brief MHQ score was 64,2 points – satisfactory recovery. 14 patients received effective thumb opposition within next 2 months post Bunnel’s tendon transfer. Mean Brief MHQ score increased to 78,2 points – good recovery. Surgical reconstruction of proximal median nerve injuries brings satisfying recovery of the entire muscle-complex of the anterior surface of the forearm, as well as the recovery to the median nerve mediated sensory component. Poor or no recovery of the thump opposition is majorly related to the distance between the site of the lesion and thenar’s motor-endplates. Bunnel’s tendon transfer dramatically increases functional outcomes at proximal median nerve injuries.
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