Zancolli procedure and nerve repair with sural graft as a treatment for patient with claw hand due to complete rupture of ulnar and median nerve: A case report.

INTRODUCTION: Combined injuries of peripheral nerve of upper extremity are usually the result of severe trauma to the extremity, and are often associated with substantial soft tissue, vascular, and bony injuries. The most common form of such combined injury is a low median-ulnar palsy, usually due to laceration of the volar wrist. It is a devastating injury, and with delayed presentation the injury is going to be more difficult to reconstruct. PRESENTATION OF CASE: Ten-year-old girl was admitted to hospital with numbness of her left palm and fingers, 5 months before admission. She was hit by a car while riding a bicycle from opposite direction from she was heading and cut her left forearm by licensed plate. Initially treated at nearby clinic but later couldn't extend her fingers after the pain subsided and left untreated for 5 months. DISCUSSION: Traditionally, number of static procedures have been described to correct the claw hand deformity by preventing MCP joint hyperextension. Nevertheless, these procedures are reserved for those having ability to extend IP joints while MCP joint hyperextension were prevented. Conversely, static procedure like Zancolli capsulodesis is simple and do not sacrifice any motors in an already compromised extremity. Combined with sural graft, the outcome for the patient is hopefully better than Zancolli procedure alone. CONCLUSION: Zancolli procedure along with nerve repair with sural graft as a treatment of claw hand due to complete rupture of ulnar and median nerve is one of feasible treatment options to correct claw hand deformity with such combined palsy.

MRI shows thickening and altered diffusion in the median and ulnar nerves in multifocal motor neuropathy.

OBJECTIVES: To study disease mechanisms in multifocal motor neuropathy (MMN) with magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) of the median and ulnar nerves. METHODS: We enrolled ten MMN patients, ten patients with amyotrophic lateral sclerosis (ALS) and ten healthy controls (HCs). Patients underwent MRI (in a prone position) and nerve conduction studies. DTI and fat-suppressed T2-weighted scans of the forearms were performed on a 3.0T MRI scanner. Fibre tractography of the median and ulnar nerves was performed to extract diffusion parameters: fractional anisotropy (FA), mean (MD), axial (AD) and radial (RD) diffusivity. Cross-sectional areas (CSA) were measured on T2-weighted scans. RESULTS: Forty-five out of 60 arms were included in the analysis. AD was significantly lower in MMN patients (2.20 ± 0.12 × 10-3 mm2/s) compared to ALS patients (2.31 ± 0.17 × 10-3 mm2/s; p < 0.05) and HCs (2.31± 0.17 × 10-3 mm2/s; p < 0.05). Segmental analysis showed significant restriction of AD, RD and MD (p < 0.005) in the proximal third of the nerves. CSA was significantly larger in MMN patients compared to ALS patients and HCs (p < 0.01). CONCLUSIONS: Thickening of nerves is compatible with changes in the myelin sheath structure, whereas lowered AD values suggest axonal dysfunction. These findings suggest that myelin and axons are diffusely involved in MMN pathogenesis. KEY POINTS: • Diffusion magnetic resonance imaging provides quantitative information about multifocal motor neuropathy (MMN). • Diffusion tensor imaging allows non-invasive evaluation of the forearm nerves in MMN. • Nerve thickening and lowered diffusion parameters suggests myelin and axonal changes. • This study can help to provide insight into pathological mechanisms of MMN.

A Study on the Conduction Veloctiy of the Median and Ulnar Nerves in Healthy Korean / 대한정형외과학회잡지

It is obvious that the examination of nerve conduction as a diagnostic tool is a relatively new field of interest with a state of still undergoing evaluation and improvement. Problems of technique and interpretation notwithstanding, determination of nerve conduction has progressed to a level where it is now used routinely as a part of the electrodiagnostic examination. The present study has been undertaken to determine the normal range of the motor nerve conduction velocity, distal motor latency, amplitude of the muscle action potentials, sensory nerve conduction velocity, distal sensory latency, amplitude and duration of the sensory nerve action potentials of median and ulnar nerves in healthy Korean. One hundred twenty healthy subjects (sixty male and sixty female) were examined. Their ages ranged from 5 to 69 in years and the subjects were arranged in three age groups of 5–9 years, 10–49 years and 50–69 years. The results obtained were as follows: l. In median nerve, mean values for motor nerve conduction velocity, distal motor latency, and amplitude of the muscle action potantials were 56.57± 4.55 (45.2–69.4) m/sec, 3.02±0.48 (1.6–4.5) msec, and 14.2±5.0 (4–28) mV, respectively. 2. In ulnar nerve, mean values for motor nerve conduction velocity, distal motor latency, and amplitude of the muscle action potentials were 58.60±5.06 (43.5–71.4) m/sec, 2.35±0.50 (1.3–4.1) msec, and 11.7±3.7(4–22) mV, respectively. 3. In median nerve, mean values for sensory nerve conduction velocity, distal sensory latency, amplitude and duration of the sensory nerve action potentials were 63.50±5.63 (53.1–75.9) m/sec, 2.37±0.38 (1.0–3.4) msec, 45.5±16.9 (13–120)u V, and 1.68±0.29 (0.9–2.5) msec, respectively. 4. In ulner nerve, mean values for sensory nerve conduction velocity, distal sensory latency, amplitude and duration of the sensory nerve action potentials were 65.34±5.16 (50.6–78.1) m/sec, 2.09±0.38 (1.3–3.2) msec, 45.6±17.5 (12–118) uV, and 1.54±0.32 (0.8–2.5) msec, respectively. In comparison of the obtained values of two nerves. 5. A significant difference was observed between motor nerve conduction studies of the median and ulnar nerves. 6. A significant difference was observed between sensory nerve conduction studies of the median and ulnar nerves except amplitude of the sensory nerve action potentials. 7. Nerve conduction velocity was significantly faster in sensory nerve than in motor nerve. In comparison of conduction velocities among 3 age groups. 8. Motor nerve conduction velocity of the median and ulnar nerves was slow in age groups of 5–9 years and 50–69 years as compared with that of age group of 10–49 years. 9. Sensory nerve conduction velocity of median nerve was slow in age groups of 5–9 years and 50–69 years as compared with that of age group of 10–49 years, and sensory nerve conduction velocity of ulnar nerve was slow in age group of 50–69 years as compared with that of age groups of 5–9 years and 10–49 years.