Use of Nerve Transfer Procedures for Motor and Sensory Restoration of a High Median Nerve Injury

Abstract

High median nerve (HMN) injuries are unusual clinical conditions, but they generate significant disability of the affected extremities to perform even basic activities of daily living. Even though they can display different degrees of dysfunction due to overlapping innervation and musculature compensation, an early assessment of the existing functional deficits and a timely surgical approach can optimize the long-term outcome. The use of distal nerve transfer procedures has gained popularity since they reduce the distance between the injured zone and the disrupted targets, accelerate the nerve regeneration and subsequently optimize the postoperative motor and sensory recovery. This report describes a patient with a significant segmental loss of the median nerve at the upper third of the left arm after a motor vehicle accident that caused multiple other injuries. The motor deficit of this injury was managed soon after the admission with extensor carpi radialis brevis (ECRB) nerve transfer to the anterior interosseous nerve (AIN). Subsequently, double side-to-side cross-palm nerve allografts between the ulnar and median nerves were utilized to restore the sensory deficit of the HMN lesion. An important functional improvement was obtained with these nerve transfer procedures, and the patient successfully returned to the workforce without limitations. Other surgical options for motor and sensory reconstruction are briefly reviewed.