Motor and sensory reinnervation in the hand after an end-to-side median to ulnar nerve coaptation in the forearm

Abstract

End-to-side coaptation of the median to ulnar nerve through an epineurial window was performed 5 cm proximal to the wrist in a patient with high median nerve injury associated with a 35 cm long nerve gap. Forty-three months after the operation, sensory examination revealed the presence of diminished protective sensation (3.61-4.31 NCM Semmes-Weinstein monofilament) in the large part of the median nerve dermatome. In the two-point discrimination test, single point was perceived in the median nerve dermatome pointing to the presence of protective sensation. MRI and EMG studies indicated limited motor reinnervation in the opponens pollicis muscle. This novel method of nerve repair may be chosen in the management of very long nerve gaps, where conventional methods are likely to give an unsuccessful result.