Sustained atypical myokymia of the abductor pollicis brevis with a focal slowing of the median nerve motor axons at the wrist

✓ After a few reports on end-to-side nerve repair at the beginning of the last century, the technique was put aside until its recent reintroduction. The authors present their results in three patients with median nerve defects that were between 15 and 22 cm long and treated using end-to-side median-to-ulnar neurorrhaphy through an epineurial window. The follow-up times were between 32 and 38 months. Sensory evaluation involved superficial touch, pinprick, and two-point discrimination tests. Motor evaluation was completed by assessing the presence of opposition and by palpating the abductor pollicis brevis muscle. Sensory recovery was observed in all patients in the median nerve dermatome, and motor recovery was absent, except in Case 1. End-to-side nerve repair can be a viable alternative to nerve grafting in patients with long gaps between the ends of the injured nerve.

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Differences in excitability properties between medial gastrocnemius, tibialis anterior, and abductor pollicis brevis motor axons

Muscle & Nerve ◽

10.1002/mus.25722 ◽

2017 ◽

Vol 57 (1) ◽

Cited By ~ 1

Author(s):

Cliff S. Klein ◽

Chen Ning Zhao ◽

Hui Liu ◽

Ping Zhou

Keyword(s):

Tibialis Anterior ◽

Medial Gastrocnemius ◽

Motor Axons ◽

Abductor Pollicis Brevis

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Functional Restoration Following Resection of Malignant Peripheral Nerve Sheath Tumour of the Median Nerve: A Case Report

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835520720121 ◽

2020 ◽

Vol 25 (03) ◽

pp. 373-377

Author(s):

Chung Ming Chan ◽

Aymeric YT. Lim ◽

Mark E. Puhaindran

Keyword(s):

Peripheral Nerve ◽

Median Nerve ◽

Index Finger ◽

Sensory Nerve ◽

Functional Restoration ◽

Flexor Digitorum Profundus ◽

Wide Resection ◽

Abductor Pollicis Brevis ◽

Nerve Branch ◽

Nerve Sheath

Management of malignant peripheral nerve sheath tumours (MPNSTs) is primarily surgical, involving surgical resection with wide margins, and frequently radiation therapy. When a MPNST involves a major peripheral nerve, wide resection leads to significant distal neurologic deficits. A patient who underwent resection of a MPNST involving the median nerve above the elbow is presented. Staged tendon and nerve transfers were performed to restore sensation to the thumb and index finger, thumb opposition and flexion, finger flexion and forearm pronation. These included: 1. radial sensory nerve branches to digital nerves of thumb and index finger, 2. ulnar nerve branch of flexor carpi ulnaris to pronator teres, 3. brachioradialis to flexor pollicis longus, 4. side-to-side transfer of flexor digitorum profundus tendon of index finger to middle, ring and little fingers, 5. extensor indicis proprius to abductor pollicis brevis. The rationale, approach, and favourable results of functional reconstruction in this patient are detailed.

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Estimation of Median Nerve Axonal Degeneration without Needle Electromyography

Iranian Journal of Neurosurgery ◽

10.32598/irjns.7.1.4 ◽

2021 ◽

Vol 7 (1) ◽

pp. 23-30

Author(s):

Mozaffar Hosseininezhad ◽

◽

Amir Reza Ghayeghran ◽

Paria Nasiri ◽

Sajjad Saadat ◽

...

Keyword(s):

Median Nerve ◽

Nerve Stimulation ◽

Compound Muscle Action Potential ◽

Axonal Loss ◽

Abductor Pollicis Brevis ◽

Needle Electromyography ◽

Median Nerve Stimulation ◽

Muscle Action Potential ◽

Stimulation Tests ◽

Tunnel Syndrome

Background and Aim: The present study aimed to use the median nerve Compound Muscle Action Potential (CMAP) amplitude by stimulation at the palm instead of Abductor Pollicis Brevis (APB) needle Electromyography (EMG) for determining axonal loss in patients with Carpal Tunnel Syndrome (CTS). Methods and Materials/Patients: This study was performed on 180 patients with CTS referred to the Electrodiagnostic (EDX) Center, Poursina Hospital, Guilan Province, Iran, in 2018-19. In this study, the APB needle EMG diagnostic test was used as the gold standard, and median nerve CMAP amplitude with stimulation at the palm and wrist were used to compare the two nerve stimulation tests. Results: All of the cases with abnormal amplitude loss detected by median nerve stimulation at the palm also had an axonal loss in the needle EMG of APB. So this test could be a good indicator of axonal loss if there is an abnormality (sensitivity: 73%, specificity: 100%). The results with wrist stimulation were not as accurate as of the palm stimulation, and some cases with decreased CMAP amplitude of median nerve had normal needle EMG of APB muscle (sensitivity: 86.6%, specificity: 94.9%). Conclusion: In cases with CTS, the abnormally decreased amplitude of the median nerve detected by stimulation at the palm could be a good indicator of axonal loss.

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