9.0: Thursday, March 17, 2005

Acute Median Nerve Neuropathy Following Trauma of the Upper Extremity

Abdullah Khalil, MD, Chenicheri Balakrishnan, MD, and Vankata S. Erella, MD.

Acute compression of the median nerve occurs when interstitial pressure within the compartment rises above critical threshold pressure. A study was carried out to determine the incidence, clinical findings and long term results of acute median nerve neuropathy in trauma patients. Over a two year period, eleven patients between ages of twenty and fifty four with isolated trauma to the upper extremity presented with symptoms of median nerve neuropathy. There was eight men and three women in the group. The trauma's included burns, foreign bodies,and a thrombosed median artery. All injuries presented within twenty-four hours. All patients were alert with no history of loss of conscious. Slow onset of numbness over the median nerve distribution and pain on passive extension of fingers were the presenting symptoms. Decompression of the carpal tunnel was performed on all patients. Post-op, all patients had improvements with their symptoms and were evaluated by two-point discrimination, and nerve conduction studies; inaddition, all patients received occupational therapy. Although this was a small study group, compression neuropathy of the median nerve seem to occur from edema in these patients. Early decompression in suspected cases confirmed the clinical findings and resulted in good functional recovery.