Median nerve injury

Case contributed by Dr Maulik S Patel

Presentation

Right distal forearm volar side laceration.

Patient Data

Age: 45 years
Gender: Female
ultrasound

The median nerve shows discontinuity with neuroma at two ends. A gap of 20 mm is present between two ends of the nerve. Associated palmar cutaneous branch injury is very likely.

Flexor carpi radialis tendon shows sutures passing through radial side edematous fibers. Its fibers along the ulnar side reveal normal echopattern favoring partial tendon thickness injury.

The radial artery shows a kink at the flexor carpi radialis tendon suture level. The artery is completely obliterated at this level. Proximal and distal arterial segment show pulsation.

Flexor pollicis longus shows a small partial thickness defect at the myotendinous junction under the scar region.

Intact palmaris longus tendon.

Short-axis cine-loop runs from the proximal to the distal direction.

Annotated image

Short-axis cine-loop runs from the proximal to the distal direction. A indicates radial artery. N indicates the median nerve. FCR is flexor carpi radialis tendon and PL is the palmaris longus tendon.

Diagram

A sketch shows nerve, artery, and tendon injuries.

Case Discussion

The patient had a distal forearm volar laceration one month prior to the presentation. Primary suturing was done a day after the injury. She presented with clinical signs of median neuropathy and radial arterial injury.

The ultrasound shows a complete cut of the median nerve. The radial artery appears to be sutured along with the flexor carpi radialis tendon.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.