Traumatic neuroma of the median nerve

Case contributed by Lam Van Le
Diagnosis certain

Presentation

A palpable mass on the anterior surface of the left wrist, tender on palpation. History of a left wrist injury that was sutured one year ago. Ultrasound shows a mass continuous with the median nerve. Electromyography (EMG) results indicate severe damage to the median nerve.

Patient Data

Age: 20 years
Gender: Male
This study is a stack
Axial
T2
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Axial PD
fat sat
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Coronal PD
fat sat
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Sagittal
PD fat sat
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Axial
T2 me2d
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Coronal
T2 me2d
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Axial
DWI
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Axial
ADC
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Coronal
T1
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Info

On the MRI, a subcutaneous mass was noted on the anterior aspect of the left wrist, measuring approximately 11 x 6 x 13 mm, with well-defined margins, a fusiform shape, and continuity with the median nerve. The lesion exhibited low signal intensity on T1-weighted images, heterogeneous high signal intensity on T2-weighted images and PDFS, and restricted diffusion.

Surgical report:

  • a previous scar was noted on the anterior aspect of the lower third of the left forearm, measuring approximately 5 cm, which was well-healed with no signs of dehiscence. On palpation, a mass was felt beneath the scar, approximately 2 x 2 cm in size, with well-defined borders

  • an incision was made on the lower third of the left forearm, and the tissue was dissected layer by layer to expose the median nerve neuroma, which was adherent to the skin on the anterior forearm; the median nerve was found to be discontinuous at the periphery

  • a segment of the saphenous vein, approximately 20 cm in length, was harvested. The vein was longitudinally incised and wrapped around the neuroma

Case Discussion

The imaging findings, clinical presentation, and electromyography results are consistent with a traumatic neuroma of the median nerve. The patient subsequently underwent surgical excision of the median nerve and wrapping of the neuroma with a saphenous vein graft. Post-surgery, the clinical symptoms improved.

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