Selective Median Nerve Neurotomy for Severe Flexion Deformity of Hand

Journal Title: Nepal Journal of Neuroscience - Year 2013, Vol 10, Issue 1

Abstract

Limb spasticity can be due to any cranial and spinal pathology. Such problems can be partially or subtotally cured by selectively dividing the over excited nerve fascicles which are responsible for spasticity. Here we review the literature and share our experience of few cases of severe spasticity of hand who underwent selective median nerve neurotomy and got better. An 18-year-old girl presented with severe spasticity of left hand since early childhood due to meningitis. She had severe flexion deformity of all the fingers, thumb and wrist. Another case, a 20-year-old boy with the history of some brain tumor operated few years back, came to my clinic with severe spasticity of right hand and fingers since then. He was not able to use his right hand and was like handicapped. There was significant cosmetic correction of the hand and fingers after selective neurotomy of median nerve in both the cases though function was still poor. Surgery was performed under general anesthesia with muscle relaxant stopped while stimulating the nerve. Median nerve was exposed both above and below the elbow. The motor branches to the major muscles of the forearm were stimulated with train of four nerve stimulator. The nerve which was supplying the overexcited muscles, according to preoperative assessment, was partially divided. In conclusion, selective peripheral nerve neurotomy is an established procedure for spastic deformity of limbs. It has not yet become a routine procedure in Nepal. This procedure is very helpful to recover the affected limb, at least from cosmetic point of view. ,

Authors and Affiliations

Dr Prabin Shrestha, MD, PhD

Keywords

Related Articles

EEG Based Carotid Endarterectomy:

decades for the treatment of stenotic and ulcerative lesions of the carotid artery. It improves the cerebral hypoperfusion caused by stenosis of the carotid artery or may prevents artery to artery embolism from ulceratio...

Role of Cisternal Drainage in Patients with Traumatic Brain Injury Undergoing Decompressive Craniectomy

The effect of decompressive craniectomy (DC) on survival and functional outcome in traumatic brain injuries (TBI) is far from satisfactory. Additional modalities including cisternal drainage (CD) that provides good contr...

Schwannoma of Small Branch of Cervical Nerve: A Rare Case Repot

A 17-year-old male presented with a swelling in the neck for 6 yrs. Neuroimaging showed a heterogeneous mass extending from the mandible to the clavicle splaying the major neck vessels without intracranial extension. FNA...

Predictors of Unfavorable Outcome in Meningitis Patients

The main objective is to study the predictors of unfavorable outcome in meningitis patients. This is a prospective analytic study of 100 patients with different types of meningitis admitted in Tribhuvan University teachi...

Contoured Loop and Modifi ed Wiring Technique for occipitocervical Fixation - A Safe and Effi cacious Option

To study the safety and effi cacy of contoured loop and modifi ed wiring techniques for occipitocervical fi xation. Retrospective study among 15 patients who underwent occipitocervical fi xation from Jan 2011-16 were rev...

Download PDF file
  • EP ID EP368507
  • DOI -
  • Views 118
  • Downloads 0

How To Cite

Dr Prabin Shrestha, MD, PhD (2013). Selective Median Nerve Neurotomy for Severe Flexion Deformity of Hand. Nepal Journal of Neuroscience, 10(1), 3-6. https://www.europub.co.uk/articles/-A-368507