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
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