Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2023; 11(25): 5941-5946
Published online Sep 6, 2023. doi: 10.12998/wjcc.v11.i25.5941
Median neuropathy after multiple punctures of the forearm for catheterization: A case report
Tomoaki Suzuki, Yuichiro Matsui, Daisuke Momma, Takeshi Endo, Norimasa Iwasaki
Tomoaki Suzuki, Yuichiro Matsui, Takeshi Endo, Norimasa Iwasaki, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
Yuichiro Matsui, Section for Clinical Education, Faculty of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan
Daisuke Momma, Center for Sports Medicine, Hokkaido University, Sapporo 060-8638, Japan
Author contributions: Suzuki T was involved in gaining ethical approval, patient recruitment and data analysis; Matsui Y, Momma D and Endo T contributed to editing and conceptualization; Iwasaki N contributed to supervision; All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient and her parents for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tomoaki Suzuki, MD, PhD, Doctor, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, No. 15 Kita, No. 7 Nishi, Kita-ku, Sapporo 060-8638, Japan. gmtm32@gmail.com
Received: May 2, 2023
Peer-review started: May 2, 2023
First decision: July 3, 2023
Revised: July 14, 2023
Accepted: August 9, 2023
Article in press: August 9, 2023
Published online: September 6, 2023
Processing time: 121 Days and 19.5 Hours
Abstract
BACKGROUND

Neuropathy may occur at some sites after catheterization for close examination of cardiac disease. Although the radial artery is considered a relatively uncom-plicated site for catheterization, the radial artery and median nerve are in relatively close proximity, with the risk of median nerve injury depending on the angle of puncture. The purpose of this study was to report the outcomes of surgery performed for conservative therapy-resistant median neuropathy following forearm catheterization.

CASE SUMMARY

A 50-year-old woman experienced palsy from the right thumb to the radial side of the ring finger after catheterization from the radial artery of the right forearm. Paresthesia developed at the same site and a positive tinel-like sign was seen for the median nerve area at the high level of the puncture site. Nerve conduction study showed reduced compound muscle action potentials and loss of sensory nerve action potentials. Symptoms did not improve despite pharmacotherapy and the patient gradually developed flexion restrictions of the index and middle fingers. Median nerve injury and associated flexor tendon adhesion was diagnosed, and the patient was referred for surgery at 3 mo after injury. When the same area was opened, no injury to the median nerve epithelium was obvious, but the area of the positive tinel-like sign was highly adherent to surrounding tissue and to the flexor digitorum superficialis of the index and middle fingers. The surgery was terminated with adequate adhesion release. Rehabilitation was initiated postoperatively, improving neurological symptoms and range of motion of the fingers. Six months after surgery, the patient returned to daily activities without discomfort.

CONCLUSION

This case provides the appropriate diagnosis and treatment for a suspected peripheral nerve injury.

Keywords: Catheterization; Median neuropathy; Surgical treatment; Case report

Core Tip: Median neuropathy during forearm puncture is unlikely but possible given the anatomic location. In general, peripheral neuropathy of the upper extremity causes difficulty in performing hand-operated tasks and daily living, leading to a decreased quality of life, so surgery is aggressively considered in cases that are resistant to conservative treatment. Even in examinations where the risk of complications is considered low, accurate diagnosis based on clinical symptoms is important to provide appropriate treatment.