Median neuropathy after multiple punctures of the forearm for catheterization: A case report

Figure 1 Preoperative physical examination. A and B: Inspection of the right hand. The Tinel like sign was positive at the 2 proximal lateral digits from the wrist crease (1); C: Finger extension. Allowable without restriction; D: Finger flexion. Restriction of the index and middle fingers prevents full grip; E: Right hand perception. Numbers represent two-point discrimination test, colors represent semmes weinstein test results. There is a decreased perception in the median nerve area; F: Nerve conduction studies results of the median nerve. Compound muscle action potential was reduced and sensory nerve action potential showed no waveform appearance.

Figure 2 Intraoperative photographs. A: The median nerve (1) is adherent to a fatty tissue (white arrow head) and flexor digitorum superficialis (FDS) for the second digit (white arrow); B: The median nerve was dissected circumferentially, and FDS muscle belly was resected; C: Microscopic findings. There was mild erythema of the neuroepithelium, but no obvious injury or defect.

Figure 3 Postoperative physical examination. A and B: Inspection of the right hand. An operation scar is present on the proximal median of the palm to the distal median of the forearm; C: Finger extension. Allowable without restriction; D: Finger flexion. Full grip is available; E: Decreased perception is localized to the phalanges of the index and middle fingers; F: Nerve conduction studies results of the median nerve at 6 mo postoperatively. The waveform of sensory nerve action potential can be confirmed.