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J Hand Microsurg 2023; 15(05): 395-398
DOI: 10.1055/s-0042-1749442
Case Report

Nerve Grafting for Isolated Injury to the Intrinsic Motor Branch of the Ulnar Nerve due to a Stab Injury: A Case Report

Takuya Yokoi
1   Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai, Japan
,
Takuya Uemura
2   Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
,
Mitsuhiro Okada
3   Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
,
Kosuke Saito
3   Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
,
Ema Onode
3   Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
,
Hiroaki Nakamura
3   Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
› Author Affiliations Funding The authors received no financial support for the research and/or authorship of this article.
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Abstract

Isolated injury to the deep motor branch of the ulnar nerve caused by stabbing is sporadic, with only one reported case in the English-language literature. We report one such case treated successfully using nerve grafting. A 33-year-old patient had sustained a stab wound to the right hypothenar eminence and showed a claw hand deformity. Needle electromyography study revealed denervation potentials with no voluntary motor unit action potentials (MUAPs) in the first dorsal interosseous (FDI) muscles. Nerve exploration revealed a neuroma-in-continuity in the intrinsic motor branch of the ulnar nerve. Intraoperative nerve stimulation confirmed the absence of compound muscle action potentials in the FDI. The damaged scarred nerve was resected, and the 15-mm defects were reconstructed with cable autografting. Two years and 5 months after the surgery, voluntary MUAPs were observed in the FDI. The pinch strengths recovered. Laceration of the deep branch of the ulnar nerve caused by stabbing can sometimes remain hidden as the hand sensation remains intact. Pre- and intraoperative electrophysiological examination is essential to assess the severity of the injured nerve and determine an appropriate surgical option. Even nerve grafting can facilitate satisfactory results as target intrinsic muscles are quite close to the repair site.

Keywords

neuroma - claw hand - intrinsic muscle - Guyon's canal - electromyography

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


Consent to Participate

Informed consent was obtained from all individual participants included in the study.


Consent for Publication

Consent for publication was obtained for every individual person's data included in the study.




Publication History

Article published online:
01 June 2022

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