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

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.

Publikationsverlauf

Artikel online veröffentlicht:
01. Juni 2022

• References

• 1 Zaworski RE. Undiagnosed deep ulnar nerve paralysis resulting from stab wounds of the palm. J Trauma 1979; 19 (12) 957-960
• 2 Ozaksar K, Toros T, Kayalar M, Ademoğlu Y. Isolated severance of the intrinsic motor branch of the ulnar nerve caused by stab injuries to the hand: a report of three cases [in Turkish]. Acta Orthop Traumatol Turc 2007; 41 (03) 249-252
• 3 Haussmann P. Isolated traumatic lesions of the motor nerve branches in the hand [in German]. Handchirurgie 1980; 12 (1-2): 23-25
• 4 Haftek J, Kasprzak H, Radek A, Jarmundowicz W, Jóźwiak J. Injury of the deep branch of the ulnar nerve [in Polish]. Neurol Neurochir Pol 1985; 19 (04) 323-326
• 5 Goth D. Motor paralysis of the ulnar nerve in an ice-stab injury [in German]. Handchir Mikrochir Plast Chir 1982; 14 (01) 18-19
• 6 Atkins SE, Logan B, McGrouther DA. The deep (motor) branch of the ulnar nerve: a detailed examination of its course and the clinical significance of its damage. J Hand Surg Eur Vol 2009; 34 (01) 47-57
• 7 Suzuki M, Kurimoto S, Shinohara T, Tatebe M, Imaeda T, Hirata H. Development and validation of an illustrated questionnaire to evaluate disabilities of the upper limb. J Bone Joint Surg Br 2010; 92 (07) 963-969
• 8 Peterson P, Sacks S. Fracture-dislocation of the base of the fifth metacarpal associated with injury to the deep motor branch of the ulnar nerve: a case report. J Hand Surg Am 1986; 11 (04) 525-528
• 9 Earle AS, Vlastou C. Crossed fingers and other tests of ulnar nerve motor function. J Hand Surg Am 1980; 5 (06) 560-565
• 10 Fredericson M, Kim BJ, Date ES, McAdams TR. Injury to the deep motor branch of the ulnar nerve during hook of hamate excision. Orthopedics 2006; 29 (05) 456-458
• 11 Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951; 74 (04) 491-516
• 12 Shea JD, McClain EJ. Ulnar-nerve compression syndromes at and below the wrist. J Bone Joint Surg Am 1969; 51 (06) 1095-1103
• 13 Terrono AL, Belsky MR, Feldon PG, Nalebuff EA. Injury to the deep motor branch of the ulnar nerve during carpal tunnel release. J Hand Surg Am 1993; 18 (06) 1038-1040