gms | German Medical Science

Objective: The neuropathic pain occuring after an injury of the afferent finger nerves has a negative influence on the function of the hand. Surgery is an alternative option to permanent antineuropathic medication but it is often difficult due to missing distal nerve ends for an end-to-end connection.

Method: We demonstrate two cases of an injury of the sensory nerves innervating the thumb. The first case is that of a 50-year-old woman, who had a distal radius fracture which was treated with osteosynthesis. After surgery she reported a sensory loss of D1-4 and a paraesthesia, induced even by light skin contact, indicating an injury of R. palmaris N. medianus. The second case presents a 61-year-old female patient with partial transsection of a sensory thumb branch of N. radialis after rhizarthritis surgery. As a result she suffered marked neuropathic pain. Explorative surgery was performed in both cases.

Results: In the first case a small nerve end could be found matching to R. palmaris coming off the main nerve trunk of the median nerve. The main trunk including the small end was embedded into a 2x2cm collagen membrane from irradiated bovine pericardium (Tutopatch^® Fa RTI Biologics Tutogen). In the second case the injured sensory branch could be identified. The nerve end was embedded into a slot of subcutaneous lip-tissue. Both patients had a clear immediate benefit from surgery and at the 6 week follow-up.

Conclusions: It is clear that in case of an injury affecting the main peripheral nerves with motor function, nerve reconstruction is the method of choice. There are, however, rare recommendations concerning the management of small sensory nerve trauma. Even for these cases, surgery has to be considered to treat neuropathic pain and to prevent neuroma-development. Wrapping the injured nerve end into biologically inert material without compressive effect seems to be an option.