Artikel
Diagnosis und therapy of isolated flexor pollicis longus fascicle lesions
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Autoren
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Johannes Mayer
- CD Laboratory for Restoration of Extremity Function, Med. University Vienna, Vienna, Austria; Eberhard Karls University Tuebingen, Tuebingen, Germany
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Andreas Gohritz
- Swiss Paraplegic Center, Nottwil, Switzerland
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Stefan Salminger
- CD Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
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Gerd Bodner
- Privat Ultrasound Center Vienna, Vienna, Austria
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Jan Friden
- Swiss Paraplegic Center, Nottwil, Switzerland
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Oskar C. Aszmann
- CD Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Isolated flexor pollicis longus (FPL) nerve fascicle lesion represents a rare differential diagnosis of thumb flexion deficiency. Iatrogenic lesions of the FPL nerve fascicles can occur during operations in the forearm (e.g. osteosynthesis, removal of osteosynthesis material) due to its anatomical location.
Here we illustrate three clinical cases and discuss the diagnostic and therapeutic modalities of thumb flexion reconstruction.
Methods: We present three patients (1 female, 2 male) who developed a thumb flexion deficiency following osteosynthesis or removal of osteosynthesis material after forearm fracture. Additionally to a thorough clinical examination, electrodiagnostic studies as well as high-resolution ultrasound investigations were performed.
In all three cases surgical exploration of the anterior interosseous nerve was performed and the isolated FPL fascicle lesions were confirmed by inspection, palpation and electrostimulation. Reconstruction in two cases was performed using a single 35 mm long nerve graft from the distal AIN (n=2). One patient was beyond nerve surgical repair (5 years after the injury) as such a tendon transfer using the extensor carpi radialis longus was performed.
Active range of motion was assessed using a goniometer at three, six and twelve months after surgery. Functional outcome was additionally documented with videography.
Results and Conclusions: All three patients regained excellent thumb interphalangeal flexion with fine motor skills as was documented in active range of motion and videography.
There was no clinically detectable deficiency in forearm pronation after nerve harvest of the distal AIN in these two cases.
Iatrogenic isolated flexor pollicis longus (FPL) nerve fascicle lesion is a rare differential diagnosis of thumb flexion deficiency. We present our clinical experience, diagnostic algorithm and therapeutic options with this rare phenomenon. Primary reconstruction of the fascicle lesion with a distal AIN graft is a viable option for reconstruction of thumb flexion in such cases. If patients present late after injury, tendon transfers are still feasible and lead to a good functional result.
