A Case of Iatrogenic High Median Nerve Injury That Occurred during Elbow Arthroscopy and Was Treated by Nerve Grafting and Nerve Transfer

Abstract

　We treated a case of iatrogenic high median nerve injury that occurred during elbow arthroscopy. Arthroscopic debridement and free body resection were performed in a 47-year-old man because of osteoarthritis in the dominant right elbow joint. Postoperatively, he complained of complete median nerve palsy, except in the thenar muscle, and poor function in his hand. We explored the median nerve and confirmed a 7-cm defect at the elbow joint level. We grafted the sural nerve to a nerve branch from the pronator teres and two sural nerve cable grafts to close the median nerve defect. In addition, the branch of the radial nerve to the ECRB was transferred to the AIN to restore thumb and finger flexion. Seventeen months postoperatively, AIN function recovered, and muscle strength increased to MMT 4; the patient was able to fully create the “perfect O” sign. The FCR, FDS, FPL and index finger FDP scores were MMT 4. Sensation recovered to “blue” in the thumb and “purple” in the index finger on the Semmes-Weinstein monofilament test. The APB was spared because of ulnar nerve innervation. Median nerve function recovered well and the patient returned to his previous work (bone setter) .