A 43-year-old woman presented with intense pain in the left upper arm, a plegic flexor pollicis longus, and flexor digitorum profundus of the 2nd digit without sensory symptoms Figure 1 Ultrasound, intraoperative photograph, and histopathology (A) Longitudinal ultrasound section of an anterior interosseous nerve fascicle in the median nerve at elbow level, hourglasslike, torsional constriction (distal constriction; proximal constriction not shown). (B) Intraoperative confirmation of 2 constrictions (thick arrows) with slight torsion at internal neurolysis; fascicular grafting followed. (C) Histology of resected fascicle with subtotal loss of vital nerve tissue within the constriction; note the torsional appearance.
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