Iatrogenic median and ulnar nerve injuries during carpal tunnel release: clinical, electrodiagnostic, and ultrasound features in 12 patients. Patient series

Abstract

BACKGROUND Nerve injuries during carpal tunnel release (CTR) are rare. Electrodiagnostic (EDX) and ultrasound (US) studies may be helpful in evaluating iatrogenic nerve injuries during CTR. OBSERVATIONS Nine patients sustained a median nerve injury, and 3 patients experienced ulnar nerve damage. Decreased sensation occurred in 11 patients, and dysesthesia occurred in 1 patient. Abductor pollicis brevis (APB) weakness occurred in all patients with median nerve injury. Of the 9 patients with median nerve injury, the compound muscle action potentials (CMAPs) of the APB and sensory nerve action potentials (SNAPs) of the 2nd or 3rd digit were not recordable in 6 and 5 patients, respectively. Of the 3 patients sustaining ulnar nerve injuries, the CMAPs of the abductor digiti minimi (ADM) and SNAPs of the 5th digit were not recordable in 1 patient; 2 patients showed prolonged latency and decreased amplitude of CMAPs/SNAPs. US studies of 8 patients with a median nerve injury showed a neuroma within the carpal tunnel. One patient underwent surgical repair urgently, and 6 did so after variable intervals. LESSONS Surgeons should be cognizant of nerve injuries during CTR. EDX and US studies are useful in evaluating iatrogenic nerve injuries during CTR.

State of the art review. Complications after carpal tunnel release

“…Injury to a sensory nerve may lead to loss of sensibility in its territory of innervation, pain symptoms and/or development of a symptomatic neuroma. Fortunately, development of a symptomatic neuroma after laceration of the PCB of the median nerve is rare and to our knowledge only described in small case series collected over a long period of time (Louis et al., 1985; Shields et al., 2023).…”

Seltene Nervenkompressionssyndrome

“…Eine Einklemmungssymptomatik wird vor allem zwischen M. brachioradialis und M. extensor carpi radialis beschrieben. Beschrieben sind Fälle, bei denen repetitive Pronations- und Supinationsbewegungen zu einer Beschwerdesymptomatik geführt haben (Scissoring-Effekt) 21 .…”