Isolated Fascial Compression of the Recurrent Motor Branch of the Median Nerve: A Case Report

Abstract

Isolated compression of the recurrent motor branch (RMB) of the median nerve is not commonly reported. This report deals with a case of fascial band compression of the RMB of the median nerve with sparing of the sensory portion of the nerve in a single patient. The episode was precipitated by the subject was clearing fallen trees after an ice storm. Symptoms occurred only in the left, nondominant hand of the patient, a 43-year-old invasive cardiologist. He presented within weeks of symptom onset, but marked clinical and electrodiagnostic abnormalities of the branch were already present. Timely decompression after evaluation led to a successful clinical outcome, with restoration of full strength on manual muscle testing by 6 months postoperatively and marked electrodiagnostic improvements as well by 11 months after operation. Final clinical examination 16 months after operation showed thenar muscle bulk and strength well maintained.

Isolated Compression of the Recurrent Motor Branch of the Median Nerve: A Case Report

“…They believed that the compression occurred at the entrance tunnel of the RMB or in the retinaculum of the transverse ligament by anomalous nerve angulation, being accompanied by a neuroma proximal to the compression point. 1 The isolated compression of RMB was also identified by Tate, 2 where bands of the palmar fascia induced the compression. Our case was similar to the case of Tate, where we observed compression of the RMB by a fascial band at the entry point into the thenar tunnel.…”

“…Among the few cases described in the literature, there are only 2 studies available regarding the compression by fascial bands. 1,2 The other reports available are secondary to compression by cystic masses or tumors. 3-6 The compression by local anatomical changes or even after vigorous shiatsu massage on the hand was reported too.…”

Tuzak nöropatilerde manyetik rezonans görüntüleme

“…Distal kesimde, etkilenen kaslarda akut ve kronik evrede oluşan denervasyona bağlı değişiklikler izlenebilir. [39,40] Tümör ve enfeksiyon durumları ile romatoid artrit gibi inflamasyon düşünülen olgularda, MR inceleme, kontrastlı çekimlerle tamamlanmalıdır (Şekil 28, 29).…”

Sonographic Visualization of Thenar Motor Branch of the Median Nerve: A Cadaveric Validation Study

“…Isolated or predominant TMB involvement has been implicated in some patients with CTS who present with disproportionate thenar atrophy or weakness, particularly in the setting of a relatively normal‐appearing median nerve. In such cases, the TMB may be stretched around the distal TCL or compressed as it passes through either the fibrous tunnel formed by the thenar fascia and the TCL, or the TCL itself [24,27,39‐45]. Iatrogenic TMB injury is perhaps the most‐feared complication of carpal tunnel release, the risk of which is hypothesized to increase dramatically in the setting of anatomic variations in the origin or course of the TMB [24,27,29,39,46‐50].…”