Restoration of Sensation and Thumb Opposition Using Nerve Transfers Following Resection of a Synovial Sarcoma of the Median Nerve

Abstract

Synovial sarcomas of peripheral nerves are rare and often leave major functional deficits after wide excision. We present a case of median nerve reconstruction using nerve transfers after resection of a synovial sarcoma of the median nerve. Sensation was restored by transferring the fourth common digital nerve to the first and second common digital nerves. Thumb opposition was restored by transferring the abductor digiti minimi branch to the recurrent motor branch. The soft tissue defect was reconstructed with a free gracilis muscle flap. Fifteen months after surgery, there was Medical Research Council grade 4þ opposition strength with co-contraction of the abductor digiti minimi. Sensation recovered slowly over time. The Disabilities of the Arm, Shoulder, and Hand score decreased from 47.4 before surgery to 13.3 afterward. The patient was able to use the right hand for writing and crafting pottery. Distal nerve transfers are a reliable option for reconstruction of complete median nerve defects.

Rare Median Nerve and Digital Nerve Tumor Resection and Distal Nerve Transfers

“…After sensory hand nerve transfers, referred sensation may be observed 10 . Sensory re-education is usually required because fingertip sensation is largely controlled by the cortex and adult patients have reduced cortical plasticity compared with children 11 .…”

Abductor Digiti Minimi and Anterior Interosseous to Ulnar Motor Nerve Transfer: The Super Turbocharge End-to-Side Transfer

“…[13][14][15][16][17] The abductor digiti minimi (ADM) muscle has long been recognized as relatively expendable, with the Huber opponensplasty described in 1921 and more recently the ADM to recurrent motor nerve transfer for thumb opposition. [18][19][20][21] Axon counts in the ADM branch have been reported as 676 ± 176. 20 We recognized that, in the setting of ulnar neuropathy, a second nerve transfer can be performed distally to further augment more critical ulnar intrinsic recovery, with transfer of the ADM in a turbocharged Summary: Anterior interosseous nerve to ulnar motor nerve supercharged end-to-side (SETS) nerve transfer to restore intrinsic function is a recently adopted nerve transfer in severe ulnar neuropathy.…”