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Isolated injury to the deep motor branch of the ulnar nerve caused by stabbing is sporadic, with only one reported case in the English-language literature. We report one such case treated successfully using nerve grafting. A 33-year-old patient had sustained a stab wound to the right hypothenar eminence and showed a claw hand deformity. Needle electromyography study revealed denervation potentials with no voluntary motor unit action potentials (MUAPs) in the first dorsal interosseous (FDI) muscles. Nerve exploration revealed a neuroma-in-continuity in the intrinsic motor branch of the ulnar nerve. Intraoperative nerve stimulation confirmed the absence of compound muscle action potentials in the FDI. The damaged scarred nerve was resected, and the 15-mm defects were reconstructed with cable autografting. Two years and 5 months after the surgery, voluntary MUAPs were observed in the FDI. The pinch strengths recovered. Laceration of the deep branch of the ulnar nerve caused by stabbing can sometimes remain hidden as the hand sensation remains intact. Pre- and intraoperative electrophysiological examination is essential to assess the severity of the injured nerve and determine an appropriate surgical option. Even nerve grafting can facilitate satisfactory results as target intrinsic muscles are quite close to the repair site.
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http://dx.doi.org/10.1055/s-0042-1749442 | DOI Listing |
Cureus
August 2025
Clinical Microbiology, Prathima Institute of Medical Sciences, Karimnagar, IND.
Background Carpal tunnel syndrome (CTS) is one of the most prevalent types of entrapment mononeuropathies, necessitating surgical treatment. The median nerve and its branches within the carpal tunnel have anatomical variances that may have clinical implications due to the possibility of iatrogenic injury while undergoing decompression treatments. Methods A total of 40 upper limb specimens (17 right and 23 left) from the Department of Anatomy were used in the dissection investigation.
View Article and Find Full Text PDFCureus
July 2025
Orthopedic Surgery, University of Arizona College of Medicine, Phoenix, USA.
Background: Joint denervation procedures continue to demonstrate promise in the management of chronic pain and functional improvement in joint pathology of the hand and wrist. As our understanding of these techniques evolves, a detailed comprehension of neuroanatomy, including the precise relationships and contributions of sensory innervation to targeted joints, is critical for optimizing outcomes.
Methods: Freshly thawed frozen upper extremity cadaveric specimens were analyzed under the direction of two fellowship-trained hand surgeons.
J Neurosurg Case Lessons
September 2025
Departments of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
Background: MRI-guided targeted fascicular biopsy has been a valuable technique for diagnosing idiopathic neuropathies. It has an 80% yield and a minor permanent morbidity rate of 5%.
Observations: A 48-year-old woman with a history of localized amyloidosis to the orbital muscle 2 years earlier presented with new neurological symptoms.
Cureus
August 2025
General Surgery, Larkin Community Hospital, Miami, USA.
We present a case of a 67-year-old male who sustained a complex glass injury to the right palm involving Zone 3. Intraoperative exploration revealed full-thickness lacerations of the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons to all four fingers, a 22 mm median nerve gap requiring cabled nerve allograft repair, laceration of the deep motor branch of the ulnar nerve and fourth common digital nerve requiring conduit-assisted repairs, and a segmental laceration of the ulnar artery requiring microsurgical reconstruction. The patient underwent staged reconstruction over two operations, including tendon repairs, nerve grafting with cabled decellularized frozen nerve allograft, vascular repair, and soft tissue coverage with adjacent tissue transfer.
View Article and Find Full Text PDFJBJS Essent Surg Tech
August 2025
Upper Extremity and Reconstructive Microsurgery Unit, Department of Orthopaedic Surgery, Institute of Orthopaedics, Lerdsin General Hospital, College of Medicine, Rangsit University, Bangkok, Thailand.
Background: Transfer of intercostal nerves to the radial nerve branch innervating the long head of the triceps muscle for elbow extension is indicated in patients with traumatic brachial plexus palsy that is either the pan-plexus type or C5-C7 palsy with no triceps muscle function. The procedure aims to restore triceps muscle function through the use of the intercostal nerves, which are expendable nerves, as donors.
Description: The procedure is performed by first identifying the third to fifth intercostal nerves and coaptating them to the radial nerve branch innervating the long head of the triceps muscle.