Ann Rehabil Med.  2019 Jun;43(3):341-346. 10.5535/arm.2019.43.3.341.

Palmar Digital Neuropathy With Anatomical Variation of Median Nerve: Usefulness of Orthodromic Technique: A Case Report

Affiliations
  • 1Department of Physical Medicine and Rehabilitation, Korea University Anam Hospital, Seoul, Korea. hkkwon@korea.ac.kr
  • 2Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, Korea.

Abstract

Anatomic variation of palmar digital nerve pathways were reported in several cases. Selective exploration of palmar digital nerves with a nerve conduction study has been challenging, because of technical issues. We report a patient who received bilateral carpal tunnel release operation, complaining of a tingling sensation, and hypoesthesia on the middle and ring fingers. An electrodiagnostic study revealed a sensory neuropathy of palmar digital nerve of the left median nerve, supplying the ulnar side of the middle finger, and radial side of the ring finger. She underwent re-operation of open left carpal tunnel release, and a branching site of common digital nerves of the median nerve was identified not at the palm, but at a far proximal site around the distal wrist crease. Usefulness of an orthodromic sensory conduction study was clarified to eliminate volume conducted response or co-activation of nearby nerves in the patient with selective involvement of palmar digital nerve.

Keyword

Median nerve; Electrodiagnosis; Carpal tunnel syndrome; Median neuropathy

MeSH Terms

Anatomic Variation
Carpal Tunnel Syndrome
Electrodiagnosis
Fingers
Humans
Hypesthesia
Median Nerve*
Median Neuropathy
Neural Conduction
Sensation
Wrist
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