Iatrogenic selective lesion of the median nerve at the elbow.
A lesion of the median nerve may occur as a consequence of a compression by a haematoma or for a direct damage of the axons caused by a needle insertion. To date, no investigation reported a very selective lesion of the median nerve at the elbow, with the suffering limited only to the fibres for the first digit. A 53 year-old left-handed violinist underwent an arterial blood gas drawing. The patient complained immediately of an electrical shock impression going down the arm, followed by pin sensation into the first finger. A tingling sensation associated with numbness in the first fingertip and difficulty in the index-thumb pinch became progressively evident. The ENG-EMG findings showed an impairment mainly of the sensory fibres innervating the first digit and a drop of the motor action potential amplitude when the nerve was stimulated at the elbow. We reported a very partial lesion of the left median nerve at the elbow in a violinist who had a selective involvement of the fibres for his first digit. Even minimal lesions of the median nerve may impair severely the quality of life of patients.
Department of Neurology and ORL, Sapienza University of Rome-Polo Pontino Latina, Italy. rob.dif@tiscali.it
Roberto
R
Di Fabio
Carlo
C
Casali
Francesco
F
Pierelli
D001707:Biopsy, Needle / Q000009:adverse effects*; D004550:Elbow / Q000294:innervation* / Q000503:physiopathology; D004576:Electromyography; D006801:Humans; D007049:Iatrogenic Disease; D008279:Magnetic Resonance Imaging; D020423:Median Neuropathy / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology