Abstract
A 50-year old man received a cut injury to the left forearm with involvement of median and ulnar nerves and consequent hand motor and sensory deficits. He underwent surgical revision of the wound, but 6 months later the patient did not present recovery. A following neurophysiological examination showed sporadic fibrillation potentials with reduced voluntary recruitment in the first dorsal interosseus muscle and complete denervation in muscles innervated by distal median nerve, indicating an axonal ulnar neuropathy and a possible median nerve axonotmesis or neurotmesis. Ultrasound examination showed: median nerve neurotmesis and amputation neuroma with a gap of about 7–8 cm between proximal and distal stumps; a slight focal increase in cross-sectional area of the ulnar nerve close to the scar. The patient newly underwent surgery. A reconstruction of the left median nerve by a sural nerve graft and neurolysis of the ulnar nerve were performed. In the following days the patient reported an improvement in the cold and hot sensitivity on the ulnar nerve distribution in the left hand. In conclusion ultrasound nerve examination played a key role in decision-making.
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