Altered hand proprioception following regional anesthesia as a cause of traumatic jersey finger: Report of two cases

Abstract

The sense of body ownership is being increasingly studied by manipulating incoming signals from the periphery with local anesthetics. We sought to understand how altered proprioception induced by anesthesia triggered a traumatic jersey finger, immediately postoperatively, in two patients who underwent surgical carpal tunnel release. Multiple mechanisms contributed to these postoperative injuries associated with a fall. Hand anesthesia deprives the brain of important afferent sensory information and modifies hand size perception in the brain. Moreover, it blocks efferent motor signals that contribute to the perception of hand position with sensory afferent signals. When the patients fell, their movement control was inadequate, generating a strong contraction of the hand extrinsic flexor muscles, against forceful distal phalanx extension. Lastly, both patients had removed their numb operated hand from their arm sling. Disrupted sensory and motor paths modify self-attribution of the hand, and thus halt adequate efferent commands. Protecting the operated hand until full sensory and motor control is regained could have prevented such rare accidents from happening. Level of evidence: V