Surgical Outcome and Management of Median Nerve Lesions

Daniel H. Kim, MD
Robert Tiel MD
David Kline, MD (New Orleans, LA)

200 out of 289 patients with median nerve lesions excluding carpal tunnel syndrome at the levels of arm, elbow and forearm, and wrist were operated. Most common mechanisms of median nerve injuries were laceration, GSW, fracture–associated stretch and contusion, compression, and injection. Lesions not in continuity required primary or secondary end to end suture or graft repairs. With use of direct intraoperative nerve action potential (NAP) recording, median nerve injuries with lesion in continuity required external or internal neurolysis or resection of the lesion followed by end to end suture or graft repair. 85% of operated patients had minimum of 18 months follow up. Functional recovery of grade 3 or better were seen 35/41 (85%) in suture repair, 36/50(72%) in graft repair and 72/76(95%) in neurolysis. 29 out of 33 patients with nerve sheath tumors of median nerve were resected with preservation of preoperative baseline function.