Poggi Domenico Sergio, Massarella Massimo, Piccirilli Eleonora
Villa Stuart Sport Clinic, Rome, Italy.
Policlinico Tor Vergata, Department of Orthopaedics and Traumatology, Rome, Italy.
Int J Surg Case Rep. 2021 Feb;79:239-242. doi: 10.1016/j.ijscr.2021.01.039. Epub 2021 Jan 15.
Flexor Pollicis Longus (FPL) lies in the volar compartment of the forearm and is responsible for the flexion of the distal phalanx of the thumb. The innervation of FPL is provided by an isolated motor branch of the anterior interosseus nerve (AIN), a branch of the median nerve. AIN disfunction causes symptoms of exclusive motor involvement concerning the FPL muscle. Solitary paralysis of the FPL is very uncommon in clinical practice.
We report the case report of a bilateral isolated paralysis of Flexor Pollicis Longus (FPL) that occurred after a trauma. Two years after the injury, no organic lesions were found and instrumental exams did not suggest any diagnosis. Surgical exploration of FPL and its innervation allowed to diagnose a pure post-traumatic bilateral neuroapraxia sustained by the presence of post traumatic connective fibrous bands.
Diagnostic and therapeutic bands release allowed the immediate functional recovery of the nerve function and the consequent restoration of FPL function. The surgical exploration of the suspected injured nerve was the resolutive procedure for diagnosis and treatment of the disease. During the surgical exploration, the cause of FPL palsy was identified and removed with a complete recovery of the neuromuscular unit function.
This case is very peculiar because of the clinical presentation with an important bilateral functional limitation of FPL. The release allowed the complete restoration of FPL function. No similar cases were described in literature.
拇长屈肌（FPL）位于前臂掌侧间隙，负责拇指远节指骨的屈曲。FPL由正中神经的分支骨间前神经（AIN）的一条独立运动支支配。AIN功能障碍会导致仅涉及FPL肌肉的运动受累症状。在临床实践中，FPL单独麻痹非常罕见。
我们报告一例创伤后发生的双侧拇长屈肌（FPL）孤立性麻痹的病例。受伤两年后，未发现器质性病变，影像学检查也未提示任何诊断。对FPL及其神经支配进行手术探查，诊断为单纯创伤后双侧神经失用症，原因是存在创伤后结缔组织纤维带。
诊断性和治疗性纤维带松解使神经功能立即恢复，从而恢复了FPL功能。对疑似受损神经进行手术探查是该疾病诊断和治疗的决定性步骤。在手术探查过程中，确定了FPL麻痹的原因并予以消除，神经肌肉单位功能完全恢复。
该病例非常特殊，因为临床表现为FPL双侧功能严重受限。纤维带松解使FPL功能完全恢复。文献中未描述过类似病例。
