Department of Orthopedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito City, Ibaraki, Japan.
Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba city, Ibaraki, Japan.
J Med Case Rep. 2023 Jun 11;17(1):253. doi: 10.1186/s13256-023-03952-8.
Various neurological manifestations associated with coronavirus disease 2019 have been increasingly reported. Herein, we report a rare case of anterior interosseous nerve syndrome, which occurred 5 days after the onset of coronavirus disease 2019.
A 62-year-old Asian woman with a history of coronavirus disease 2019 who developed a complete motor deficit in the left flexor pollicis longus and pronator quadratus without sensory deficits. The symptoms appeared as a sudden onset fatigue and severe pain of the left arm, 5 days after the onset of coronavirus disease 2019. She noticed paralysis of the left thumb at 2 weeks after the onset of coronavirus disease 2019. Electromyography assessment of the anterior interosseous nerve-dominated muscles revealed neurogenic changes such as positive sharp wave and fibrillation in flexor pollicis longus and pronator quadratus, confirming the diagnosis of anterior interosseous nerve syndrome. There were no other diseases that could have resulted in peripheral nerve palsy. We performed a functional reconstruction surgery of the thumb by tendon transfer from the extensor carpi radialis longus to the flexor pollicis longus. The patient reported a good patient-reported outcome (2.27 points in QuickDASH Disability/Symptom scoring and 5 points in Hand20 scoring) at final follow-up (1 year after the surgery).
This case highlights the need for vigilance regarding the possible development of anterior interosseous nerve syndrome in patients with coronavirus disease 2019. Tendon transfer from extensor carpi radialis longus to flexor pollicis longus can provide good functional recovery for unrecovered motor paralysis after anterior interosseous nerve syndrome.
与 2019 冠状病毒病相关的各种神经表现已越来越多地被报道。在此，我们报告一例罕见的前骨间神经综合征病例，该病例发生在 2019 冠状病毒病发病后 5 天。
一名 62 岁的亚裔女性，有 2019 冠状病毒病病史，在发病 5 天后出现左侧屈拇长肌和旋前方肌完全运动功能丧失，无感觉功能障碍。症状表现为左臂突发疲劳和剧烈疼痛，在发病后 5 天出现。她在发病后 2 周注意到左手拇指瘫痪。前骨间神经支配的肌肉肌电图评估显示神经源性改变，如屈拇长肌和旋前方肌出现正锐波和纤颤，确诊为前骨间神经综合征。没有其他可导致周围神经麻痹的疾病。我们通过从桡侧腕长伸肌向屈拇长肌转移肌腱进行拇指功能重建手术。患者最终随访（手术 1 年后）报告了良好的患者报告结局（QuickDASH 残疾/症状评分 2.27 分，Hand20 评分 5 分）。
本病例强调了对 2019 冠状病毒病患者可能发生前骨间神经综合征的警惕性。从前臂肌向屈拇长肌转移肌腱可为前骨间神经综合征后未恢复运动性瘫痪的患者提供良好的功能恢复。
