Stevens Kali N, Malone Kevin J
Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
J Hand Surg Glob Online. 2024 Mar 27;6(3):418-421. doi: 10.1016/j.jhsg.2024.02.001. eCollection 2024 May.
We report a case of posttraumatic compressive neuropathy of the deep motor branch of the ulnar nerve occurring in the setting of heterotopic ossification following a direct blow to the hypothenar eminence. Over several weeks, the patient developed ring and little finger claw deformities and atrophy of his first dorsal interosseous and adductor pollicis muscles with sparing of sensation. Electromyography and nerve conduction study localized the area of injury, and computed tomography confirmed the presence of heterotopic bone near the deep motor branch of the ulnar nerve. Intraoperatively, the deep motor branch of the ulnar nerve was under tension as it traversed volarly over the hook of hamate and heterotopic bone. Decompression of the deep motor branch of the ulnar nerve with resection of heterotopic bone and the hook of hamate was performed. Six months postoperatively, the patient demonstrated resolution of clawing and improving strength of his ulnar nerve innervated intrinsic muscles.
我们报告一例尺神经深运动支创伤后压迫性神经病变，发生于小鱼际肌隆起直接受击后出现异位骨化的情况下。在数周时间里，患者出现环指和小指爪形畸形，以及第一背侧骨间肌和拇收肌萎缩，但感觉未受影响。肌电图和神经传导研究确定了损伤部位，计算机断层扫描证实尺神经深运动支附近存在异位骨。术中发现，尺神经深运动支在向掌侧越过钩骨钩和异位骨时处于紧张状态。遂进行了尺神经深运动支减压术，切除了异位骨和钩骨钩。术后6个月，患者爪形畸形消失，尺神经支配的固有肌力量有所改善。
