Fagan Mitchell G, Greene Bradley H C, Gillis Joshua A
Memorial University of Newfoundland, St. John's, NL, Canada.
Dalhousie University, Halifax, NS, Canada.
Hand (N Y). 2025 May 22:15589447251339506. doi: 10.1177/15589447251339506.
Iatrogenic and traumatic sensory nerve injury at the level of the wrist can lead to debilitating neuroma. Targeted muscle reinnervation (TMR) is an effective treatment for the management of symptomatic neuromas. We investigate the use of the anterior interosseous nerve (AIN) as a recipient nerve for the treatment of iatrogenic neuromas. This case series describes 4 patients treated for neuromas of the lateral antebrachial cutaneous nerve (LABC), palmar cutaneous branch of median nerve (PCB), and radial sensory nerve (RSN).
Four cases involved a symptomatic neuroma of the LABC, PCB, or RSN. These were treated with TMR, using the AIN motor branch to pronator quadratus. The neuromas were identified in all 4 cases and transected distally. The AIN was identified through a proximal extension of the exploratory incision and an end-to-end coaptation was performed to the proximal aspect of the donor nerve and the distal AIN.
All 4 patients underwent routine follow-up for a duration of 2 to 10 months, with a long-term follow-up from 25 to 49 months. At routine follow-up, all patients reported resolution of pain and symptoms and had a negative Tinel's sign over their previous neuroma site. At the long-term follow-up, 2 patients reported recurrence of hyperesthesia, both to a lesser severity than before treatment. All 4 patients reported returning to work or routine and stated the TMR procedure improved their pain and symptoms.
The motor branch of the distal AIN to pronator quadratus is a viable option as a TMR recipient for the management of symptomatic neuromas of the wrist level. Long-term follow-up shows reduction of reported pain and improvement of function.
手腕水平的医源性和创伤性感觉神经损伤可导致使人衰弱的神经瘤。靶向肌肉再支配（TMR）是治疗有症状神经瘤的有效方法。我们研究将骨间前神经（AIN）用作治疗医源性神经瘤的受区神经。本病例系列描述了4例接受治疗的前臂外侧皮神经（LABC）、正中神经掌皮支（PCB）和桡神经感觉支（RSN）神经瘤患者。
4例患者涉及LABC、PCB或RSN的有症状神经瘤。采用TMR治疗，使用AIN运动支至旋前方肌。在所有4例病例中均识别出神经瘤并在远端切断。通过探索性切口的近端延伸识别AIN，并将其与供体神经的近端和远端AIN进行端端吻合。
所有4例患者均接受了2至10个月的常规随访，长期随访时间为25至49个月。在常规随访中，所有患者均报告疼痛和症状消失，原神经瘤部位Tinel征阴性。在长期随访中，2例患者报告感觉异常复发，严重程度均低于治疗前。所有4例患者均报告恢复工作或日常活动，并表示TMR手术改善了他们的疼痛和症状。
远端AIN至旋前方肌的运动支作为TMR受区用于治疗手腕水平有症状神经瘤是一种可行的选择。长期随访显示报告的疼痛减轻，功能改善。
