Nara Y, Hasegawa O, Matsumoto M, Komiyama A, Sakano H, Hyodo A
Division of Clinical Laboratory, Yokohama City University Hospital, Japan.
No To Shinkei. 1995 Aug;47(8):779-82.
A unique case of mononeuropathy was encountered in a 20-year-old man with isolated involvement of the recurrent motor branch of the right median nerve following a skiing accident one year previously. There was also isolated involvement of the right thenar muscles innervated by the median nerve. Sensation was intact in the right hand and fingers. Conventional conduction studies in the right median nerve yielded no abnormal findings except a reduction in the amplitude of the muscle action potential. However, insertion of a needle electrode into the abductor pollicis brevis muscle revealed some delayed motor unit potentials following electrical stimulation at the wrist. We performed surgery and found the right recurrent motor branch to be entrapped by fibrous scar tissue 3 to 4 mm distal to branching from the median nerve. Direct recordings made from the nerve trunk using a tungsten microelectrode with supramaximal stimulation at the elbow revealed reduced amplitude of the compound nerve action potential distal to the site of entrapment. We concluded that scar tissue resulting from the previous injury had compressed the recurrent motor branch, causing this unique neuropathy.
一名20岁男性出现了一种独特的单神经病病例。该患者在一年前的一次滑雪事故后，右侧正中神经返支单独受累，由正中神经支配的右侧鱼际肌也单独受累。右手和手指感觉正常。右侧正中神经的常规传导研究除肌肉动作电位幅度降低外未发现异常。然而，将针电极插入拇短展肌后发现，在腕部进行电刺激后出现了一些运动单位电位延迟。我们进行了手术，发现右侧正中神经返支在从正中神经分支处远端3至4毫米处被纤维瘢痕组织卡压。使用钨微电极在肘部进行超强刺激，从神经干直接记录显示，在卡压部位远端复合神经动作电位幅度降低。我们得出结论，先前损伤导致的瘢痕组织压迫了正中神经返支，导致了这种独特的神经病。
