318 - From Trauma to Tingle: A Case of Post-Traumatic Neuroma and Median Nerve Transection

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

JL

Jack E. Leal, DO

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States

Co-Author(s)

AR

Aniroodh Reddy, MD

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
KS

Kanwardeep Singh, MD

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
DM

Diane N. Moya, DO

Resident Physician
Nassau University Medical Center
East Meadow, New York, United States
TP

Thomas Pobre, MD

Attending Physician
Nassau University Medical Center
East Meadow, New York, United States

Case Diagnosis: Median nerve transection secondary to post-traumatic neuroma.

Case Description: 41-year-old male presented to the physiatry clinic for evaluation of chronic left wrist pain and second digit contracture following a traumatic hand injury sustained 26 years prior. Over time, he developed an enlarging lump across his wrist, left wrist pain, grip weakness, second digit contracture and intermittent hand paresthesias. Physical examination revealed a 10-cm linear scar across the lateral aspect of the left palm and distal forearm with an overlying 1 x 2-cm mass. Additional findings included thenar atrophy, second digit firmly flexed at the level of the PIP with decreased sensation to light touch across the median nerve distribution and weakness of thumb abduction and opposition. EMG/NCS demonstrated complete axonal injury of the left median nerve at the wrist. MRI showed a lobulated heterogeneous lesion on the volar wrist adjacent to a transected median nerve, suggestive of post-traumatic neuroma. The patient was referred to hand surgery for further evaluation.

Discussions: A median nerve neuroma is an anomalous growth of nerve tissue that develops along the median nerve, often originating from repetitive stress injuries or trauma. The benign mass of tangled nerve fibers can lead to adjacent nerve compression provoking neuropathic symptoms in the distribution of the affected nerve, as in this case. The neuroma can be identified clinically in conjunction with ultrasound or MRI imaging confirmation, while nerve damage is assessed using electrodiagnostics. Treatment options range from conservative approaches, including occupational therapy, to surgical excision if necessary, followed by potential nerve repair or grafting.

Conclusions: This case demonstrates a unique instance of severe median nerve injury due to neuroma formation and illustrates the pivotal role physiatrists play in localizing the lesion and guiding proper management.