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Inducing Ulnar Nerve Function while Eliminating Claw Hand and Reducing Chronic Neuropathic Pain
Christian A Foy1, William F Micheo2, Damien P Kuffler2
1Section of Orthopedic Surgery, Institute of Neurobiology, Medical School, University of Puerto Rico, San Juan, Puerto Rico.
Plastic and Reconstructive Surgery. Global Open
|April 13, 2023
Summary
A novel surgical technique successfully repaired severe ulnar nerve gaps, restoring hand function and eliminating chronic pain and finger clawing in a gunshot injury patient.
Area of Science:
- Regenerative Medicine
- Neurosurgery
- Peripheral Nerve Repair
Background:
- Ulnar nerve injuries can cause debilitating finger clawing, grip weakness, and chronic neuropathic pain.
- Restoring function and alleviating pain after significant ulnar nerve gaps is challenging.
Observation:
- A 25-year-old patient with a 5.7-month-old gunshot wound presented with three 10 cm ulnar nerve gaps.
- The patient experienced severe finger clawing and escalating neuropathic pain.
Findings:
- A novel technique using sural nerve grafts within a PRP-filled collagen tube bridged the nerve gaps.
- Axonal regeneration occurred across all gaps, restoring S4 sensitivity, 4mm two-point discrimination, M4 motor function, and full range of motion.
- Finger clawing was eliminated, and neuropathic pain reduced from 7/10 to 0/10, with sustained relief for over 3.75 years.
Implications:
- This technique shows promise for treating extensive ulnar nerve defects.
- It offers potential for functional recovery and pain reduction in severe nerve injuries.
- Further research is needed to confirm the role of platelet-rich plasma (PRP).
