Million-dollar nerve dysfunction after Dupuytren's contracture surgery

Area of Science:

• Hand surgery
• Neurology
• Anatomy

Background:

• The recurrent motor branch (RMB) of the median nerve innervates thenar muscles, essential for thumb function.
• RMB integrity is vital for thumb motion, yet it is often overlooked due to its size and location.
• Dupuytren's contracture surgery typically aims to preserve nerve structures, but complications can arise.

Purpose of the Study:

• To report a case of recurrent motor branch (RMB) injury following Dupuytren's contracture surgery.
• To highlight the clinical significance and diagnostic challenges of RMB dysfunction.
• To emphasize the importance of anatomical knowledge and timely intervention for managing such injuries.

Main Methods:

• Case report of a 70-year-old male with post-operative thumb weakness.
• Clinical examination noting thenar atrophy and decreased strength, with preserved sensation.
• Diagnostic imaging including ultrasound and MRI to identify local compression.
• Electromyography (EMG) to confirm partial RMB injury.

Main Results:

• The patient presented with isolated thenar weakness and atrophy after Dupuytren's surgery.
• Imaging confirmed local compression, and EMG verified a partial RMB injury.
• This case demonstrates an uncommon but clinically relevant RMB dysfunction.

Conclusions:

• Recurrent motor branch (RMB) injury is a potential complication of Dupuytren's contracture surgery, possibly due to surgical manipulation.
• Early recognition of RMB injury, supported by anatomical knowledge and diagnostic tools, is crucial.
• Timely rehabilitation following diagnosis can improve functional recovery in patients with RMB dysfunction.