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 its small size and location make it vulnerable.
• Dupuytren's contracture surgery, while generally safe for the RMB, can pose risks due to surgical manipulation.

Purpose of the Study:

• To report a case of recurrent motor branch (RMB) injury following Dupuytren's contracture surgery.
• To emphasize the clinical significance of RMB dysfunction, even when uncommon.
• To highlight the importance of anatomical knowledge and prompt rehabilitation for recovery.

Main Methods:

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

Main Results:

• The patient presented with significant thenar atrophy and weakness post-Dupuytren's surgery.
• Imaging confirmed local compression affecting the median nerve's recurrent motor branch.
• Electromyography verified a partial RMB injury, correlating with clinical findings.
• Sensation remained intact, indicating a specific motor nerve compromise.

Conclusions:

• Recurrent motor branch (RMB) dysfunction is an uncommon but clinically relevant complication after Dupuytren's surgery.
• Surgical techniques involving wide incisions or extensive retraction may inadvertently injure the RMB.
• Accurate diagnosis and timely rehabilitation, guided by RMB anatomical knowledge, are crucial for functional recovery.