Effect of sensory re-education after low median nerve complete transection and repair

J Hand Surg Am. 2009 Sep;34(7):1210-5. doi: 10.1016/j.jhsa.2009.04.014. Epub 2009 Jun 25.

Abstract

Purpose: To compare the sensory results of patients with low median nerve complete transection and repair, with and without sensory re-education.

Methods: We studied 40 patients, aged 20 to 32 years, with low median nerve complete transection. Primary epineural repair using 8-0 single-strand sutures was done in all patients. Hands were immobilized in a splint for 4 weeks, followed by physical therapy for 1 month. At a mean of 3.5 months (range, 3-4 months) after surgery, when vibration sense (pallesthesia), using the 256-cycles-per-second tuning fork, was perceived at the fingertips of the 3.5 radial fingers innervated by the median nerve, the patients were randomly assigned to 2 equal groups: group A patients were rehabilitated with a sensory re-education program, and group B patients had no further treatment. Clinical evaluation at 18 months after surgery (range, 17.5-18.5 months) included locognosia (the ability to localize touch), the static and moving 2-point discrimination tests, and the Moberg pick-up test.

Results: All patients were included in the postoperative evaluation. Static and moving 2-point discrimination were not statistically significant between groups. Locognosia was significantly improved in group A, and a statistical trend was identified regarding the Moberg pick-up test in group A compared to group B.

Conclusions: Sensory re-education appeared to have significant value only in re-education of locognosia at 18 months after low median nerve complete transection and repair.

Type of study/level of evidence: Therapeutic II.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Female
  • Follow-Up Studies
  • Hand Strength
  • Humans
  • Male
  • Median Nerve / injuries*
  • Median Nerve / physiopathology*
  • Median Neuropathy / etiology
  • Median Neuropathy / rehabilitation*
  • Median Neuropathy / surgery
  • Motor Skills / physiology
  • Neural Conduction / physiology
  • Recovery of Function / physiology*
  • Sensation / physiology*
  • Treatment Outcome
  • Young Adult