Published online Sep 6, 2023. doi: 10.12998/wjcc.v11.i25.5941
Peer-review started: May 2, 2023
First decision: July 3, 2023
Revised: July 14, 2023
Accepted: August 9, 2023
Article in press: August 9, 2023
Published online: September 6, 2023
Neuropathy may occur at some sites after catheterization for close examination of cardiac disease. Although the radial artery is considered a relatively uncom-plicated site for catheterization, the radial artery and median nerve are in relatively close proximity, with the risk of median nerve injury depending on the angle of puncture. The purpose of this study was to report the outcomes of surgery performed for conservative therapy-resistant median neuropathy following forearm catheterization.
A 50-year-old woman experienced palsy from the right thumb to the radial side of the ring finger after catheterization from the radial artery of the right forearm. Paresthesia developed at the same site and a positive tinel-like sign was seen for the median nerve area at the high level of the puncture site. Nerve conduction study showed reduced compound muscle action potentials and loss of sensory nerve action potentials. Symptoms did not improve despite pharmacotherapy and the patient gradually developed flexion restrictions of the index and middle fingers. Median nerve injury and associated flexor tendon adhesion was diagnosed, and the patient was referred for surgery at 3 mo after injury. When the same area was opened, no injury to the median nerve epithelium was obvious, but the area of the positive tinel-like sign was highly adherent to surrounding tissue and to the flexor digitorum superficialis of the index and middle fingers. The surgery was terminated with adequate adhesion release. Rehabilitation was initiated postoperatively, improving neurological symptoms and range of motion of the fingers. Six months after surgery, the patient returned to daily activities without discomfort.
This case provides the appropriate diagnosis and treatment for a suspected peripheral nerve injury.
Core Tip: Median neuropathy during forearm puncture is unlikely but possible given the anatomic location. In general, peripheral neuropathy of the upper extremity causes difficulty in performing hand-operated tasks and daily living, leading to a decreased quality of life, so surgery is aggressively considered in cases that are resistant to conservative treatment. Even in examinations where the risk of complications is considered low, accurate diagnosis based on clinical symptoms is important to provide appropriate treatment.