Injury of the Median and Ulnar Nerves

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Abstract
In considering the results of suture of the median and ulnar nerves, we have excluded cases in which nerve regeneration might be hindered by excessive scar, by tension at the line of suture, by long delay at carrying out operation, or by multiple operative procedures. We have attempted to correlate return of useful sensation in the hand with return of pinprick, two-point discrimination, and sudomotor function. One hundred and fifty patients were examined, thirty of whom were re-examined five or more years after operation. The ninhydrin prints appeared normal in twenty-four and obviously abnormal in only six of the thirty patients. Three had normal two-point discrimination. In twelve patients, Moberg's picking-up test was performed, and function was good or almost normal in only four. Special attention was paid to the ninhydrin fingerprint test and to the picking-up test in the hope that an objective evaluation of the quality of sensory return might be possible. Both in patients with fresh injuries and in patients first seen weeks or months after nerve division who had not had nerve suture, anhydrosis was demonstrated with but a few exceptions. Sweating and response to pinprick invariably returned together, and we have not found that the ninhydrin test is more specific than the return of response to pinprick as an indication of satisfactory sensory return. There was poor correlation between sweating and normal tactile gnosis. There was little correlation also between the return of either two-point sensation or tactile gnosis and the patient's ability to return to his former status in industry or in recreation. The twelve children in this study obtained the best functional results. Two were followed for over five years and obtained nearly perfect return of function. Three children re-examined two years after operation had regained normal sensation and normal sweating. Two other children had normal sensation as early as thirteen months after nerve repair. These five children had normal sensation to pinprick, tactile gnosis, normal muscle function, and complete return of sweating. The remaining five children had been followed for less than one year and none of them had complete return of sensation or sweating at the time of follow-up.

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