Targeted Muscle Reinnervation Using the Anterior Interosseous Nerve for Symptomatic Wrist Level Neuromas.

Abstract

Background: Iatrogenic and traumatic sensory nerve injury at the level of the wrist can lead to debilitating neuroma. Targeted muscle reinnervation (TMR) is an effective treatment for the management of symptomatic neuromas. We investigate the use of the anterior interosseous nerve (AIN) as a recipient nerve for the treatment of iatrogenic neuromas. This case series describes 4 patients treated for neuromas of the lateral antebrachial cutaneous nerve (LABC), palmar cutaneous branch of median nerve (PCB), and radial sensory nerve (RSN).

Methods: Four cases involved a symptomatic neuroma of the LABC, PCB, or RSN. These were treated with TMR, using the AIN motor branch to pronator quadratus. The neuromas were identified in all 4 cases and transected distally. The AIN was identified through a proximal extension of the exploratory incision and an end-to-end coaptation was performed to the proximal aspect of the donor nerve and the distal AIN.

Results: All 4 patients underwent routine follow-up for a duration of 2 to 10 months, with a long-term follow-up from 25 to 49 months. At routine follow-up, all patients reported resolution of pain and symptoms and had a negative Tinel's sign over their previous neuroma site. At the long-term follow-up, 2 patients reported recurrence of hyperesthesia, both to a lesser severity than before treatment. All 4 patients reported returning to work or routine and stated the TMR procedure improved their pain and symptoms.

Conclusions: The motor branch of the distal AIN to pronator quadratus is a viable option as a TMR recipient for the management of symptomatic neuromas of the wrist level. Long-term follow-up shows reduction of reported pain and improvement of function.