Evaluation of the improvement of sensibility after primary median nerve repair at the wrist

Abstract

In the Istanbul Hand Surgery and Microsurgery Centre, between 1991-1996, 28 out of 54 patients who had clean-cut median nerve laceration at the wrist level were evaluated in a detailed manner regarding the improvement of sensibility following primary repair. Semmes-Weinstein monofilament and vibration tests form the group of threshold tests, and static and dynamic two-point discrimination tests and the Moberg pick-up test form the group of functional tests which were applied to the patients. Follow-up was from 1 to 5 years. Moreover, subjective findings such as cold intolerance, pain, and paraesthesia were also evaluated. All the results obtained were evaluated in relation to the SO-S4 sensibility improvement criterion which Waylett-Rendall recommended. The following results were obtained: S4 in 35.7% of the patients, S3+ in 28.5%, S3 in 14.2%, S2+ in 7.14%, S2 in 10.7%, and S1 in 3.5%. In our opinion the most important reason for the high rate of success was the fact that we worked with a highly selective group of patients and the fact that there was a high rate of young patients in this group (21.4% of them were under the age of 15). It was observed that there was a significant correlation between age and functional sensibility improvement (P = 0.04). Moreover, when we observed the relation between age and Semmes-Weinstein monofilament, static two-point discrimination, and dynamic two-point discrimination tests, it was seen that age had a significant correlation with each of the parameters (r = 0.61, P = 0.001; r = 0.58, P = 0.002; r = 0.57, P = 0.002). There was a clear decline in the intensity of the paraesthesia in S3+ and S4 group (X2 = 4.7, P = 0.02) and in these groups the period of Moberg pick-up test was meaningfully short (P < 0.05).

Relationship Between Sensibility Tests and Functional Outcomes in Patients With Traumatic Upper Limb Nerve Injuries: A Systematic Review

“…Some studies reported statistical significance only, and the strength of correlation or effect size cannot be assessed. 40 , 45 , 47 In contrast, there were correlations with moderate strength but statistically nonsignificant. 42 The nonsignificance may be because of small sample size, 42 and the results may still have clinical value.…”

“… NA MRC sensory scales † Jaquet et al 14 RTW-yes/no Poor sensory recovery had an odds ratio of 2.94 for inability to return to work; 95% CI, 1.50–5.76; P =.002. Age, sex Selma et al 47 Moberg's pick-up Means of the pick-up performance between 2 groups (S3+, S4 vs S1, S2, S2+, S3) were different, P <.05, Mann-Whitney U . \ Vordemvenne et al 48 DASH In the 3-factor analysis, MRC sensory score and DASH both had meaningful loadings (0.863, 0.552) on the sensory factor.…”

“… 13 , 41 Lower score on MRC sensory scale predicted inability to return to work (odds ratio, 2.94; 95% CI, 1.50-5.76; P =.002) and was also associated with poorer pick-up performance ( P <.05). 14 , 47 …”

“…Eight studies did not control for extraneous variables when examining the relationship between sensibility and functional outcomes. 13 , 15 , 38 , 41 , 46 , 47 , 48 , 49 Seven studies controlled for 1 or more of age, surgery delay, follow-up time, sex, hand dominance, grip strength, and cold intolerance, as shown in table 2. 11 , 14 , 39 , 40 , 42 , 43 , 45 These variables may or may not be related to sensibility test performance or function outcomes; below are what the included studies found.…”

“…Age correlated with SWMF, s2-PD, and m2-PD for median nerve lacerations at wrist. 47 The effect of age on ADL and DASH was found equivocal. 45 , 48 The nerves injured (median vs ulnar) 46 , 48 and the extent of injury (partial vs complete transection) 41 , 42 had no significant association with ADL performance, although 1 study showed significant difference in SHFT results between median and ulnar nerve injuries.…”