Functional Status of People Operated of Total Median Nerve Injuries
Authors: Antunez Marcela , Aguirre Marcela , Arciego Jorge , Sanhueza Eduardo , Carrasco Gabriel 
Published: September 2016

Objective: Describe functional status of people with total median nerve injuries at wrist level operated and rehabilitated in a public orthopedic hospital. Materials and Methods: Exploratory, retrospective case analysis. Population corresponds to participants with median nerve injury operated and rehabilitated through sensory reeducation protocol, in an orthopedic hospital in Santiago, Chile, between 18 and 60 years old between May 2013 and May 2014. Exclusion criteria include participants with an incomplete assessment recorded in hospital’s clinical record. Data were obtained from clinical records, taking into consideration: mechanical detection threshold, static and dynamic 2-point discrimination, palmar abduction grip, and lateral and three-digit pinch strength. The outcomes are as follows: cause of injury, tendon injury associated, time between injury and surgery, time between surgery and assessment, age at surgery, quantity of therapy sessions, static and dynamic 2-point discrimination, mechanical detection threshold, palmar abduction manual muscle test, grip, and lateral and three-digit pinch strength. Data were tabulated and analyzed with SPSS v23.0 software, and distribution and descriptive analysis was conducted for parametric data. This study has approval of the ethics committee of the establishment. Results: Six patients had complete data for this study. All data distributed normally with Shapiro-Wilk test. Five were males and 1 female, average age of at the moment of injury was 35.1 (standard deviation [SD] = 9.19) years old, 5 out of 6 were right-handed, 4 were injured by glass, 1 by knife, and 1 by circular saw, and, in average, people had to wait 11.17 (SD = 7.05) days for repair surgery. All the cases had associated tendon injury that was also repaired in the surgery. The participants received between 10 and 54 sessions of physiotherapy that lasted 19 weeks on average. Only 3 of the 6 participants were given the medical clearance. The functional assessment took place 24 weeks after surgery on average; half the participants ended their rehabilitation period with at least 4.31 points when evaluated with Semmes-Weinstein Monofilaments. In static 2-point discrimination, 66.6% had less than 6 mm, and in dynamic 2-point discrimination, 4 participants had less than 6 mm; the rest was over this threshold. Four out of 6 had M3 in the manual muscle test of the palmar abduction strength and 2 had M4. For grip strength, patients show average of 25.0 kg (SD = 8.46) on their operated hand and 45.3 kg (SD = 3.37) on the contralateral hand with P = .004. For lateral pinch, strength operated hand average is 6.75 kg (SD = 0.42) and contralateral hand average is 9.46 kg (SD = 0.45) with P = .004. For three-digit strength, operated hand average is 5.17 kg (SD = 0.28) and contralateral hand average is 9.79 kg (SD = 0.40) with P = .000, resulting in statistical significance for these 3 variables. Conclusions: Patients achieved protective sensibility and muscle strength necessary for their daily life activities, presenting mild to moderate alterations to their autonomic function, which can influence in their capacities to return to their normal activities. Sensorial reeducation protocol and assessments done to this type of patients must be registered in a more comprehensive way to determine functional prognosis, communication between the rehabilitation team, and safe return to previous daily life and work activities.