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Case Reports
. 2015 Nov 16;46(6):741-4.
doi: 10.1016/S2255-4971(15)30336-0. eCollection 2011 Nov-Dec.

ACUTE LESION OF THE MOTOR BRANCH OF THE ULNAR NERVE IN THE WRIST AFTER TUG-OF-WAR TRAINING

Vladimir Ferreira Seguti  1 , Aloísio Fernandes Bonavides Jr  2 , Leandro Pretto Flores  3 , Lisiane Seguti Ferreira  4
Affiliations
Case Reports

ACUTE LESION OF THE MOTOR BRANCH OF THE ULNAR NERVE IN THE WRIST AFTER TUG-OF-WAR TRAINING

Vladimir Ferreira Seguti et al. Rev Bras Ortop. .

Abstract

Papers correlating clinical and electrophysiological findings relating to ulnar nerve lesions in the wrist are uncommon in the literature, if compared with elbow injuries. We present the case of a patient with atrophy of the intrinsic musculature of the hand, secondary to injury only of the motor branch of the ulnar nerve, which is located in Guyon's canal close to the hamate hook. We review the anatomical, clinical and neurophysiological aspects of distal ulnar nerve injuries and we emphasize the importance of multidisciplinary approaches. Specifically in relation to the mechanism of injury of this patient (tug-of-war), we did not find any similar cases in the literature. We issue an alert regarding the risks during military physical training.

Keywords: Military; Ulnar Nerve/anatomy & histology; Ulnar Nerve/injuries.

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Figures

Figure 1
Figure 1
Observe the compound muscle action potential (CMAP) captured in the first dorsal interosseous muscle – upper line (green) with amplitude of 1.9 and compare with the contralateral CMAP (third line in yellow), corresponding to a decrease close to 90%.
Figure 2
Figure 2
Recruitment significantly reduced upon exertion. Only two motor unit potentials were recorded here.
Figure 3
Figure 3
Planning of surgery.
Figure 4
Figure 4
The ulnar nerve was dissected at the wrist and the deep branch was followed up to the point of entry of the pisohamate hiatus, where proximal ingurgitation of the nerve was observed (pseudoneuroma).
Figure 5
Figure 5
Performance of decompression in the deep branch of the ulnar nerve, followed by complete sectioning of the pisohamate ligament.
Figure 6
Figure 6
There are no signs of hypotrophy one year after the surgical procedure.
See this image and copyright information in PMC

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