Annals of Rehabilitation Medicine

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Palmar Digital Neuropathy With Anatomical Variation of Median Nerve: Usefulness of Orthodromic Technique: A Case Report: Jun Soo Noh, Jong Woong Park, Hee-Kyu Kwon; Ann Rehabil Med 2019;43(3):341-346. Published online June 28, 2019; DOI: https://doi.org/10.5535/arm.2019.43.3.341

Anatomic variation of palmar digital nerve pathways were reported in several cases. Selective exploration of palmar digital nerves with a nerve conduction study has been challenging, because of technical issues. We report a patient who received bilateral carpal tunnel release operation, complaining of a tingling sensation, and hypoesthesia on the middle and ring fingers. An electrodiagnostic study revealed a sensory neuropathy of palmar digital nerve of the left median nerve, supplying the ulnar side of the middle finger, and radial side of the ring finger. She underwent re-operation of open left carpal tunnel release, and a branching site of common digital nerves of the median nerve was identified not at the palm, but at a far proximal site around the distal wrist crease. Usefulness of an orthodromic sensory conduction study was clarified to eliminate volume conducted response or co-activation of nearby nerves in the patient with selective involvement of palmar digital nerve.

Citations

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Occupational nerve injuries
Sandra L. Hearn, Shawn P. Jorgensen, Joelle M. Gabet, Gregory T. Carter
Muscle & Nerve.2025; 71(5): 732. CrossRef
Anatomical Variants of the Upper Limb Nerves: Clinical and Preoperative Relevance
Christoph Schwabl, Romed Hörmann, Carola Johanna Strolz, Elena Drakonaki, Robert Zimmermann, Andrea Sabine Klauser
Seminars in Musculoskeletal Radiology.2023; 27(02): 129. CrossRef
Electrophysiological and Ultrasonographic Evaluation of Palmar Digital Nerve Injury in Distal Finger
Jun Yeon Lee, Ji Yoon Kim, Ki Hoon Kim
Journal of Electrodiagnosis and Neuromuscular Diseases.2023; 25(3): 125. CrossRef

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Complex Regional Pain Syndrome of Non-hemiplegic Upper Limb in a Stroke Patient: A Case Report: Ahry Lee, Youjin Jung, Hee-Kyu Kwon, Sung-Bom Pyun; Ann Rehabil Med 2018;42(1):175-179. Published online February 28, 2018; DOI: https://doi.org/10.5535/arm.2018.42.1.175

Abstract
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Complex regional pain syndrome (CRPS) type I in stroke patients is usually known to affect the hemiplegic upper limb. We report a case of CRPS presented in an ipsilesional arm of a 72-year-old female patient after an ischemic stroke at the left middle cerebral artery territory. Clinical signs such as painful range of motion and hyperalgesia of her left upper extremity, swollen left hand, and dystonic posture were suggestive of CRPS. A three-phase bone scintigraphy showed increased uptake in all phases in the ipsilesional arm. Diffusion tensor tractography showed significantly decreased fiber numbers of the corticospinal tract and the spinothalamic tract in both unaffected and affected hemispheres. Pain and range of motion of the left arm of the patient improved after oral steroids with a starting dose of 50 mg/day.

Citations

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The Usefulness of Diffusion Tensor Tractography in Diagnosing Neuropathic Pain: A Narrative Review
Seoyon Yang, SuYeon Kwon, Min Cheol Chang
Frontiers in Neuroscience.2021;[Epub] CrossRef
Alteration of White Matter in Patients with Central Post-Stroke Pain
Jung Geun Park, Bo Young Hong, Hae-Yeon Park, Yeun Jie Yoo, Mi-Jeong Yoon, Joon-Sung Kim, Seong Hoon Lim
Journal of Personalized Medicine.2021; 11(5): 417. CrossRef