Implantation of the palmar cutaneous branch of the median nerve into the pronator quadratus for treatment of painful neuroma.

Abstract

A neuroma of the palmar cutaneous branch (PCB) of the median nerve can cause pain in the scar following carpal tunnel release, with secondary decreased wrist range of motion and decreased grip strength. The results of PCB resection and implantation of the PCB into the pronator quadratus muscle are reported in a series of 13 patients. Pain relief was demonstrated before surgery by anesthetic block of the PCB, which did not result in sensory loss in the distribution of the median nerve. Results, at a mean of 19 months after surgery, were excellent (no residual pain, return to previous jobs) in six patients and good (some residual pain, return to a different job, stable or improved grip strength and wrist range of motion) in seven patients.