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Median Nerve Injury

The Pediatric Upper Extremity

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Abstract

Median nerve injuries in children are rare but can lead to devastating functional deficits if they are not recognized and treated promptly. These injuries most commonly occur secondary to fractures, dislocations, penetrating wounds, and lacerations. As the neurologic evaluation of children can be challenging, clinicians should maintain a high level of suspicion for median nerve injury in children presenting with injuries in proximity to the anatomic course of the median nerve. An initial period of observation for patients presenting with median nerve palsy following closed fractures or gunshot injuries may be warranted. However, in patients who demonstrate motor or sensory deficits in the distribution of the median nerve following open fractures, penetrating wounds, or lacerations, a low threshold for early exploration is appropriate. EMG/NCV studies can help guide treatment in patients with delayed return of median nerve function.

Options for surgical intervention depend upon the length of the nerve defect and the time elapsed from injury to operative intervention. For patients with median nerve defects ≤2 cm, options include primary epineural or fascicular repair or use of a synthetic conduit. For patients with median nerve defects ≥2 cm, options include allograft, autograft, or nerve transfers. Patients with late presentations or who have undergone a failed nerve repair are candidates for tendon transfers to restore lost median nerve motor function. Children are generally believed to have better potential for motor and sensory recovery than adults following injury to the median nerve.

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Authors and Affiliations

  1. The Pediatric Hand and Upper Extremity, Center of Georgia, 980 Johnson Ferry Rd., NE, Atlanta, GA, 30342, USA

    Dr. Allan Peljovich

  2. Yale Orthopaedics and Rehabilitation, PO Box 208071, New Haven, CT, 06520, USA

    Dr. Felicity Fishman

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  1. Dr. Allan Peljovich
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  2. Dr. Felicity Fishman
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Correspondence to Allan Peljovich .

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Editors and Affiliations

  1. Dept. of Orthopedics, U. of Maryland School of Medicine, Timonium, Maryland, USA

    Joshua M. Abzug

  2. Shriners Hospital for Children - Phila., Philadelphia, Pennsylvania, USA

    Scott Kozin

  3. Shriners Hospital For Children - Phila., Philadelphia, Pennsylvania, USA

    Dan A. Zlotolow

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Peljovich, A., Fishman, F. (2014). Median Nerve Injury. In: Abzug, J., Kozin, S., Zlotolow, D. (eds) The Pediatric Upper Extremity. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8758-6_25-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8758-6_25-1

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  1. Latest

    Median Nerve Injury of the Pediatric Upper Extremity
    Published:
    13 December 2023

    DOI: https://doi.org/10.1007/978-1-4614-8758-6_25-2

  2. Original

    Median Nerve Injury
    Published:
    18 June 2014

    DOI: https://doi.org/10.1007/978-1-4614-8758-6_25-1

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