MEDIAN NERVE INJURY - AN UNDERRECOGNISED COMPLICATION OF BRACHIAL-ARTERY CARDIAC-CATHETERIZATION

Objective-To describe the local neurological complications associated with cardiac catheterisation via the right brachial artery. Methods-A follow up study to determine the mechanism of injury and outcome of pa tients who sustained a high median nerve palsy after this procedure. F ive right handed patients were identified in a 24 month period. Each w as assessed clinically and electrophysiologically at presentation. All were followed up initally (range six to 22 months) clinically, electr ophysiologically, and using components from the Chessington occupation al therapy neurological assessment battery (COTNAB) functional hand as sessment. Results-The incidence of this complication was between 0.2 a nd 1.4%. Three mechanisms of injury were identified. These included di rect nerve compression due to formation of antecubital fossa haematoma , direct nerve trauma, and ischaemia secondary to brachial artery occl usion. The initial neurological and nerve conduction deficits improved with time. However, all cases had persistent disability in hand funct ion as documented clinically and on the dexterity and stereognosis sub component of the COTNAB test. Conclusion-This is an uncommon, but prob ably underrecognised complication. Those performing cardiac catheteris ation via the right brachial artery should be aware of the potential r isks of damage to the median nerve. They should evaluate hand function after the procedure and take prompt action if median nerve dysfunctio n is noted. Damage to the median nerve results in appreciable long ter m disability, which may have medicolegal relevance.