Post-traumatic distal nerve entrapment syndrome

Eleven patients With paralysis of muscle groups in the upper or lower extre mity were clinically diagnosed after previous proximal direct trauma to the corresponding peripheral nerves, without complete nerve disruption. Patien ts were seen within an average of 8 months after trauma (minimum 3 months a nd maximum 2 years after). Nerve lesions were caused either by gunshot, mot or-vehicle accident, and other direct trauma or, in one case, after tumor e xcision. All patients presented with complete sensory and motor loss distal to the trauma site, but demonstrated a positive Tinel sign and pain on tes ting over the "classic" (distal) anatomic nerve entrapment sites only. Afte r surgical release through decompression of the nerve compression site dist al to the trauma, a recovery of sensory function was achieved after surgery in all cases. Good-to-excellent restoration of motor Function (M4/M5) was achieved in 63 percent of ail cases. Twenty-five percent had no or only poo r improvement in motor function, despite a good sensory recovery. Those pat ients in whom nerve compression sites were surgically released before 6 mon ths after trauma had an improvement in almost all neural functions, compare d to those patients who underwent surgery later than 9 months post trauma. A possible explanation of traumatically caused neurogenic paralysis with su bsequent distal nerve compressions is provided, using the "double crush syn drome" hypothesis.