Effect of Sensory Re-Education After Low Median Nerve Complete Transection and Repair

Purpose To compare the sensory results of patients with low median nerve complete transection and repair, with and without sensory re-education. Methods We studied 40 patients, aged 20 to 32 years, with low median nerve complete transection. Primary epineural repair using 8-0 single-strand sutures was done in all patients. Hands were immobilized in a splint for 4 weeks, followed by physical therapy for 1 month. At a mean of 3.5 months (range, 3-4 months) after surgery, when vibration sense (pallesthesia), using the 256-cycles-per-second tuning fork, was perceived at the fingertips of the 3.5 radial fingers innervated by the median nerve, the patients were randomly assigned to 2 equal groups: group A patients were rehabilitated with a sensory re-education program, and group B patients had no further treatment. Clinical evaluation at 18 months after surgery (range, 17.5-18.5 months) included locognosia (the ability to localize touch), the static and moving 2-point discrimination tests, and the Moberg pick-up test. Results All patients were included in the postoperative evaluation. Static and moving 2-point discrimination were not statistically significant between groups. Locognosia was significantly improved in group A, and a statistical trend was identified regarding the Moberg pick-up test in group A compared to group B. Conclusions Sensory re-education appeared to have significant value only in re-education of locognosia at 18 months after low median nerve complete transection and repair. (J Hand Surg 2009;34A:1210-1215. Copyright (C) 2009 by the American Society for Surgery of the Hand. All rights reserved.)