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Electrodiagnosis, Antebrachial Cutaneous Sensory Nerve, Sensory Neuropathy, Neurotmesis, Radial Nerve
Objective: To discuss a case of traumatically-induced sensory neuropathy and neurotmetic injury due to a small animal bite. Terminology associated with neuronal injury is reviewed. Accompanying electrodiagnostic studies are also discussed.
Clinical Features: A 26-year old man was referred by an orthopedic surgeon for electrodiagnostic evaluation following an exotic animal bite to his right arm, which occurred approximately 2 months prior to the examination. His symptoms included right distal anterolateral “scraping and burning” arm pain. The pain was reported as constant and varied from 1-6/10 in severity, and radiated into the lateral forearm and dorsal aspects of the 1st and 2nd digits of his hand, with intermittent paresthesia. Heat and sunlight provoked pain, and no palliative measures were reported. The injury was a closed lesion. Abnormal sensory nerve action potentials (SNAPs) of the both the lateral antebrachial cutaneous and superficial radial nerves on the right were obtained, characterized by ‘no response’. A decreased amplitude in the left distal median motor nerve was also present, which appears consistent with an incidental finding of a left sided Martin-Gruber anastomosis (anomalous innervation).
Intervention and Outcome: A comprehensive electrodiagnostic evaluation was performed, including nerve conduction studies of sensory and motor nerves, F-Wave studies, and both surface and Needle EMG examinations. The patient’s injury caused abnormal distal sensory latencies and amplitudes of both the right lateral antebrachial cutaneous and superficial radial nerves. Electrophysiological evidence was consistent with severe sensory neuropathies of the lateral antebrachial cutaneous and superficial radial nerves on the right. These findings are consistent with neurotmetic lesions.
Conclusions: Clinical correlation was advised, and the patient was sent back to the referring physician
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