DIAGNOSIS OF MULTIPLE SENSORY NEUROPATHIES VIA ELECTRODIAGNOSTIC EXAMINATION FOLLOWING A SMALL ANIMAL BITE

Main Article Content

Luis Vera
Sean Norkus
Amber Kingsley

Keywords

Electrodiagnosis, Antebrachial Cutaneous Sensory Nerve, Sensory Neuropathy, Neurotmesis, Radial Nerve

Abstract

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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References

1. Stedman's medical dictionary [Internet] Baltimore (MD): Lippincott Williams &Wilkins; c2016. Neuropathy; [cited 2020 Oct 30]; [about 1 screen]. Available from:http://online.statref.com.palmer.idm.oclc.org/document/w_4SEIi3fuX3CrJLlWSZjj?searchid=1608217307878277360&categoryType=Dictionary Registration and login required.
2. Weinberg J, Rokito S, Silber JS. Etiology, treatment, and prevention of athletic “stingers.” Clin Sports Med 2003;22(3):493-500
3. Olson DE, McBroom SA, Nelson BD, Broton MS, Pulling TJ. Unilateral cervical nerve injuries: brachial plexopathies. Curr Sports Med Reports 2007;6(1):43-49
4. DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 -. Record No. T905473, Burners and Stingers; [updated 2018 Nov 30, cited 2020 Sep 7]. Available from https://www.dynamed.com/topics/dmp~AN~T905473. Registration and login required.
5. Menorca RMG, Fussell TS, Elfar JC. Nerve physiology: mechanisms of injury and recovery. Hand Clin 2013;29(3):317-330
6. Stewart JD. Peripheral nerve fascicles: anatomy and clinical relevance. Muscle Nerve 2003;28(5):525-541
7. Cruz AJM, De Jesus O. Neurotmesis. StatPearls [Internet]: StatPearls Publishing; 2020
8. Siemionow M, Brzezicki G. Chapter 8: Current techniques and concepts in peripheral nerve repair. Int Rev Neurobiol 2009;87:141-172