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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9000
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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June 28 I had some medium pains in my right arm resulting in

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June 28 I had some medium pains in my right arm resulting in loss of use in my right thumb - no more pain anywhere. July 1 I discovered a splinter in that thumb and upon pulling out, measured to be 1/2" . July 2 my doc examined and suspected tendon issue so referred to Dr in Kansas City. July 5 exam by this specialist confirmed suspected severed flexor tendon. Surgery July 6 however found no issues. Follow up on July18 shows good healing from surgery but still no function so they are suggesting PT. My thought is that if tendon and nerves at the hand sight are OK, then upstream may be root cause and if so, what to do? Is there a window of time that this needs to have been resolved in? Thanks.

neuromd2012 :

Hello


 

neuromd2012 :

Hello this is sounding like anterior interrosseus syndrome. You have problems flexing your thumb?


 

neuromd2012 :

I will try to find some information for you hang on, if you come online, please wait and I shall return


 

neuromd2012 :

so in this problem, there is compression of a branch of the median nerve, usually in the flexor aspect of the forearm just after the elbow. There is a muscle there called pronator teres, and by swinging a hammer excessively you can damage this nerve. It makes it difficult to flex your thumb, and use a pincer movement between your thumb and your index finger.


 

neuromd2012 :

please get back to me to discuss this possibility further, just leave a message or question in the box and I will return to reply. Dr Frank T.


 

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Customer: replied 5 years ago.
Sorry for delay - was waiting on password XXXXX email. Occupational therapy then and the splinter was likely a distraction to the real root cause?

right, that is what is sounds like to me, not seeing you. very weird coincidence. anyway. do you have any bruising in the flexor area of your elbow or lower on your forearm? Do you have weakness with pronation? that is turning your wrist over, like a forearm swing with a tennis racket giving topswing, or hitting a draw with your golf club

let me know

The other thing I would say, it that it can work in reverse. You damage the flexor tendon in your thumb, and since you cannot use your thumb flexors, the muscles that do that job get weak. how long did you have the spinter? let me know

Customer: replied 5 years ago.
As I don't know when the splinter entered, am guessing it was in there from the day before the initial pain until Sunday when i took it out (4 days). No bruising. The surgery also explored the Carpal tunnel area when they found nothing at the flexor tendon in the thumb nor any issue with nerves there either. The PA told me yesterday that in surgery, they could stimulate the nerve at my forearm and the thumb moved appropriately. That could not be replicated yesterday however which he was not surprised at with me be concious and all. Also no to your question about other mobility of that arm (thankfully).

Ok. So because you can pronate your arm, you do not have pronator teres syndrome, which comes from a median nerve problem at the elbow. It sounds like you have anterior interosseus syndrome, that is the branch after pronator teres, and is a pure motor nerve. they probably stimulate this nerve during surgery and it worked. It is pretty deep so superficial stimulation while you are awake probably will not work.

I don't have much more to add, the fact that during surgery it worked is good news for you, and it should come back with some physical therapy/rehab.

get back to me if you have questions about this ok? Dr Frank T.