Case Report
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2025; 13(27): 108003
Published online Sep 26, 2025. doi: 10.12998/wjcc.v13.i27.108003
Median nerve neuropathy after flexor pollicis longus tendon reconstruction: A case report
Ji Woong Ho, Young-Keun Lee
Ji Woong Ho, Young-Keun Lee, Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, South Korea
Young-Keun Lee, Department of Orthopedic Surgery, Jeonbuk Nation University Medical School, Jeonbuk-do 54896, South Korea
Author contributions: Ho JW and Lee YK as the patient’s orthopedic surgeons reviewed the literature and contributed to manuscript drafting; All authors issued final approval for the version to be submitted.
Informed consent statement: The patient signed an informed consent form for the publication of this case report and any accompanying images.
Conflict-of-interest statement: All named authors hereby declare that they have no conflicts of interest relevant to this study to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Young-Keun Lee, MD, PhD, Professor, Department of Orthopedic Surgery, Jeonbuk National University Medical School, 567 Baekje-daero, Deokjin-gu, Jeonju-si, Jeonbuk-do 54896, South Korea. trueyklee@naver.com
Received: April 2, 2025
Revised: April 30, 2025
Accepted: June 16, 2025
Published online: September 26, 2025
Processing time: 125 Days and 7.5 Hours
Abstract
BACKGROUND

To treat flexor pollicis longus (FPL) muscle function loss, the 4th flexor digitorum superficialis (FDS) to the FPL tendon transfer is preferred as a reconstruction method. Various complications can occur during transfer. However, median nerve neuropathy has not been reported yet. We present a case of median nerve neuropathy caused by irritation of suture knots of the 4th FDS to the FPL tendon transfer with a review of the literature.

CASE SUMMARY

A 52-year-old male patient presented with paresthesia along median nerve distribution of right hand after tendon transfer. He complained of right thumb flexion limitation due to FPL function loss so authors performed the 4th FDS to FPL transfer using Pulvertaft weave technique. FPL function loss was due to adhesion resulting from repeated surgery of radius shaft. He had a history of radius shaft open fracture 9 years ago and nonunion 7 years ago. During surgery, FPL muscle was severely adhered and indistinguishable. However, tendon continuity remained intact. After tendon transfer, he experienced paresthesia along median nerve distribution upon movement of thumb. He was diagnosed with median nerve neuropathy caused by irritation of tendon suture knots. Exploration was then performed. The median nerve was irritated by suture knots of transferred tendon. Thus, knots were removed. Twelve months later, he demonstrated thumb flexion of 80°. Additionally, median nerve neuropathy symptoms fully resolved.

CONCLUSION

Median nerve neuropathy can occur after tendon transfer from irritation of suture knots. Covering knots using surrounding tissue is recommended.

Keywords: Tendon transfer; Flexor tendon; Median nerve; Neuropathy; Case report

Core Tip: Median nerve neuropathy can occur as a complication of flexor tendon reconstruction using the Pulvertaft weave technique at wrist due to irritation of tendon suture knots. Thus, physicians should be aware of nerve irritation as a possible complication of tendon reconstruction and prevent it. The preventive method to cover tendon suture knots using surrounding tissue such as deep transverse carpal ligament dissected during the approach is recommended.