Distal Anterior Interosseous Nerve in the Recurrent Motor Branch Graft for Reconstruction of a Median Nerve Neuroma-in-Continuity

Median nerves with neuromas-in-continuity are preferably managed by the identification and preservation of the functioning motor fascicles proximal and distal to the neuroma. The non-functioning, painful sensory fibers are divided proximally and distally and are reconstructed with nerve grafts. In cases where the proximal motor fascicle may not be safely and effectively isolated because of scarring or previous surgical intervention, the distal anterior interosseous nerve (dAIN) may be grafted to the recurrent motor branch of the median (RMB) nerve distal to the neuroma. The primarily motor fibers of the dAIN provide an expendable donor of adequate size and fascicle number to restore thenar muscle function.