case_images: PMC10858754_01
case_images: (a) Preoperative presentation of the patient showing physical examination consistent with benediction hand. (b) Preoperative photograph showing compressible swelling in the upper arm. A positive Tinel's sign over the expected course of the median nerve in the upper arm was also noted to be present.
case_images: SNI-15-11-g001.jpg
case_images: PMC10858754_01_SNI-15-11-g001.jpg
case_images: F1
case_images: A 69-year-old male presented to our multidisciplinary brachial plexus clinic with severe proximal median neuropathy causing paresthesia in the median nerve distribution, benediction hand [Figure 1a], and weakness of his extrinsic finger flexors, flexor digitorum profundus (FDP) to his index finger, flexor pollicis longus (FPL), and median innervated hand intrinsics. He was noted to have compressible swelling over the medial upper arm [Figure 1b] with a positive Tinel sign over the expected course of the median nerve proximal to the elbow.
case_images: A 4.2 x 5.2 x 6.7 cm mass located at the level of the mid humeral shaft abutting the medial aspect of the brachial artery (dashed arrow). The median nerve (solid arrow) demonstrates thickening, edema, and abnormal enhancement at the level of the mass through the distal humerus. The median nerve is compressed as it contours the anterior margin of the mass.
case_images: SNI-15-11-g002.jpg
case_images: PMC10858754_01_SNI-15-11-g002.jpg
case_images: F2
case_images: (a and b) Pseudoaneurysm (PSA) before and after opening.
case_images: SNI-15-11-g003.jpg
case_images: PMC10858754_01_SNI-15-11-g003.jpg
case_images: F3
case_images: Intraoperatively, we were able to successfully resect and reconstruct the brachial artery PSA [Figures 3a and b].
case_images: Intraoperative photograph showing the proximal extensor carpi radialis brevis (ECRB) branch with a tension-free coaptation to the anterior interosseous nerve (AIN) with nerve wrap.
case_images: SNI-15-11-g004.jpg
case_images: PMC10858754_01_SNI-15-11-g004.jpg
case_images: F4
case_images: In addition, distal ECRB to AIN transfer was performed with coaptation using an 8-0 nylon suture and nerve wrap [Figure 4].