Rehabilitation of Median Nerve Palsy Following Supracondylar Median Nerve Schwannoma Enucleation

Abstract Median nerve schwannomas occurring above the elbow are rare. Although surgical enucleation is usually curative, persistent post-operative motor deficits are uncommon and can significantly affect hand function, creating rehabilitation challenges. We describe the recovery of median nerve palsy following schwannoma enucleation with a tailored rehabilitation approach. A 48-year-old male presented 1 month after surgical enucleation of a right supracondylar median nerve schwannoma with hand weakness and paraesthesia in the palmar aspect of the lateral three and a half fingers. Clinical examination showed sensory impairment in the median nerve distribution and motor weakness involving the thenar muscles, flexor pollicis longus and first and second lumbricals, which was confirmed by nerve conduction studies. The patient underwent a comprehensive rehabilitation programme including pharmacological management of neuropathic pain, sensory care, neuromuscular electrical stimulation and activity of daily living modifications. After 6 months, significant functional recovery was achieved with improved grasp, fine motor function and Rosen score.