Median Nerve Compression by Hematoma Due to an Iatrogenic Pseudoaneurysm of the Radial Artery

In this article, we report a case of severe median nerve compression in the forearm caused by a large hematoma resulting from an iatrogenic pseudoaneurysm of the radial artery. Two weeks before presenting to our emergency room with neuropathic pain and persistent numbness of the palm, thumb, index, and middle fingers, as well as thumb motor deficits, the patient had undergone wrist denervation at an external outpatient clinic. Duplex ultrasound indicated a large pseudoaneurysm of the radial artery, which was confirmed by computed tomography angiography. The patient underwent emergency surgery, including evacuation of the hematoma compressing the median nerve beneath the forearm fascia, repair of the injured radial artery, and decompression of the median nerve. The procedure also included a carpal tunnel release. The patient experienced symptom improvement immediately after surgery. By the third postoperative day, when discharged, sensation in the median nerve distribution was equal bilaterally as assessed by the TEN-test, and he was able to abduct his thumb using the abductor pollicis brevis muscle. This article highlighted a relatively rare complication following wrist denervation surgery. Because this procedure involves exposure of the radial artery, there is an increased risk for iatrogenic pseudoaneurysm. This case also illustrated the diagnostic steps and microsurgical expertise required to manage such complications and to prevent severe damage to the median nerve through early decompression.