Assessment of Nerve Regeneration in Post-Operative Median and Ulnar Nerve Injury Patients in Civil Hospital Karachi using Clinical Tools

Abstract: Background: Traumatic upper limb peripheral nerve injuries are frequent and lead to long-term severe sensorimotor dysfunctions. An early, objective evidence of nerve regeneration is important for assessment of surgical results and rehabilitation especially in resource-poor settings where the sophisticated investigations may not be readily available. Objective: To evaluate nerve regeneration in post operative median and ulnar nerve injury patients using clinical assessment tools at Civil Hospital Karachi, Pakistan. Materials and Methods: This prospective cohort study was carried out in the Department of Plastic Surgery, Dr. Ruth K.M. Pfau, Civil Hospital, Karachi, Pakistan, from 18th February 2025 to 15th December 2025. The ERC was obtained from Dow University of Health Sciences bearing number IRB-3684/DUHS/Approval/2024/67. Adults (≥18 years) who underwent primary repair of median and/or ulnar nerves in flexor zone V were enrolled by consecutive sampling. Surgery consisted of tension free end to end neurorrhaphy or autologous nerve grafting. Patients were assessed at 1, 3, and 6 months post operatively using the Visual Analogue Scale (VAS) for neuropathic pain and sensory recovery, Tinel’s sign, and the Medical Research Council Manual Muscle Testing (MMT) scale; electrophysiological studies were performed selectively. SPSS version 23 was used to analyze the data. Result: Sixty patients (mean age 30.96 ± 13.20 years) were included; males predominated (71.7%). Tinel’s sign was positive in all patients at 1 month, 83.6% at 3 months, and all assessed at 6 months. Median (IQR) VAS improved from 5 (5–6) at 1 month to 8 (7–8) at 3 months and 8 (8–9) at 6 months (p < 0.001). MMT grades improved progressively, though differences between repair and grafting groups were not statistically significant (p = 0.215; p = 0.280). Conclusion: Serial evaluation with VAS, Tinel’s sign, and MMT provides a reliable clinical measure of nerve regeneration. Significant functional recovery was observed within six months post-repair. Keywords: Peripheral nerve injury, Median nerve, Ulnar nerve, Nerve regeneration, Tinel’s sign, Manual muscle testing, Visual analogue scale.