A previously healthy male soldier sustained a penetrating shrapnel injury to the left arm during an armed conflict, with immediate loss of all motor and sensory function in the distribution of the left median nerve. Electromyography and nerve conduction studies performed 3 weeks later were consistent with a complete left median nerve transection at the midarm level. A few days following his injury, the patient started developing progressive swelling with red-bluish discoloration and cold intolerance in his left hand, in the sensory distribution of the median nerve (Figure). He denied the presence of Raynaud phenomenon or any change in his left hand's sweating pattern but reported that his left fingernails have since been growing much slower than their right counterparts. In addition to swelling and discoloration, examination of the left hand revealed markedly decreased temperature, which was most prominent in the median nerve sensory distribution.
Rahme R, Moussa R, Awada A. Vasomotor Dysfunction Following Traumatic Median Nerve Injury. Arch Neurol. 2008;65(9):1250. doi:10.1001/archneur.65.9.1250