Could you recognize the median nerve?

Frontiers in Veterinary Science 2025

Author

Obi Veterinary Education
October 08, 2025

Jeffery Smith, Marc Kent, Eric Glass, Garrett Davis

Background
Malignant nerve sheath neoplasms (MNSNs) are uncommon tumors in dogs, often affecting the brachial plexus or cervical spinal nerves. These tumors can cause lameness due to neuropathic pain or paresis, particularly when affecting weight-bearing nerves like the radial nerve. This case report describes the diagnosis and surgical treatment of an MNSN affecting the median nerve in a dog, highlighting successful limb preservation and resolution of lameness.

Methods
A 7-year-old Golden Retriever was evaluated for a six-month history of progressive right thoracic limb lameness. Initial radiographs and CT scans failed to reveal a clear cause. MRI identified a 5.0 × 1.5 cm ovoid mass arising from the median nerve near the elbow. The dog underwent compartmental resection of the mass with limb preservation. Histopathology confirmed an MNSN, and postoperative follow-ups were conducted for up to one year.

Results
Immediately postoperatively, the dog showed mild lameness (grade 1/5), which resolved completely by the three-month follow-up. At one year postoperatively, the dog maintained a normal gait without recurrence of clinical signs. Unlike MNSNs affecting the radial nerve, which can cause permanent gait impairment, resection of the median nerve tumor did not result in functional deficits, supporting the hypothesis that the lameness was primarily due to neuropathic pain rather than motor dysfunction.

Limitations
This is a single-case report, limiting the generalizability of findings. Histopathologic margins were not clear, and the dog did not undergo postoperative radiation therapy, making long-term recurrence risk uncertain. Additionally, while MRI identified the tumor, preoperative CT failed to detect it, highlighting potential limitations of imaging modalities in nerve sheath tumors.

Conclusions
Compartmental resection of an MNSN affecting the median nerve successfully resolved neuropathic pain-induced lameness without requiring limb amputation. This case supports limb-preserving surgical techniques for median nerve tumors and underscores the importance of advanced imaging, particularly MRI, in diagnosing nerve sheath neoplasms. Further studies are needed to assess long-term outcomes and recurrence rates following limb-sparing resections.

(A) On CT, the mass is identified as a round, soft tissue attenuating mass (red arrow) adjacent to the brachial artery and vein on the medial aspect of the right distal humerus (yellow arrows). (B) For comparison, the left brachial artery and vein are seen at approximately the same location on the left limb (yellow arrows). Transverse multiplanar reconstruction CT; acquired using a bone algorithm, window and level have been adjusted to make the mass most conspicuous. Inset: The yellow line is approximately the location of the transverse images in panel A and B. A-biceps brachii m. B-cleidobrachialis m. C-brachialis m. D- anconeus m. E- triceps brachii m, medial head, *- tendon of insertion of the triceps brachii muscle.

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