Background: Nerve injuries cause significant functional impairment, and can have unsatisfactory outcomes following repair. Complete severance of the nerve leading to endoneurial disruption creates distinct challenges in terms of the regenerative capacity of the nerve, in contrast to an injury causing isolated conduction block or axonal loss in which the surrounding structures remain intact. 

Case description: We present the case of a 65-year-old female, who underwent endoscopic right carpal tunnel release for carpal tunnel syndrome, during which she suffered complete severance of her median nerve. The nerve was repaired three weeks later.

Results: Electrophysiological studies were carried out five months after repair and have been repeated several times over the ensuing nine years. The extent of recovery in sensory fibres is much less than the improvement in motor function resulting in problematic symptoms that continue to interfere with quality of life.

Discussion: We document from a neurophysiological perspective, the course of median nerve regeneration following complete transection. We explore the physiological explanations for preferential motor reinnervation in addition to other phenomenology exemplified in this case such as the persistence of sensory nerve deficits in spite of continued motor recovery.