Orthopedic hardware induced median nerve compression

Case contributed by Dr Maulik S Patel

Presentation

Volar plate fixation across distal radius shaft fracture 3 months prior to the presentation. Complaining of the weakness of the first three digits. The nerve conduction test suggested median neuropathy. Referred for median nerve ultrasound evaluation.

Patient Data

Age: 25 years
Gender: Male

The transverse images run from the proximal to the distal direction. The median nerve passes closer to the radius plate and disappears under the ulnar side of the plate edge. At the end of the radius plate, the nerve reappears at a deeper level showing hypoechoic echopattern. The nerve shows a normal echopattern just proximal to the carpal tunnel.

The longitudinal images show non-localization of about 25 mm long segment of the median nerve at the distal radius plate region. At the end of the radius plate, the nerve reappears at a deeper level. The nerve has to take an oblique upward course to reach the superficial plane near the carpal tunnel.

Both transverse loops run from the proximal to the distal direction showing the nerve. The first loop shows the disappearance of the median nerve under the plate. The second loop shows the reappearance of the nerve at the end of the radius plate.

A rough sketch was supplied with the report. Possibly a picture worth of few words of the findings.

Case Discussion

The case shows median nerve compression by the radius fracture fixation plate. The nerve hypoechogenicity near the compression is due to edema. A surgical release was done. The compressed nerve segment (which could not be evaluated by the ultrasound) showed edema with continuity.

The case shows the importance of the ultrasound for peripheral nerve evaluation, especially in post-operative cases.

 

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