Post-traumatic median neuropathy
Right distal humerus shaft comminuted fracture fixation 2 months before the presentation. Referred for peripheral nerve ultrasound with a clinical diagnosis of the median neuropathy at the elbow.
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There is a posterior kink of the median nerve about 2 cm proximal to the elbow joint. The kink increased with elbow flexion. The affected nerve segment is hypoechoic and edematous. However, the nerve shows continuity. There was no orthopedic hardware trapping the nerve. The adjacent brachial artery shows intimal thickening without thrombosis.
A female patient had distal humeral shaft comminuted fracture fixation 2 months prior to the ultrasound. She developed median neuropathy at the elbow region. Ultrasound shows the posterior kink of the median nerve near the elbow. The surgical exploration revealed posterior nerve kink and compression in the bony groove. The nerve showed continuity without any neuroma formation. The nerve was repositioned.
As per the operating surgeon, there was a significant improvement in symptoms at the end of a month follow up.
The ultrasound is now considered as the first-line modality for the evaluation of the peripheral nerves. There are many advantages of ultrasound over magnetic resonance imaging like higher soft-tissue resolution, cost-effectiveness, real-time and dynamic imaging, and the ability to scan an entire extremity quickly and efficiently2.
- 1. Ashwin D Lawande, Sudhir S Warrier, Mukund S Joshi. Role of ultrasound in evaluation of peripheral nerves. (2014) Indian Journal of Radiology and Imaging. 24 (3): 254. doi:10.4103/0971-3026.137037 - Pubmed
- 2. Jordan M. Brown, Corrie M. Yablon, Yoav Morag, Catherine J. Brandon, Jon A. Jacobson. US of the Peripheral Nerves of the Upper Extremity: A Landmark Approach. (2016) RadioGraphics. 36 (2): 452-63. doi:10.1148/rg.2016150088 - Pubmed