Entrapment of the median nerve after posterior dislocation of the elbow

MR neurography in intraosseous median nerve entrapment

Intraosseous entrapment of the median nerve is an uncommon complication of elbow dislocation and fractures. The condition is seen to occur in adolescent age group with a remote history of trauma. We report two rare cases of type 2 intraosseous median nerve entrapment. Though the diagnosis of median neuropathy is made with clinical tests and neurophysiological studies, however exact site of entrapment and presurgical mapping of nerve is done accurately with MR neurography. Imaging thus plays a pivotal role in management of this condition.

Median nerve reconstruction after entrapment in the elbow

Median nerve entrapment in the elbow is a known but rare complication of pediatric elbow dislocations. It is classified on the anatomical basis of entrapment. Due to a variety of factors, it is often diagnosed late. Because of this, substantial injury occurs to the nerve, requiring some form of restorative surgery in addition to release from the joint. Such nerve injury has been treated in a variety of ways including neurolysis, end-to-end anastomosis and nerve grafting. To date, there has been no conclusive evidence in the literature that one method should be preferred over another. A case of median nerve entrapment that was treated with sural nerve grafting is presented. In a review of the literature, previous treatment of such cases is discussed and compared.

Intra-articular median nerve incarceration after spontaneous reduction of a pediatric elbow dislocation: case report and review of the literature

Intra-articular incarceration of the median nerve after closed reduction of an elbow dislocation is a rare and potentially devastating complication. We report the case of a 4-year-old boy who had an entrapment of the median nerve after spontaneous reduction of a posterior dislocation. All the cases previously reported in the literature are reviewed. The diagnostic algorithm and treatment options are discussed. This is the only case in the literature in which spontaneous reduction of the dislocation occurred before medical evaluation. This scenario can occur in children as young as 4 years of age. Although incarceration of the median nerve after an elbow dislocation is an uncommon complication, it must be recognized early and explored to prevent permanent disability.

LEVEL OF EVIDENCE

Level IV.

The assessment and treatment of nerve dysfunction after trauma around the elbow

Nerve dysfunction after trauma around the elbow can lead to significant long-term pain and functional deficit. Fortunately, most of these injuries are neurapraxias that will recover spontaneously after conservative treatment. The necessity and time frame for surgical intervention for specific patterns of nerve dysfunction remains controversial. Often surgical exploration exacerbates rather than alleviates the presenting nerve problem. Distal humeral shaft fractures, elbow dislocations, Monteggia fracture-dislocations, supracondylar fractures in children, and proximal forearm trauma all have been associated with various types of nerve injuries with a variable degree of recovery. The early recognition of nerve dysfunction combined with appropriate treatment measures is the key to successful outcome.

Type 4 median nerve entrapment after elbow dislocation

A rare case of median nerve entrapment after posterior elbow dislocation is reported. Nerve entrapment was both in the healed medial epicondyle fracture and within the elbow joint and we recommend placing this type of entrapment separately in an extended classification of median nerve entrapment following elbow dislocation.