Electrophysiologic Features of Radial Neuropathy in Childhood and Adolescence

Childhood focal compressive mononeuropathies during the COVID-19 pandemic in Buenos Aires, Argentina

Introduction/Aims

Focal peripheral neuropathies are infrequently seen in pediatric patients. The COVID‐19 pandemic has disrupted normal life for many people, including complete lockdowns and school closing for long periods of time in many countries, which prompted children to stay at home. Our aim is to assess whether there has been an increased incidence of focal compressive peripheral neuropathies in the pediatric population during COVID‐19–associated lockdown.

Methods

Clinical, electrophysiological, and imaging characteristics were reviewed for patients referred to the electrodiagnostic (EDx) laboratory with suspicion of a focal neuropathy. The incidence of focal compressive peripheral neuropathies seen during the period of March to September 2020 was compared with the same time period in 2019.

Results

An increased incidence of focal neuropathies was seen in 2020 (31%) compared with 2019 (6.8%). During 2020, 7 fibular (peroneal) mononeuropathies and 2 ulnar neuropathies were diagnosed. Most patients with focal neuropathies were underweight and acknowledged prolonged screen time periods. Electrophysiological findings consisted of mostly demyelinating lesions with an overall good clinical outcome.

Discussion

In this study we raise awareness about a possible increased incidence of focal compressive peripheral neuropathies in children during COVID‐19–associated lockdown, which may be prevented with changing positions during sedentary activities.

Current concepts in diagnosis and management of common upper limb nerve injuries in children

Peripheral nerve injuries (PNI) of the upper limb are a common event in the paediatric population, following both fractures and soft tissues injuries. Open injuries should in theory be easier to identify and the repair of injured structures performed as soon as possible in order to obtain a satisfying outcome. Conversely, due to the reduced compliance of younger children during clinical assessment, the diagnosis of a closed nerve injury may sometimes be delayed. As the compliance of patients is influenced by pain, anxiety and stress, the execution of the clinical manoeuvres intended to identify a loss of motor function or sensibility, can be impaired. Although the majority of PNI are neuroapraxias resulting in spontaneous recovery, there are open questions regarding certain aspects of closed PNI, e.g. when to ask for electrophysiological exams, when and how long to wait for a spontaneous recovery and when a surgical approach becomes mandatory. The aim of the article is therefore to analyse the main aspects of the different closed PNI of the upper limb in order to provide recommendations for timely and correct management, and to determine differences in the PNI treatment between children and adults.

The "Texas Longhorn" Syndrome: A Case of Posterior Interosseous Nerve Palsy With Noteworthy Observations

The posterior interosseous nerve (PIN) is quite a fascinating nerve. It wraps around the radial neck akin to the fibular nerve wrapping around the fibular neck. It can be compressed by the arcade of Frohse in a fashion similar to median nerve entrapment by the carpal tunnel. Furthermore, it divides into a number of branches, a simulacrum of the cauda equina, as it emerges from the supinator muscle. It is also associated with space-occupying pathologies; lipomas, and ganglion cysts being among the most common. It also has other interesting anatomical properties, such as fascicular compartmentalization, explaining PIN paralysis with radial nerve injuries. Finally, PIN lesions can lead to partial paralysis of finger extensors leading to the "Texas longhorn" hand gesture. We seize upon a case of PIN entrapment by fibrous adhesions and the arcade of Frohse, and explore the functional anatomy of the PIN.

Utility and practice of electrodiagnostic testing in the pediatric population: An AANEM consensus statement

Nerve conduction studies and needle electromyography, collectively known as electrodiagnostic (EDX) studies, have been available for pediatric patients for decades, but the accessibility of this diagnostic modality and the approach to testing vary significantly depending on the physician and institution. The maturation of molecular diagnostic approaches and other diagnostic technologies such as neuromuscular ultrasound indicate that an analysis of current needs and practices for EDX studies in the pediatric population is warranted. The American Association of Neuromuscular & Electrodiagnostic Medicine convened a consensus panel to perform literature searches, share collective experiences, and develop a consensus statement. The panel found that electrodiagnostic studies continue to have high utility for the diagnosis of numerous childhood neuromuscular disorders, and that standardized approaches along with the use of high-quality reference values are important to maximize the diagnostic yield of these tests in infants, children, and adolescents.

Focal Neuropathy Mimicking Focal Dystonia in a Child: Diagnostic and Rehabilitative Tools

OBJECT

Focal neuropathy results from an injury of any etiology that occurs in a peripheral nerve. The lesion may be followed by alteration of the sensory sphere (either dysesthesia or paresthesia with or without neuropathic pain), or by compensatory attitudes that are attributable to the altered contraction in muscles that are innervated by the injured nerve.

METHODS

We describe the case of a 13-year-old boy who attended our hospital for a focal neuropathy of the radial nerve.

CONCLUSION

This neuropathy was revealed after the removal of a plaster Zimmer splint that was applied following a post-traumatic subluxation of the metacarpal-trapezoid joint.