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A rare case of type 2 entrapment of the median nerve after posterior elbow dislocation with MRI and ultrasound correlation

  • Patrick K. O’Callaghan
  • Kyle Freeman
  • Leah C. DavisEmail author
  • Robert F. Murphy
Case Report
  • 23 Downloads

Abstract

A 9-year-old boy sustained an ulnohumeral dislocation with a medial epicondyle fracture and experienced incomplete post-traumatic median nerve palsy in addition to post-traumatic stiffness following closed reduction and cast immobilization. When his motor palsy and stiffness did not improve, MRI and ultrasound were obtained, which demonstrated entrapment of the median nerve in an osseous tunnel at the fracture site, compatible with type 2 median nerve entrapment. Subsequently, the patient underwent surgery to mobilize the medial epicondyle and free the median nerve, resulting in improved range of motion, near complete restoration of motor function, and complete restoration of sensory function in the median nerve distribution within 6 months of surgery. Median nerve entrapment, particularly intraosseous, is a rare complication of posterior elbow dislocation and medial epicondyle fracture that may result in significant, sometimes irreversible, nerve damage if there is a delay in diagnosis and treatment. A high degree of clinical suspicion with early imaging is indicated in patients with persistent stiffness or nerve deficits following reduction of an elbow dislocation. Intra-articular entrapment diagnosed on ultrasound has been reported and intraosseous entrapment diagnosed clinically and on MR neurography have been reported; however, to our knowledge, this is the first reported case of intraosseous (type 2) median nerve entrapment clearly visualized and diagnosed on traditional MRI and ultrasound. The use of ultrasound for diagnosing median nerve entrapment is an accurate, accessible, and non-invasive imaging option for patients presenting with suspected nerve entrapment following elbow dislocation.

Keywords

Median neuropathy Elbow Joint dislocations Ultrasound Magnetic resonance imaging 

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© ISS 2019

Authors and Affiliations

  • Patrick K. O’Callaghan
    • 1
  • Kyle Freeman
    • 2
  • Leah C. Davis
    • 2
    Email author
  • Robert F. Murphy
    • 1
  1. 1.Department of OrthopedicsMedical University of South CarolinaCharlestonUSA
  2. 2.Department of Radiology and Radiological SciencesMedical University of South CarolinaCharlestonUSA

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