Abstract
Suspected mononeuropathies are the second most common reason for referral to the pediatric EMG laboratory. As with other disease categories, the presentation and distribution of specific mononeuropathies is often different in children compared to adults. Evaluation of a child presenting with mononeuropathy starts with a detailed history and a meticulous clinical examination. The electrodiagnostic approach to potential mononeuropathies aims to confirm the presence of a mononeuropathy, exclude alternative diagnoses, localize the injury site, assess the chronicity of the lesion, evaluate for nerve continuity, and clarify underlying pathophysiological mechanisms that may provide prognostic information. This chapter reviews the clinical and electrodiagnostic findings and differential diagnosis of the most common upper and lower extremity mononeuropathies.
References
- 1.Karakis I, Liew W, Darras BT, Jones HR, Kang PB. Referral and diagnostic trends in pediatric electromyography in the molecular era. Muscle Nerve. 2014;50(2):244–9.CrossRefPubMedGoogle Scholar
- 2.Sunderland S. Nerves and nerve injuries. Edinburgh: E. & S. Livingstone; 1968.Google Scholar
- 3.Fuller G. Focal peripheral neuropathies. J Neurol Neurosurg Psychiatry. 2003;74(Suppl 2):ii20–i4.PubMedPubMedCentralGoogle Scholar
- 4.Ryan MM, Jones HR. In: Darras BT, Jones HR, Ryan MM, De Vivo DC, editors. Mononeuropathies. 2nd ed. San Diego: Academic Press; 2015.Google Scholar
- 5.Stewart J. Focal peripheral neuropathies. New York: Elsevier; 1987.Google Scholar
- 6.Deymeer F, Jones HR Jr. Pediatric median mononeuropathies: a clinical and electromyographic study. Muscle Nerve. 1994;17(7):755–62.CrossRefPubMedGoogle Scholar
- 7.Nakano KK, Lundergran C, Okihiro MM. Anterior interosseous nerve syndromes. Diagnostic methods and alternative treatments. Arch Neurol. 1977;34(8):477–80.CrossRefPubMedGoogle Scholar
- 8.Davis L, Vedanarayanan VV. Carpal tunnel syndrome in children. Pediatr Neurol. 2014;50(1):57–9.CrossRefPubMedGoogle Scholar
- 9.Van Meir N, De Smet L. Carpal tunnel syndrome in children. Acta Orthop Belg. 2003;69(5):387–95.PubMedGoogle Scholar
- 10.Batdorf NJ, Cantwell SR, Moran SL. Idiopathic carpal tunnel syndrome in children and adolescents. J Hand Surg [Am]. 2015;40(4):773–7.CrossRefGoogle Scholar
- 11.Sonel B, Senbil N, Yavus Gurer YK, Evcik D. Cavanagh’s syndrome (congenital thenar hypoplasia). J Child Neurol. 2002;17(1):51–4.CrossRefPubMedGoogle Scholar
- 12.Van Heest AE, House J, Krivit W, Walker K. Surgical treatment of carpal tunnel syndrome and trigger digits in children with mucopolysaccharide storage disorders. J Hand Surg [Am]. 1998;23(2):236–43.CrossRefGoogle Scholar
- 13.Haddad FS, Jones DH, Vellodi A, Kane N, Pitt MC. Carpal tunnel syndrome in the mucopolysaccharidoses and mucolipidoses. J Bone Joint Surg. 1997;79(4):576–82.CrossRefGoogle Scholar
- 14.Felice KJ, Royden Jones H Jr. Pediatric ulnar mononeuropathy: report of 21 electromyography-documented cases and review of the literature. J Child Neurol. 1996;11(2):116–20.CrossRefPubMedGoogle Scholar
- 15.Karakis I, Liew W, Szelag Fournier H, Jones HR, Darras BT, Kang PB. American Association of neuromuscular and electrodiagnostic. Medicine. 2016.Google Scholar
- 16.Stewart JD. The variable clinical manifestations of ulnar neuropathies at the elbow. J Neurol Neurosurg Psychiatry. 1987;50(3):252–8.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Baysefer A, Izci Y, Akay KM, Kayali H, Timurkaynak E. Surgical outcomes of ulnar nerve lesions in children. A retrospective clinical study. Pediatr Neurosurg. 2004;40(3):107–11.CrossRefPubMedGoogle Scholar
- 18.Escolar DM, Jones HR Jr. Pediatric radial mononeuropathies: a clinical and electromyographic study of sixteen children with review of the literature. Muscle Nerve. 1996;19(7):876–83.CrossRefPubMedGoogle Scholar
- 19.Monica JT, Waters PM, Bae DS. Radial nerve palsy in the newborn: a report of four cases and literature review. J Pediatr Orthop. 2008;28(4):460–2.CrossRefPubMedGoogle Scholar
- 20.Alsubhi FS, Althunyan AM, Curtis CG, Clarke HM. Radial nerve palsy in the newborn: a case series. CMAJ. 2011;183(12):1367–70.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Jones HR Jr. Compressive neuropathy in childhood: a report of 14 cases. Muscle Nerve. 1986;9(8):720–3.CrossRefPubMedGoogle Scholar
- 22.Tyagi A, Drake J, Midha R, Kestle J. Axillary nerve injuries in children. Pediatr Neurosurg. 2000;32(5):226–9.CrossRefPubMedGoogle Scholar
- 23.Vastamaki M, Kauppila LI. Etiologic factors in isolated paralysis of the serratus anterior muscle: a report of 197 cases. J Shoulder Elb Surg. 1993;2(5):240–3.CrossRefGoogle Scholar
- 24.Henry D, Bonthius DJ. Isolated musculocutaneous neuropathy in an adolescent baseball pitcher. J Child Neurol. 2011;26(12):1567–70.CrossRefPubMedGoogle Scholar
- 25.Laulund T, Fedders O, Sogaard I, Kornum M. Suprascapular nerve compression syndrome. Surg Neurol. 1984;22(3):308–12.CrossRefPubMedGoogle Scholar
- 26.Montagna P, Colonna S. Suprascapular neuropathy restricted to the infraspinatus muscle in volleyball players. Acta Neurol Scand. 1993;87(3):248–50.CrossRefPubMedGoogle Scholar
- 27.Park SH, Esquenazi Y, Kline DG, Kim DH. Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures. J Neurosurg Spine. 2015;23(4):518–25.CrossRefPubMedGoogle Scholar
- 28.Grossman JA, Ruchelsman DE, Schwarzkopf R. Iatrogenic spinal accessory nerve injury in children. J Pediatr Surg. 2008;43(9):1732–5.CrossRefPubMedGoogle Scholar
- 29.Ravishankar N. Respiratory paralysis in a child: the severe axonal variant of childhood Guillain-Barre syndrome. J Pediatr Neurosci. 2015;10(1):67–9.PubMedPubMedCentralGoogle Scholar
- 30.Sevilla T, Jaijo T, Nauffal D, Collado D, Chumillas MJ, Vilchez JJ, et al. Vocal cord paresis and diaphragmatic dysfunction are severe and frequent symptoms of GDAP1-associated neuropathy. Brain J Neurol. 2008;131(Pt 11):3051–61.CrossRefGoogle Scholar
- 31.Katirji B. Electrodiagnostic approach to the patient with suspected mononeuropathy of the lower extremity. Neurol Clin. 2002;20(2):479–501, vii.CrossRefPubMedGoogle Scholar
- 32.Srinivasan J, Ryan MM, Escolar DM, Darras B, Jones HR. Pediatric sciatic neuropathies: a 30-year prospective study. Neurology. 2011;76(11):976–80.CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Jones HR Jr, Gianturco LE, Gross PT, Buchhalter J. Sciatic neuropathies in childhood: a report of ten cases and review of the literature. J Child Neurol. 1988;3(3):193–9.CrossRefPubMedGoogle Scholar
- 34.Bhattad SB, Gupta A, Suri D, Sharma D, Sinha A, Singh S. Piriformis syndrome in a young child—an unusual clinical entity. Indian J Pediatr. 2016;83(4):361–2.CrossRefPubMedGoogle Scholar
- 35.Engstrom JW, Layzer RB, Olney RK, Edwards MB. Idiopathic, progressive mononeuropathy in young people. Arch Neurol. 1993;50(1):20–3.CrossRefPubMedGoogle Scholar
- 36.Karakis I, Khoshnoodi, M., Liew, W., Nguyen E.S., Jones H.R., Darras B.T., Kang, P.B. Electrophysiologic features of peroneal neuropathy in childhood and adolescence. Muscle Nerve. 2016;55(5):693–7.Google Scholar
- 37.Wilbourn AJ. AAEE case report #12: common peroneal mononeuropathy at the fibular head. Muscle Nerve. 1986;9(9):825–36.CrossRefPubMedGoogle Scholar
- 38.Jones HR Jr, Felice KJ, Gross PT. Pediatric peroneal mononeuropathy: a clinical and electromyographic study. Muscle Nerve. 1993;16(11):1167–73.CrossRefPubMedGoogle Scholar
- 39.Kang PB, Preston DC, Raynor EM. Involvement of superficial peroneal sensory nerve in common peroneal neuropathy. Muscle Nerve. 2005;31(6):725–9.CrossRefPubMedGoogle Scholar
- 40.Molloy AP, Lyons R, Bergin D, Kearns SR. Flexor digitorum accessorius causing tarsal tunnel syndrome in a paediatric patient: a case report and review of the literature. Foot Ankle Surg. 2015;21(2):e48–50.CrossRefPubMedGoogle Scholar
- 41.Smuts I, Potgieter D, van der Westhuizen FH. Combined tarsal and carpal tunnel syndrome in mucolipidosis type III. A case study and review. Ann N Y Acad Sci. 2009;1151:77–84.CrossRefPubMedGoogle Scholar
- 42.Brockmann K, Schneider-Sickert F, Kolenda H, Aden I, Hanefeld F. Tarsal tunnel syndrome in a 7-year-old boy. Eur J Pediatr. 2004;163(1):46–7.CrossRefPubMedGoogle Scholar
- 43.Albrektsson B, Rydholm A, Rydholm U. The tarsal tunnel syndrome in children. J Bone Joint Surg. 1982;64(2):215–7.Google Scholar
- 44.Kachko L, Ben Ami S, Liberman A, Birk E, Kronenberg S. Duloxetine contributing to a successful multimodal treatment program for peripheral femoral neuropathy and comorbid ‘reactive depression’ in an adolescent. Pain Res Manag. 2011;16(6):457–9.CrossRefPubMedPubMedCentralGoogle Scholar
- 45.Murnaghan ML, Browne RH, Sucato DJ, Birch J. Femoral nerve palsy in Pavlik harness treatment for developmental dysplasia of the hip. J Bone Joint Surg Am. 2011;93(5):493–9.CrossRefPubMedGoogle Scholar
- 46.van Hoff J, Shaywitz BA, Seashore JH, Collins WF. Femoral nerve injury following inguinal hernia repair. Pediatr Neurol. 1985;1(3):195–6.CrossRefPubMedGoogle Scholar
- 47.Murray IR, Perks FJ, Beggs I, Moran M. Femoral nerve palsy secondary to traumatic iliacus haematoma—a young athlete’s injury. BMJ Case Reports. 2010;2010 doi: 10.1136/bcr.05.2010.3045.
- 48.Ehrmann L, Lechner K, Mamoli B, Novotny C, Kos K. Peripheral nerve lesions in haemophilia. J Neurol. 1981;225(3):175–82.CrossRefPubMedGoogle Scholar
- 49.Shetty GM, Murari AS, Song HR, Lee SH, Yang JH. Neurofibromatous sensory neuropathy of the thigh in a 7-year-old boy. Arch Orthop Trauma Surg. 2008;128(10):1093–7.CrossRefPubMedGoogle Scholar
- 50.McMillan HJ, Torres C, Michaud J, Ying Y, Boyd KU, Bourque PR. Diagnosis and outcome of childhood perineurioma. Childs Nerv Syst. 2016;Google Scholar
- 51.Kim DH, Kline DG. Surgical outcome for intra- and extrapelvic femoral nerve lesions. J Neurosurg. 1995;83(5):783–90.CrossRefPubMedGoogle Scholar
- 52.Bradshaw C, McCrory P, Bell S, Brukner P. Obturator nerve entrapment. A cause of groin pain in athletes. Am J Sports Med. 1997;25(3):402–8.CrossRefPubMedGoogle Scholar
- 53.Nishimura M, Kodama Y, Fukano R, Okamura J, Ogaki K, Sakaguchi Y, et al. Meralgia paresthetica as a presentation of acute appendicitis in a girl with acute lymphoblastic leukemia. J Pediatr Hematol Oncol. 2015;37(3):e182–3.CrossRefPubMedGoogle Scholar
- 54.Fernandez-Mayoralas DM, Fernandez-Jaen A, Jareno NM, Perez BC, Fernandez PM, Sola AG. Meralgia paresthetica in the pediatric population: a propos of 2 cases. J Child Neurol. 2010;25(1):110–3.CrossRefPubMedGoogle Scholar
- 55.Tejwani SG, Scaduto AA, Bowen RE. Transient meralgia paresthetica after pediatric posterior spine fusion. J Pediatr Orthop. 2006;26(4):530–3.CrossRefPubMedGoogle Scholar
- 56.Edelson R, Stevens P. Meralgia paresthetica in children. J Bone Joint Surg Am. 1994;76(7):993–9.CrossRefPubMedGoogle Scholar
- 57.Richer LP, Shevell MI, Stewart J, Poulin C. Pediatric meralgia paresthetica. Pediatr Neurol. 2002;26(4):321–3.CrossRefPubMedGoogle Scholar
- 58.Reisin R, Pardal A, Ruggieri V, Gold L. Sural neuropathy due to external pressure: report of three cases. Neurology. 1994;44(12):2408–9.CrossRefPubMedGoogle Scholar
- 59.Hattori H, Asagai Y, Yamamoto K. Sudden onset of saphenous neuropathy associated with hereditary multiple exostoses. J Orthop Sci. 2006;11(4):405–8.CrossRefPubMedGoogle Scholar