Short report letter

The Journal of Hand Surgery

(European Volume)
0(00) 1–2
jhs.sagepub.com

the ulna (Nunley and Urbaniak, 1980; Watson and

Median nerve entrapment in a paediatric Singer, 1994). In both cases there were signs of
fracture of the ulna demonstrated by good recovery.
magnetic resonance imaging Even though this case demonstrates that improve-
ment can be achieved several months after injury,
Dear Sir, early diagnosis and intervention is preferred if
An 11-year-old girl fell while running, sustaining a entrapment is suspected. MRI may not have the spe-
closed mid-shaft forearm fracture of the right radius cificity and sensitivity of nerve conduction studies in
and ulna with dorsal angulation. On admission she prediction of entrapment neuropathies (Jarvik et al.,
complained of symptoms of median nerve dysfunc- 2002), especially in the case of median nerve mono-
tion, both sensory and motor, with paraesthesiae in neuropathy (Hof et al., 2008). However, this case
the thumb and index finger. She underwent closed
reduction of the fracture and cast immobilization on
the same day and was discharged after 24 hours with
persistent sensory symptoms. The cast was removed
at 6 weeks and though the fracture healed well there
were persisting median nerve symptoms. Initial
nerve conduction studies ordered 6 weeks after
injury showed no motor or sensory responses from
the median nerve.
At 6 months, there was marked wasting of her
thenar eminence with absent abductor pollicis
brevis function. Repeat nerve conduction studies
confirmed persisting mononeuropathy of the
median nerve with no further motor or sensory
response from the nerve in the wrist or hand.
An MRI with T2 weighted images showed increased
signal in the median nerve with deviation and entrap-
ment at the fracture site in the ulna (Figure 1).
At surgical exploration, the median nerve was
noted to plunge deep to the flexor digitorum profun-
dus, with 90% of it encased in the remodelling bone
of the ulna (Figure 2). The involved segment was
excised with direct neurolysis and repair. Six
months after the operation, there was a positive
Tinel sign from the level of the scar distally to the
fingertips. There was increased muscle bulk in the
thenar eminence and amelioration of the paraesthe-
siae in the median nerve distribution. One year after
her operation she was symptom-free.
Median nerve entrapment at a fracture site is a
rare complication after forearm fractures in children. Figure 1. T2-weighted MR image displaying significant
To the authors’ knowledge there have only been two deviation of median nerve (arrows) with entrapment at the
reports of median nerve entrapment in a fracture of fracture site in the ulna.

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2 The Journal of Hand Surgery (Eur) 0(00)

Conflict of interests
None declared.

References
Jarvik JG, Yuen E, Haynor DR et al. MR nerve imaging in a
prospective cohort of patients with suspected carpal
tunnel syndrome. Neurology. 2002, 58: 1597–602.
Hof JJ, Kliot M, Slimp J, Haynor D. What’s new in MRI of
peripheral nerve entrapment? Neurosurg Clin N Am.
2008, 19: 583–95.
Nunley JA, Urbaniak JR. Partial bony entrapment of the
median nerve in a greenstick fracture of the ulna.
J Hand Surg Am. 1980, 5: 557–9.
Watson JA, Singer GC. Irreducible Monteggia fracture:
beware nerve entrapment. Injury. 1994, 25: 325–7.

Figure 2. Intraoperative photograph showing median

Dr Gerald Yeo, Dr Shane Prodger and
nerve (A) entrapped in shaft of ulna (B).
Dr Kim Latendresse
Department of Orthopaedics, Nambour General
demonstrates the usefulness of MRI in tracing the
Hospital, Nambour, Queensland, Australia
course of the median nerve in the forearm after frac-
E-mail: dr.geraldyeo@gmail.com
ture. Therefore we advocate the use of this investi-
gation as an adjunct to nerve conduction studies if
symptoms of neurapraxia have not improved by the ß The Author(s) 2011
time of cast removal, or earlier if entrapment is sus- Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav
pected clinically or from radiographic features previ- doi: 10.1177/1753193410397902 available online at http://jhs.sagepub.com
ously described.

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