Case report: Acute cubital tunnel syndrome in a hemophiliac patient

Abstract

A 24-year-old right-hand dominant male with severe Hemophilia A presented with acute elbow pain, associated paresthesias, and weakness in the ulnar nerve distribution after upper body weight lifting. In the week prior, he missed three doses of Factor VIII replacement. After no improvement with conservative measures, he was taken to the operating room urgently for decompression and was noted to have a perineural hematoma in the cubital tunnel. At final follow-up, the patient reported complete resolution of symptoms. Acute cubital tunnel syndrome in hemophiliac patients that does not respond to medical treatment is best treated with surgical decompression using minimal dissection to prevent hematoma formation, preserve perineural membranous tissue, and avoid destabilizing the nerve.

The Treatment of Advanced Cubital Tunnel Syndrome in a Patient with Hemophilia and Its Postoperative Results

“…Debkowska MP et al stated that in this case, there was no response to medical treatment alone. In such cases, they recommended the prevention of hematoma with minimal dissection to provide decompression of the nerve (3) .…”

The good, the bad and the ugly of pain in haemophilia: Recent evidence on the epidemiology, molecular mechanisms and knowledge gaps preventing optimal treatment

“…Localised acute pain and other associated symptoms can occur when a PWH is not compliant with prophylaxis 23 or when the prophylactic treatment is ineffective and the therapy needs to be adjusted.…”

Evidence-Based Approach to Timing of Nerve Surgery

“…[126][127][128][129] Treatment algorithms have been described in the literature for acute median nerve compression, which is frequently associated with distal radius fractures. [130][131][132][133][134] In healthy patients, carpal tunnel pressure has been reported from 5 to 14 mm Hg. Although carpal tunnel pressure has been reported from 12 to 43 mm Hg in patients with chronic carpal tunnel syndrome, acute cases may be elevated between 40 and 60 mm Hg.…”

“…Treatment algorithms have been described in the literature for acute median nerve compression, which is frequently associated with distal radius fractures 130–134 . In healthy patients, carpal tunnel pressure has been reported from 5 to 14 mm Hg.…”