Peripheral nerve injuries in the pediatric population: a review of the literature. Part II: entrapment neuropathies

Abstract

The presence of an entrapment neuropathy (specially carpal tunnel syndrome) in a pediatric-age patient should alert medical care providers to the potential of some underlying genetic condition or syndrome.

Fascial entrapment neuropathy

“…Effective management depends very much on proper identification of the involved nerve and the anatomical location of compression (Flanigan and DiGiovanni, 2011). Entrapment neuropathies are not frequent in children, but clinicians treating pediatric age patients must always keep them in mind (Costales et al, 2018).…”

“…There are many potential entrapment sites of the median nerve in the upper extremity, which include the biceps brachii aponeurosis (lacertus fibrosis) (Hobson‐Webb and Juel, ), and Struthers’ ligament (a band of connective tissue) (Bilge et al, ), which is present in 1–13% of the general population (Dang and Rodner, ; Siqueira and Martins, ). Costales et al () noticed during surgery that abnormal fibrous bands, adhesions, or neuromas could be found at sites of medial nerve entrapment.…”

“…The superficial margin of the tunnel is marked by the flexor retinaculum (a fascial thickening) and the distal end point is narrow and merges with both the superficial and deep fasciae of abductor hallucis muscle (Harries et al, 2000;Kohno et al, 2000). Costales et al (2018) affirmed that during surgery, it is common to encounter local nerve swelling, a narrow tarsal tunnel, fibrous adhesions around the nerve, and constricting bands.…”

“…There are many potential entrapment sites of the median nerve in the upper extremity, which include the biceps brachii aponeurosis (lacertus fibrosis) (Hobson-Webb and Juel, 2017), and Struthers' ligament (a band of connective tissue) (Bilge et al, 1990), which is present in 1-13% of the general population (Dang and Rodner, 2009;Siqueira and Martins, 2005). Costales et al (2018) noticed during surgery that abnormal fibrous bands, adhesions, or neuromas could be found at sites of medial nerve entrapment. Ettema et al (2006) hypothesized that idiopathic carpal tunnel syndrome is the result of shear injury to the subsynovial connective tissue, causing fibrosis that ultimately leads to nerve compression and ischemia.…”

“…This ligament lies between the medial and ulnar heads of flexor carpi ulnaris (Hobson-Webb and Juel, 2017). Costales et al (2018) said that nerve also becomes entrapped by repetitive trauma and scar formation in the cubital tunnel.…”