Peripheral Nerve Injury Associated with a Subdermal Contraceptive Implant: Illustrative Cases and Systematic Review of Literature

Abstract

Nerve injuries related to SCIs are rare but potentially serious. For nonpalpable SCIs, a multidisciplinary approach, including practitioners with experience treating peripheral nerve injuries, is invaluable.

Neurovascular anatomy of the adult female medial arm in relationship to potential sites for insertion of the etonogestrel contraceptive implant

“…As shown in published case reports, neurovascular injuries are usually associated with user errors including deep insertion, insertion too close to the elbow or blind dissection deep within the arm during attempted removal [4][5][6][7][8]. While nerve injury associated with insertion or removal of the contraceptive implant is rare, the sequelae can result in permanent pain or sensorimotor loss if the injury is not repaired.…”

“…Deep implant insertion or efforts to remove a deeply placed implant adjacent to major vessels or nerves may result in rare cases of neurovascular injury (e.g., nerve damage or hematoma) [1][2][3][4][5][6][7][8]. As noted in case reports, implant placement on or near a nerve may be associated with paresthesia or pain [4,6]. Ulnar nerve injury may also occur during insertion or removal if the implant is placed too close to the elbow, where the nerve travels superficially.…”

“…Ulnar nerve injury may also occur during insertion or removal if the implant is placed too close to the elbow, where the nerve travels superficially. Nerve injuries, albeit rare, may result in permanent sensorimotor dysfunction or chronic neuropraxia if not diagnosed and repaired [4,7,8]. Furthermore, improper deep placement may result in rare intravascular insertion and possible implant migration to the pulmonary artery [9].…”

Advanced implantable drug delivery technologies: transforming the clinical landscape of therapeutics for chronic diseases

“…When inserting implants into the upper arm, it is important to avoid the sulcus between the biceps and triceps muscles and the neurovascular bundle that lies deeper in the subcutaneous tissue to avoid complications such as peripheral nerve injury and paresthesia (Laumonerie et al 2018). Equally important, the presence of the device must always be verified immediately after insertion to circumvent implant migration.…”

“…Equally important, the presence of the device must always be verified immediately after insertion to circumvent implant migration. There are reports of difficulty removing Implanon®/Nexplanon® devices associated with peripheral nerve injury and implant migration (Barlow-Evans et al 2017;Chevreau et al 2018;Chung et al 2017;Diego et al 2017;Guiahi et al 2014;Laumonerie et al 2018;Odom et al 2017). Regardless, the benefits are indisputable given the high efficacy rate and that most common adverse effects reported for these implants include erythema, hematoma, application site pain, and edema are quick to resolve (FDA Reference IDs: 2887911; 3080389; 4099967; 4100681; 4215185) (Davis et al 2014;Donnelly et al 2015;Fisher et al 2014;Itzoe and Guarnieri 2017;Pedroso et al 2015;Serati et al 2015;Shumer et al 2016;Silverman et al 2015;Simon et al 2016;Smith et al 2017).…”