Post-traumatic entrapment of the median nerve in the ulno-humeral joint: Diagnosis, treatment and literature review

Montanari, Sara; Sartore, Roberta; Spina, Vincenzo; Adani, Roberto

doi:10.1016/j.jos.2021.02.006

Cited by 2 publications

(5 citation statements)

References 13 publications

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“…This phenomenon is well known and commonly published as case reports in the literature. The type of nerve injury and the delay between that injury and the operation are two particularly important factors in the outcome after nerve repair [1,5]. Therefore, the median nerve entrapped in the joint is a lesion that will not heal spontaneously and should be treated without delay for functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, delay in treatment in nerve injuries causes poor results. Montanari et al and Brendan et al evaluated the publications of median nerve injury after elbow dislocation and showed that there is a significant relationship between nerve healing and surgical timing [1]. Montanari et al reported that the mean treatment delay in patients with complete recovery was 1.5 months, and the mean treatment delay in patients with poor clinical outcomes was 12.4 months [1].…”

Section: Discussionmentioning

confidence: 99%

“…Montanari et al and Brendan et al evaluated the publications of median nerve injury after elbow dislocation and showed that there is a significant relationship between nerve healing and surgical timing [1]. Montanari et al reported that the mean treatment delay in patients with complete recovery was 1.5 months, and the mean treatment delay in patients with poor clinical outcomes was 12.4 months [1]. Brendan et al reported that the recovery of mixed motor nerves degrades dramatically over time, as repairs delayed more than 1 month.…”

Section: Discussionmentioning

confidence: 99%

“…Elbow dislocations are the second most common major joint dislocation after shoulder joint dislocation in the adult population, and the most common major joint dislocation in children [1]. Nerve injury is reported to occur in 5-22% of cases after an elbow dislocation [2].…”

Section: Introductionmentioning

confidence: 99%

“…Montanari et al evaluated the publications of median nerve injury after elbow dislocation in children between 1945 and 2020 and showed that there is a significant relationship between nerve healing and surgical timing. They stated that there was complete or almost complete recovery in patients who were treated within 4 months, and poorer functional recovery treated in an average of 12.4 months [1]. Brendan et al reported that the recovery of mixed motor nerves degrades dramatically over time, as repairs delayed more than 1 month.…”

Section: Introductionmentioning

confidence: 99%

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Entrapment of median nerve after elbow fracture dislocations: expected surgical time frame based on cadaver study

Yoğun,

Bezirgan,

ŞEN ESMER

et al. 2024

JPHS

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Introduction: Median nerve injuries occur in approximately 3% of pediatric elbow fracture dislocations. These rare injuries can be difficult to diagnose, and the results are poor in delay cases. Surgical timing is one of the most important prognostic factors. We aimed to present three patients with median nerve palsy who were referred to our clinic late, and according to these cases, we emphasized the expected time frame for exploration based on our anatomical cadaver study. Materials and Methods: Between 2008 and 2010, three patients were referred to our clinic because of median nerve paralysis after a treated elbow dislocation. The mean interval between injury and referral was 15 (min: 13–max: 18) months, and the mean age of the patients was 15 (13–18) years. Neurolysis was performed in two patients, and for the third patent, after neurolysis, axonal continuity was observed to be disrupted so sural nerve grafting was performed with four cables. Tendon transfers were performed in all patients. A total number of 20 upper extremities of 10 cadavers were dissected. Due to its proximal innervation and ease of assessment, the muscle innervation of the flexor pollicis longus (FPL) was planned to be evaluated. The distance from the medial epicondyle is calculated in the cadaver study where the nerve injury is found. Results: The mean length from the medial epicondyle to the motor innervation of FPL was calculated in each specimen and found to be 101.99 millimeters (mm) (range: 87.5–134.2). The mean longest innervation of FPL was 110.83 mm from (range 87.5–148.1) the medial epicondyle calculated by including each specimens longest nerve length. Knowing that the healing time of a nerve lesion is 1 mm per day, we calculated that the recovery of FPL would take approximately 4 months. Conclusion: When nerve healing is expected to be 1 mm a day in axonotmesis type injury, after the median nerve palsy following elbow dislocation, thumb flexion should be achieved in the following 4 months generally if the nerve was not entrapped in the joint. This cadaver-based study objectively defined how long to wait for the innervation of the FPL in median nerve injuries in elbow fracture dislocations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Entrapment of median nerve after elbow fracture dislocations: expected surgical time frame based on cadaver study

Yoğun,

Bezirgan,

ŞEN ESMER

et al. 2024

JPHS

View full text Add to dashboard Cite

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Visualization of Median Nerve Entrapment After Reduction of an Elbow Fracture Dislocation Using 3-Dimensional Magnetic Resonance Imaging

Gross,

Meza,

Nimura

et al. 2024

JBJS Case Connector

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Case: A 10-year-old girl presented after closed reduction of an elbow fracture dislocation. She demonstrated intact vascularity but a dense median nerve palsy. Preoperative magnetic resonance neurography (MRN) precisely mapped the median nerve entrapped within the medial epicondylar fracture. Intraoperatively, the median nerve was freed preceding reduction and fracture fixation. Postoperatively, neurological symptoms completely resolved, and she regained full elbow function. Conclusion: Median nerve injury can present without associated vascular injury. In this case, MRN was helpful in preoperatively illustrating the spatial relationship between the median nerve and the medial epicondyle.

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Post-traumatic entrapment of the median nerve in the ulno-humeral joint: Diagnosis, treatment and literature review

Cited by 2 publications

References 13 publications

Entrapment of median nerve after elbow fracture dislocations: expected surgical time frame based on cadaver study

Entrapment of median nerve after elbow fracture dislocations: expected surgical time frame based on cadaver study

Visualization of Median Nerve Entrapment After Reduction of an Elbow Fracture Dislocation Using 3-Dimensional Magnetic Resonance Imaging

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