Aggarwal A, Jana M, Kumar V, Srivastava DN, Garg K. MR neurography in intraosseous median nerve entrapment. World J Radiol 2017; 9(10): 400-404 [PMID: 29104742 DOI: 10.4329/wjr.v9.i10.400]
Corresponding Author of This Article
Deep Narayan Srivastava, Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, Room No 69, Ground Floor, Near South Extension, New Delhi 110029, India. drdeepsrivastava@rediffmail.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ankita Aggarwal, Manisha Jana, Deep Narayan Srivastava, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
Vijay Kumar, Department of Orthopedics, All India Institute of Medical Sciences, New Delhi 110029, India
Kanwaljeet Garg, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi 110029, India
Author contributions: Aggarwal A and Srivastava DN designed the research; Aggarwal A, Jana M and Srivastava DN performed the research; Kumar V and Srivastava DN provided administrative support; Aggarwal A and Garg K prepared the manuscript.
Institutional review board statement: Ethics clearance for this study was taken from the Ethics Committee of All India Institute of Medical Sciences, New Delhi, India.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors do not have any conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Deep Narayan Srivastava, Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, Room No 69, Ground Floor, Near South Extension, New Delhi 110029, India. drdeepsrivastava@rediffmail.com
Telephone: +91-98-99245764
Received: February 13, 2017 Peer-review started: February 14, 2017 First decision: April 19, 2017 Revised: June 24, 2017 Accepted: July 7, 2017 Article in press: July 10, 2017 Published online: October 28, 2017 Processing time: 254 Days and 4.1 Hours
Abstract
Intraosseous entrapment of the median nerve is an uncommon complication of elbow dislocation and fractures. The condition is seen to occur in adolescent age group with a remote history of trauma. We report two rare cases of type 2 intraosseous median nerve entrapment. Though the diagnosis of median neuropathy is made with clinical tests and neurophysiological studies, however exact site of entrapment and presurgical mapping of nerve is done accurately with MR neurography. Imaging thus plays a pivotal role in management of this condition.
Core tip: Intraosseous entrapment of median nerve at the level of elbow joint is rare but serious complication of closed reduction of posterior elbow dislocation. We report two cases of type 2 intraosseous medan nerve entrapment (wherein the median nerve gets entrapped in fractured medial epicondyle) and discuss the role of MR neurography. MR delineates the posterior course of median nerve with altered signal intensity, thickening and loss of fascicular pattern. In addition, secondary denervation changes in muscles supplied by median nerve is indirect evidence of nerve pathology. Management of such cases would differ depending on the time of diagnosis.
