Keywords
acute - cubital tunnel syndrome - foreign body
Peripheral nerve injuries of the upper extremity are leading causes of hand surgery
emergencies. However, foreign bodies are one of the rare causes of these injuries.[1] Here, we present a case of a foreign body inside the cubital tunnel with acute cubital
tunnel syndrome symptoms.
Case
A 48-year-old male patient presented with a traffic accident and was followed up in
an unconscious state for 2 days in the intensive care unit of our hospital. After
he became cooperative, we consulted him for paresthesia on the fourth and fifth fingers
and the informed consent was taken. He had a small scar in the epicondylar region.
Accordingly, conventional cubital tunnel incision was performed to explore the nerve,
revealing a piece of glass inside the cubital tunnel and a partial laceration in the
ulnar nerve ([Fig. 1]). We removed the foreign body and repaired the nerve epineurally. Furthermore, a
cast was applied, and physiotherapy was initiated for the patient. Patient was followed
up with physical examination and the neurological function was fully recovered.
Fig. 1 Intraoperative view shows the piece of glass inside the cubital tunnel and the laceration
of the ulnar nerve.
Discussion
Although foreign bodies are common on the upper extremity, these rarely cause nerve
damage. Choudhari et al reported a patient with progressive ulnar nerve dysfunction
because of a foreign body migration.[1] Retained objects can cause nerve dysfunction even in the absence of a nerve laceration;
however, owing to the granuloma, which they form around the nerve. In our case, the
foreign body lacerated the nerve itself and, remarkably, it was inside the cubital
tunnel. Pleser et al defined a foreign body located inside the ulnar nerve in the
distal humerus.[2] Our case exhibited symptoms of acute cubital tunnel syndrome. In addition, some
studies have reported venous thrombosis, hemangioma, and calcific neuritis resulting
in acute cubital tunnel syndrome.[3]
[4]
[5] However, the compression neuropathy symptoms due to the acute trauma is interesting.
It is known that the repetitive traumas and injuries are the main etiologies for the
compression neuropathies. As a chronic disease, the compression neuropathies can be
detected with nerve conduction studies; however, because being a trauma patient with
the absolute indication for acute exploration and the degree of muscle denervation
after nerve injury cannot be determined until Wallerian degeneration is completed
(approximately after 4 weeks), we did not perform any preoperative electromyography
study.[6] Notably, the determination of etiology that causes the syndrome for patients who
are unconscious for a period, like our case, remains challenging. Hence, a detailed
history should be obtained, and a comprehensive physical examination should be performed
in cases such as ours.
Furthermore, nerve laceration with a foreign body should be considered in acute-onset
cubital tunnel syndrome, in which the foreign body history of a trauma patient cannot
be determined explicitly.
