Median Nerve Compression From a Nondisplaced Fracture of the Coronoid Process of the Ulna

Abstract

Median nerve neuropathy following an elbow injury is uncommon. When it occurs, understanding the median nerve distribution and anatomy is crucial for identifying the cause and for distinguishing cases that can be managed with observation as opposed to intervention. The consequences of misdiagnosis can result in permanent disability. Understanding the mechanisms of nerve injury will help the clinician anticipate prognosis and guide treatment. Stretch, transection, and compression of nerves may present similarly, but isolating the mechanism and the extent of injury can guide the treatment modalities and help predict the overall recovery. The case is a report of median nerve compression in a woman after a nondisplaced fracture of the coronoid process of the ulna. Despite the unique nature of the patient’s symptoms, the neuropathy resolved with “watchful waiting.” The location of the injury was a key component in identifying the cause of the neuropathy. It highlights the importance of identifying a cause; some cases will resolve without intervention. Clinicians should consider median nerve compression when presented with a patient experiencing neurologic symptoms following such a fracture.

Epidemiologic features and management of elbow dislocation with associated fracture in pediatric population

“…Median nerve compression following a pediatric elbow injury is rare and misdiagnosis can result in permanent disability. [ 30 ] A clinical diagnosis is based on weakness, pain over point of compression, and positive scratch collapse test. [ 31 ] Despite the unique nature of the patient's symptoms, some patients have an excellent prognosis with conservative management.…”

“…[ 31 ] Despite the unique nature of the patient's symptoms, some patients have an excellent prognosis with conservative management. [ 30 ] It has been reported that the nerve injury found exclusively in the skeletally immature, especially in elbow fracture dislocation, should be an indication for surgical exploration and release of the entrapped nerve. [ 32 ] Although it was difficult to draw a conclusion from 1 case only, we believed that a correct diagnosis and early surgical intervention of elbow trauma were important to obtain a good result in treating the complication.…”