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Peripheral nerve injuries in the pediatric population: a review of the literature. Part II: entrapment neuropathies

Abstract

Introduction

Entrapment neuropathies are infrequent in children, and therefore remain unrecognized. The incidence of radial, median, and cubital mononeuropathies are all similar. Despite the rarity of such cases, extensive, albeit scattered, literature has accumulated concerning entrapment neuropathies in children.

Objective

To the literature concerning entrapment neuropathies in children.

Methods

A systematic review of the existing literature has been made.

Results

The management of chronic pediatric pain is very important in such patients to prevent youths from experiencing prolonged absences from school, sports, or other productive activities, and limit the psychological burden of chronic disease. Nonsurgical treatment of both cubital and carpal tunnel syndromes has been disappointing in pediatric patients, with only limited success; and, to date, there is no clear explanation for the outcome differences generated by nonsurgical management between adults and youths. Simple decompression of the ulnar nerve at the elbow also has much higher rates of failure in children than in adults.

Conclusions

The presence of an entrapment neuropathy (specially carpal tunnel syndrome) in a pediatric-age patient should alert medical care providers to the potential of some underlying genetic condition or syndrome.

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References

  1. Escolar DM (1996) Pediatric radial mononeuropathies: a clinical and electromyographic study of sixteen children with review of the literature. Muscle Nerve 19(7):876–883

    Article  CAS  PubMed  Google Scholar 

  2. Lagos JC (1971) Compression neuropathy in childhood. Dev Med Child Neurol 13:531–532

    Article  CAS  PubMed  Google Scholar 

  3. Sharma R, Ramachandran S, Bhat D, Bindu PS, Devi BI (2013) Bilateral carpal tunnel syndrome in two children: common manifestation of an uncommon disease. Pediatr Neurosurg 49:300–302. https://doi.org/10.1159/000365762

    Article  PubMed  Google Scholar 

  4. Lamberti PM, Light TR (2002) Carpal tunnel syndrome in children. Hand Clin 18:331–337

    Article  PubMed  Google Scholar 

  5. Mc Donald CM (2015) Electrodiagnosis in pediatrics. In: Alexander MA, Matthews DJ (eds) Pediatric Rehabilitation. Principles and Practice, 5th edn. Demos Medical Publishing, New York, pp 113–152

    Google Scholar 

  6. Pronicka E, Tylki-Szymanska A, Kwast O et al (1988) Carpal tunnel syndrome in children with mucopolysaccharidoses: needs for surgical tendons and median nerve release. J Ment Defic Res 32(Pt 1):79–82

    PubMed  Google Scholar 

  7. Fisher RC, Horner RL, Wood VE (1974) The hand in mucopolysaccharide disorders. Clin Orthop 104:191–199

    Article  Google Scholar 

  8. Gschwind C, Tonkin MA (1992) Carpal tunnel syndrome in children with mucopolysaccharidosis and related disorders. J Hand Surg 17:44–47

    Article  CAS  Google Scholar 

  9. Van Meir N, De Smet L (2005) Carpal tunnel syndrome in children. J Pediatr Orthop Part B 14:42–45

    Article  Google Scholar 

  10. al-Qattan MM, Thomson HG, Clarke HM (1996) Carpal tunnel syndrome in children and adolescents with no history of trauma. J Hand Surg Edinb Scotl 21:108–111

    Article  CAS  Google Scholar 

  11. Bouwman VEW, Knepper AB, de Vries TW (2015) Carpal tunnel syndrome and Down’s syndrome. Ned Tijdschr Geneeskd 159:A8943

    PubMed  Google Scholar 

  12. Yuen A, Dowling G, Johnstone B, Kornberg A, Coombs C (2007) Carpal tunnel syndrome in children with mucopolysaccaridoses. J Child Neurol 22:260–263. https://doi.org/10.1177/0883073807300528

    Article  PubMed  Google Scholar 

  13. Potulska-Chromik A, Lipowska M, Gawel M et al (2014) Carpal tunnel syndrome in children. J Child Neurol 29:227–231. https://doi.org/10.1177/0883073813504458

    Article  PubMed  Google Scholar 

  14. Davis L, Vedanarayanan VV (2014) Carpal tunnel syndrome in children. Pediatr Neurol 50:57–59. https://doi.org/10.1016/j.pediatrneurol.2013.08.019

    Article  PubMed  Google Scholar 

  15. Senger J-L, Classen D, Bruce G, Kanthan R (2014) Fibrolipomatous hamartoma of the median nerve: a cause of acute bilateral carpal tunnel syndrome in a three-year-old child: a case report and comprehensive literature review. Plast Surg Oakv Ont 22:201–206

    Article  Google Scholar 

  16. Leduc A, Perrot P, Truffandier MV, Bellier-Waast F, Duteille F (2014) Carpal tunnel syndrome in children. About 10 clinical cases. Ann Chir Plast Esthet 59:155–160. https://doi.org/10.1016/j.anplas.2013.12.001

    Article  CAS  PubMed  Google Scholar 

  17. Algahtani H, Watson BV, Thomson J, Al-Rabia MW (2014) Idiopathic bilateral carpal tunnel syndrome in a 9-month-old infant presenting as a pseudo-dystonia. Pediatr Neurol 51:147–150. https://doi.org/10.1016/j.pediatrneurol.2014.01.047

    Article  PubMed  Google Scholar 

  18. Michaud LJ, Hays RM, Dudgeon BJ, Kropp RJ (1990) Congenital carpal tunnel syndrome: case report of autosomal dominant inheritance and review of the literature. Arch Phys Med Rehabil 71:430–432

    CAS  PubMed  Google Scholar 

  19. Swoboda KJ, Engle EC, Scheindlin B, Anthony DC, Jones HR (1998) Mutilating hand syndrome in an infant with familial carpal tunnel syndrome. Muscle Nerve 21:104–111

    Article  CAS  PubMed  Google Scholar 

  20. Danta G (1975) Familial carpal tunnel syndrome with onset in childhood. J Neurol Neurosurg Psychiatry 38:350–355

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Deymeer F, Jones HR (1994) Pediatric median mononeuropathies: a clinical and electromyographic study. Muscle Nerve 17:755–762. https://doi.org/10.1002/mus.880170709

    Article  CAS  PubMed  Google Scholar 

  22. Gibson CT, Manske PR (1987) Carpal tunnel syndrome in the adolescent. J Hand Surg 12:279–281

    Article  CAS  Google Scholar 

  23. Batdorf NJ, Cantwell SR, Moran SL (2015) Idiopathic carpal tunnel syndrome in children and adolescents. J Hand Surg 40:773–777. https://doi.org/10.1016/j.jhsa.2015.01.026

    Article  Google Scholar 

  24. Lettin AW (1965) Carpal tunnel syndrome in childhood: report of a case. J Bone Joint Surg Br 47:556–559

    Article  CAS  PubMed  Google Scholar 

  25. Hotta T, Kanbara H, Sato S et al (1970) Case of carpal tunnel syndrome due to calcification of the flexor digitorum sublimis II in a child. Seikeigeka Orthop Surg 21:948–950

    CAS  Google Scholar 

  26. Bilge T, Yalaman O, Bilge S, Çokneşeli B, Barut Ş (1990) Entrapment neuropathy of the median nerve at the level of the ligament of Struthers. Neurosurgery 27:787–789

    Article  CAS  PubMed  Google Scholar 

  27. Mittal RL, Gupta BR (1978) Median and ulnar-nerve palsy: an unusual presentation of the supracondylar process. Report of a case. J Bone Joint Surg Am 60:557–558

    Article  CAS  PubMed  Google Scholar 

  28. Nakano KK, Lundergran C, Okihiro MM (1977) Anterior interosseous nerve syndromes. Diagnostic methods and alternative treatments. Arch Neurol 34:477–480

    Article  CAS  PubMed  Google Scholar 

  29. Fearn CB, Goodfellow JW (1965) Anterior interosseous nerve palsy. J Bone Joint Surg Br 47:91–93

    Article  CAS  PubMed  Google Scholar 

  30. Spinner M, Schreiber SN (1969) Anterior interosseous-nerve paralysis as a complication of supracondylar fractures of the humerus in children. J Bone Joint Surg Am 51:1584–1590

    Article  CAS  PubMed  Google Scholar 

  31. Hartz CR, Linscheid RL, Gramse RR, Daube JR (1981) The pronator teres syndrome: compressive neuropathy of the median nerve. J Bone Joint Surg Am 63:885–890

    Article  CAS  PubMed  Google Scholar 

  32. Ouvrier RA, Shield L (1999) Focal lesions of peripheral nerves. In: Ouvrier RA, Mcleod JG, Pollard JD (eds) Peripheral Neuropathy in childhood. MacKeith Press, London

    Google Scholar 

  33. Felice KJ, Royden Jones H (1996) Pediatric ulnar mononeuropathy: report of 21 electromyography-documented cases and review of the literature. J Child Neurol 11:116–120. https://doi.org/10.1177/088307389601100211

    Article  CAS  PubMed  Google Scholar 

  34. Boero S, Sénès FM, Catena N (2009) Pediatric cubital tunnel syndrome by anconeus epitrochlearis: a case report. J Shoulder Elb Surg 18:e21–e23. https://doi.org/10.1016/j.jse.2008.06.001

    Article  Google Scholar 

  35. Stutz CM, Calfee RP, Steffen JA, Goldfarb CA (2012) Surgical and nonsurgical treatment of cubital tunnel syndrome in pediatric and adolescent patients. J Hand Surg 37:657–662. https://doi.org/10.1016/j.jhsa.2012.01.016

    Article  Google Scholar 

  36. Torg JS, Pollack H, Sweterlitsch P (1972) The effect of competitive pitching on the shoulders and elbows of preadolescent baseball players. Pediatrics 49:267–272

    CAS  PubMed  Google Scholar 

  37. Lyman S, Fleisig GS, Waterbor JW et al (2001) Longitudinal study of elbow and shoulder pain in youth baseball pitchers. Med Sci Sports Exerc 33:1803–1810

    Article  CAS  PubMed  Google Scholar 

  38. Godshall RW, Hansen CA (1971) Traumatic ulnar neuropathy in adolescent baseball pitchers. J Bone Joint Surg Am 53:359–361

    Article  CAS  PubMed  Google Scholar 

  39. Shimizu H, Beppu M, Arai T, Kihara H, Izumiyama K (2011) Ultrasonographic findings in cubital tunnel syndrome caused by a cubitus varus deformity. Hand Surg Int J Devoted Hand Up Limb Surg Relat Res J Asia-Pac Fed Soc Surg Hand 16:233–238. https://doi.org/10.1142/S0218810411005473

    CAS  Article  Google Scholar 

  40. Abe M, Ishizu T, Shirai H, Okamoto M, Onomura T (1995) Tardy ulnar nerve palsy caused by cubitus varus deformity. J Hand Surg 20:5–9. https://doi.org/10.1016/S0363-5023(05)80047-4

    Article  CAS  Google Scholar 

  41. Ogino T, Minami A, Fukuda K (1986) Tardy ulnar nerve palsy caused by cubitus varus deformity. J Hand Surg Edinb Scotl 11:352–356

    Article  CAS  Google Scholar 

  42. Jones HR, Bolton CF, Harper CM (1996) Mononeuropathies. In: Pediatric clinical electromyography. Lippincott-Raven, Philadelphia, pp 171–250

    Google Scholar 

  43. Uchida Y, Sugioka Y (1991) Peripheral nerve palsy associated with congenital constriction band syndrome. J Hand Surg Edinb Scotl 16:109–112

    Article  CAS  Google Scholar 

  44. Gessini L, Jandolo B, Pietrangeli A, Occhipinti E (1981) Ulnar nerve entrapment at the elbow by persistent epitrochleoanconeus muscle. Case report. J Neurosurg 55:830–831. https://doi.org/10.3171/jns.1981.55.5.0830

    Article  CAS  PubMed  Google Scholar 

  45. Lauland T, Fedders O, Sogaard I, Kornun M (1984) Suprascapular nerve compression syndrome. Surg Neurol 22

  46. Montagna P, Colonna S (1993) Suprascapular neuropathy restricted to the infraspinatus muscle in volleyball players. Acta Neurol Scand 87:248–250

    Article  CAS  PubMed  Google Scholar 

  47. Jones HR (1986) Compressive neuropathy in childhood: a report of 14 cases. Muscle Nerve 9:720–723. https://doi.org/10.1002/mus.880090807

    Article  PubMed  Google Scholar 

  48. Feldman GV (1957) Radial nerve palsies in the newborn. Arch Dis Child 32:469–471

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Ross D, Jones R, Fisher J, Konkol RJ (1983) Isolated radial nerve lesion in the newborn. Neurology 33:1354–1356

    Article  CAS  PubMed  Google Scholar 

  50. Weeks PM (1982) Radial, median, and ulnar nerve dysfunction associated with a congenital constricting band of the arm. Plast Reconstr Surg 69:333–336

    Article  CAS  PubMed  Google Scholar 

  51. Manske PR (1977) Compression of the radial nerve by the triceps muscle: a case report. J Bone Joint Surg Am 59(6):835–836

    Article  CAS  PubMed  Google Scholar 

  52. Töllner U, Bechinger D, Pohlandt F (1980) Radial nerve palsy in a premature infant following long-term measurement of blood pressure. J Pediatr 96(5):921–922

    Article  PubMed  Google Scholar 

  53. Barrios C, de Pablos J (1991) Surgical management of nerve injuries of the upper extremity in children: a 15-year survey. J Pediatr Orthop 11:641–645

    Article  CAS  PubMed  Google Scholar 

  54. Ford FR (1966) Diseases of the nervous system in infancy, childhood and adolescence, 5th edn. Springfield, IL

  55. Tubbs RS, Griessenauer C, Rizk E, Shoja MM, Pehler SF, Wellons JC II, Conklin MJ (2013) Posterior interosseous nerve palsy in a child associated with recurrent dislocation of the head of the radius. J Neurosurg Pediatr 11:389–391. https://doi.org/10.3171/2013.1.PEDS12411

    Article  PubMed  Google Scholar 

  56. Cağli K, Ozçakar L, Beyazit M, Sirmali M (2006) Thoracic outlet syndrome in an adolescent with bilateral bifid ribs. Clin Anat 19:558–560. https://doi.org/10.1002/ca.20280

    Article  PubMed  Google Scholar 

  57. Chavhan GB, Batmanabane V, Muthusami P, Towbin AJ, Borschel GH (2017) MRI of thoracic outlet syndrome in children. Pediatr Radiol 47:1222–1234. https://doi.org/10.1007/s00247-017-3854-5

    Article  PubMed  Google Scholar 

  58. Yang J, Letts M (1996) Thoracic outlet syndrome in children. J Pediatr Orthop 16:514–517

    Article  CAS  PubMed  Google Scholar 

  59. Davis DB, King JC (1938) Cervical rib in early life. Am J Child 56:744–755

    Google Scholar 

  60. Rehemutula A, Zhang L, Chen L, Chen D, Gu Y (2015) Managing pediatric thoracic outlet syndrome. Ital J Pediatr 41:22. https://doi.org/10.1186/s13052-015-0128-4

    Article  PubMed  PubMed Central  Google Scholar 

  61. Nagasao T, Morotomi T, Kuriyama M, Kogure T, Kudo H, Hamamoto Y, Tamai M (2017) Thoracic outlet syndrome after the Nuss procedure for pectus excavatum: is it a rare complication? J Plast Reconstr Aesthetic Surg 70:1433–1439. https://doi.org/10.1016/j.bjps.2017.05.043

    Article  Google Scholar 

  62. Vercellio G, Baraldini V, Gatti C, Coletti M, Cipolat L (2003) Thoracic outlet syndrome in paediatrics: clinical presentation, surgical treatment, and outcome in a series of eight children. J Pediatr Surg 38:58–61. https://doi.org/10.1053/jpsu.2003.50010

    Article  CAS  PubMed  Google Scholar 

  63. Crumrine PK, Koenigsberger MR, Chutorian AM (1975) Footdrop in the neonate with neurologic and electrophysioloic data. J Pediatr 86(5):779–780

    Article  CAS  PubMed  Google Scholar 

  64. Kreusser KL, Volpe JJ (1984) Peroneal palsy produced by intravenous fluid infiltration in a newborn. Dev Med Child Neurol 26:522–524

    Article  CAS  PubMed  Google Scholar 

  65. Fischer AQ, Strasburger J (1982) Footdrop in the neonate secondary to use of footboards. J Pediatr 101:1003–1004

    Article  CAS  PubMed  Google Scholar 

  66. Jones HR, Felice KJ, Gross PT (1993) Pediatric peroneal mononeuropathy: a clinical and electromyographic study. Muscle Nerve 16:1167–1173. https://doi.org/10.1002/mus.880161105

    Article  PubMed  Google Scholar 

  67. Levin KH, Wilbourn AJ, Jones HR (1991) Childhood peroneal neuropathy from bone tumors. Pediatr Neurol 7:308–309

    Article  CAS  PubMed  Google Scholar 

  68. Ritter FJ, Seay AR, Lahey ME (1983) Peripheral mononeuropathy complicating anaphylactoid purpura. J Pediatr 103:77–78

    Article  CAS  PubMed  Google Scholar 

  69. Sheth D, Gutmann L, Blumenthal DT et al (1994) Compressive sciatic neuropathy due to uterine abnormality. Muscle Nerve 17:1486–1488. https://doi.org/10.1002/mus.880171225

    Article  CAS  PubMed  Google Scholar 

  70. Ramos-Fernández JM, Oliete-García FM, Roldán-Aparicio S, Kirchschläger E, Barrio-Nicolás A (1998) Neonatal sciatic palsy: etiology and outcome of 21 cases. Rev Neurol 26:752–755

    PubMed  Google Scholar 

  71. Deverell WF, Ferguson JH (1968) An unusual case of sciatic nerve paralysis. JAMA 205:699–700

    Article  CAS  PubMed  Google Scholar 

  72. Gille M, Delbecq J, Depré A, van den Bergh P (1995) Painful sciatic neuropathy after heroin overdose. J Neurol 242:478–480

    Article  CAS  PubMed  Google Scholar 

  73. Lester PD, McAlister WH (1970) Congenital iliac anomaly with sciatic palsy. Radiology 96:397–399. https://doi.org/10.1148/96.2.397

    Article  CAS  PubMed  Google Scholar 

  74. Venna N, Bielawski M, Spatz EM (1991) Sciatic nerve entrapment in a child. Case report. J Neurosurg 75:652–654. https://doi.org/10.3171/jns.1991.75.4.0652

    Article  CAS  PubMed  Google Scholar 

  75. Tejwani SG, Scaduto AA, Bowen RE (2006) Transient meralgia paresthetica after pediatric posterior spine fusion. J Pediatr Orthop 26:530–533. https://doi.org/10.1097/01.bpo.0000217721.95480.9e

    Article  PubMed  Google Scholar 

  76. Sanders AE, Andras LM, Choi PD, Tolo VT, Skaggs DL (2016) Lateral femoral cutaneous nerve palsy after spinal fusion for adolescent idiopathic scoliosis (AIS). Spine 41:E1164–E1167. https://doi.org/10.1097/BRS.0000000000001574

    Article  PubMed  Google Scholar 

  77. Franklin AD, Cierny GB, Luckett TR (2016) Interventional and multimodal pain rehabilitation in a child with meralgia paresthetica. J Clin Anesth 33:456–459. https://doi.org/10.1016/j.jclinane.2016.04.015

    Article  PubMed  Google Scholar 

  78. Edelson R, Stevens P (1994) Meralgia paresthetica in children. 8027128;76(7):993–9

  79. Smuts I, Potgieter D, van der Westhuizen FH (2009) Combined tarsal and carpal tunnel syndrome in mucolipidosis type III. A case study and review. Ann N Y Acad Sci 1151:77–84. https://doi.org/10.1111/j.1749-6632.2008.03451.x

    Article  CAS  PubMed  Google Scholar 

  80. Albrektsson B, Rydholm A, Rydholm U (1982) The tarsal tunnel syndrome in children. J Bone Joint Surg Br 64:215–217

    Article  CAS  PubMed  Google Scholar 

  81. Molloy AP, Lyons R, Bergin D, Kearns SR (2015) Flexor digitorum accessorius causing tarsal tunnel syndrome in a paediatric patient: a case report and review of the literature. Foot Ankle Surg Off J Eur Soc Foot Ankle Surg 21:e48–e50. https://doi.org/10.1016/j.fas.2015.01.015

    Article  CAS  Google Scholar 

  82. Edwards WG, Lincoln CR, Bassett FH, Goldner JL (1969) The tarsal tunnel syndrome. Diagnosis and treatment. JAMA 207:716–720

    Article  CAS  PubMed  Google Scholar 

  83. Sobey JH, Franklin A (2016) Ultrasound-guided tibial nerve block for definitive treatment of tarsal tunnel syndrome in a pediatric patient. Reg Anesth Pain Med 41:415–416. https://doi.org/10.1097/AAP.0000000000000384

    Article  PubMed  Google Scholar 

  84. Chance PF, Alderson MK, Leppig KA, Lensch MW, Matsunami N, Smith B, Swanson PD, Odelberg SJ, Disteche CM, Bird TD (1993) DNA deletion associated with hereditary neuropathy with liability to pressure palsies. Cell 72:143–151

    Article  CAS  PubMed  Google Scholar 

  85. Meier C, Moll C (1982) Hereditary neuropathy with liability to pressure palsies. Report of two families and review of the literature. J Neurol 228:73–95

    Article  CAS  PubMed  Google Scholar 

  86. Ichikawa K, Nezu A (2005) Hereditary neuropathy with liability to pressure palsies in childhood: report of a case and a brief review. Brain and Development 27:152–154. https://doi.org/10.1016/j.braindev.2003.12.005

    Article  PubMed  Google Scholar 

  87. Earl CJ, Fullerton PM, Wakefield GS, Schutta HS (1964) Hereditary neuropathy, with liability to pressure palsies; a clinical and electrophysiological study of four families. Q J Med 33:481–498

    CAS  PubMed  Google Scholar 

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Correspondence to Mariano Socolovsky.

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Costales, J.R., Socolovsky, M., Sánchez Lázaro, J.A. et al. Peripheral nerve injuries in the pediatric population: a review of the literature. Part II: entrapment neuropathies. Childs Nerv Syst 35, 37–45 (2019). https://doi.org/10.1007/s00381-018-3975-7

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Keywords

  • Entrapment neuropathies
  • Carpal tunnel
  • Ulnar nerve compression
  • Pediatric population