Upper Extremity Compressive Neuropathies in the Pediatric and Adolescent Populations

Abstract

Purpose of review: Although somewhat rare, upper extremity compressive neuropathies can occur in the pediatric and adolescent populations due to various etiologies. Some of the most common conditions seen include thoracic outlet syndrome, supracondylar process syndrome, cubital tunnel syndrome with subluxation of the ulnar nerve, and carpal tunnel syndrome. This review will focus on these diagnoses and how to address them in the pediatric and adolescent populations.

Recent findings: Due to the rarity of upper extremity compressive neuropathies in the pediatric and adolescent populations, substantial advancement in the literature does not routinely occur. However, recent literature has found a difference in the rate of various subtypes of thoracic outlet syndrome in children versus adults. Additionally, cubital tunnel syndrome associated with ulnar nerve subluxation/instability has recently been found to have better outcomes following surgical decompression of the ulnar nerve and transposition than those with stable ulnar nerves. In summary, this review provides the most recent knowledge surrounding upper extremity compressive and entrapment neuropathies in the pediatric and adolescent populations.

Keywords: Carpal tunnel syndrome; Cubital tunnel syndrome; Lipofibromatous hamartoma; Mucopolysaccharidoses; Supracondylar process; Thoracic outlet syndrome.

Fig. 1

14-year-old female with pain and right thoracic outlet syndrome attributed to cervical rib. (Courtesy of Shriners Hospital for Children, Philadelphia). a. Decreased right arm abduction secondary to pain. b. X-ray demonstrates cervical rib with intervening synchondrosis. c. CT scan better delineates cervical rib and synchondrosis. d. Supraclavicular approach with brachial plexus tented over cervical rib. e. Exposure and resection of cervical rib. f. Resected cervical rib and synchondrosis. g. Resolution of pain and full shoulder motion

Fig. 2

Ulnar nerve subluxation. a. Note the nerve is posterior to the medial epicondyle lying in the groove when the elbow is somewhat extended. b. Note the nerve has subluxated to lie anterior to the medial epicondyle upon flexion of the elbow. (Courtesy of Joshua M. Abzug, MD)

Fig. 3

14-year-old female with complaints of numbness and tingling in the ulnar nerve distribution. a. Intraoperative photograph of an anconeus epitrochlearis muscle compressing the ulnar nerve. b. Resection of the anconeus epitrochlearis. (Courtesy of Joshua M. Abzug, MD)

Fig. 4

Lipofibromatous hamartoma of the median nerve. (Courtesy of Shriners Hospital for Children, Philadelphia)

Fig. 5

Lipofibromatous hamartoma of the median nerve associated with macrodactyly. (Courtesy of Shriners Hospital for Children, Philadelphia)