COVID-19 Peripheral Neuropathy: A Report of Three Cases

Abstract

This study includes three patients with various peripheral neuropathies after contracting coronavirus disease 2019 (COVID-19) infection, treated both conservatively and surgically. While cases of neurological complications have been described, neuropathy associated with COVID-19 is under-reported in orthopaedic literature. These patients presented with ulnar neuropathy, critical care polyneuropathy (CCP) with anterior interosseous nerve (AIN) neuropathy, and lateral femoral cutaneous nerve (LFCN) neuropathy. COVID-19 infection may be associated with peripheral neuropathy in addition to various neurological sequelae. Orthopaedic surgeons should screen patients for recent infections and evaluate the severity of the illness to assess for risk of neurological sequelae of COVID-19 infection.

Keywords: ain neuropathy; anterior interosseous nerve neuropathy; covid-19; critical care polyneuropathy; lateral femoral cutaneous nerve; lfcn neuropathy; meralgia paresthetica; peripheral neuropathy; ulnar neuropathy.

Figure 1. Sensory NCS revealed absent ulnar nerve response

NCS: nerve conduction study

Figure 2. Motor NCS revealed significant slowing of the left ulnar nerve across the elbow when recorded from the abductor digiti minimi and first dorsal interosseous nerve

NCS: nerve conduction study; APB: abductor pollicis brevis; ADM: abductor digiti minimi; FDI: first dorsal interosseous

Figure 3. Axial (A) and Sagittal (B) MRI of the left elbow reveals thickening and increased signal intensity of the ulnar nerve proximally and at the level of the cubital tunnel, consistent with ulnar neuritis/cubital tunnel syndrome.