Submitted by: Rebecca O'Bryan, MD
Edited by: Shan Chen, MD
Gallone G, MD; Di Gennaro G, MD; Farr S, MD. Peripheral nerve compression syndromes in children
. Journal of Hand Surgery
. 2020; 45(9):857-863.
Non-traumatic neuropathies of the upper limb are rare in children. Therefore, high quality evidence-based diagnostic guidelines are lacking.
Carpal tunnel syndrome (CTS) can be seen in children with lysosomal storage diseases. Interestingly, ultrasound was found to be more sensitive than a nerve conduction study (NCS) for diagnosis. However, NCS was preferred for follow-up post-operatively. CTS in children can also be associated with hereditary neuropathy with liability to pressure palsies (HNPP). In a small study of 12 children with PMP22 mutation/HNPP, all showed electrophysiological evidence of nerve entrapment, and 7 had bilateral limb involvement. HNPP should be strongly suspected in children with bilateral CTS. Idiopathic CTS in children has been associated with playing musical instruments, sports, obesity, and abnormal anatomy.
Cubital tunnel syndrome or ulnar neuropathy at the elbow (UNE) in children is rare, and is associated with sports participation, wheelchair/surgical/sleep positioning, and cubitus varus deformity, as well as HNPP. Children who present with clinical UNE often fail conservative management, and need surgical intervention. Outcomes were better in children with non-traumatic presentation. Congenital constriction band syndrome usually arise in utero, and require very prompt surgical intervention including excision of the affected nerve.
Radial neuropathies in children are often associated with labor and delivery. Patients tend to recover well without surgical intervention; however, surgical intervention is needed when compression is evident.
This review described the rare yet interesting manifestations of non-traumatic compressive syndromes in children. Lack of normative data of NCS in pediatric population makes the diagnosis quite challenging. Other non-EDX modalities can also help aid in the diagnosis such as ultrasound or other imaging studies. NCS remains the key for the diagnosis.