title: Dual pathology proximal median nerve compression of the forearm.
abstract: We report an unusual case of synchronous pathology in the forearm- the coexistence of a large lipoma of the median nerve together with an osteochondroma of the proximal ulna, giving rise to a dual proximal median nerve compression. Proximal median nerve compression neuropathies in the forearm are uncommon compared to the prevalence of distal compression neuropathies (eg Carpal Tunnel Syndrome). Both neural fibrolipomas (Refs. 1,2) and osteochondromas of the proximal ulna (Ref. 3) in isolation are rare but well documented. Unlike that of a distal compression, a proximal compression of the median nerve will often have a definite cause. Neural fibrolipoma, also called fibrolipomatous hamartoma are rare, slow-growing, benign tumours of peripheral nerves, most often occurring in the median nerve of younger patients. To our knowledge, this is the first report of such dual pathology in the same forearm, giving rise to a severe proximal compression of the median nerve. In this case, the nerve was being pushed anteriorly by the osteochondroma, and was being compressed from within by the intraneural lipoma. This unusual case highlights the advantage of preoperative imaging as part of the workup of proximal median nerve compression.
authors.affiliation: Department of Plastic Reconstructive and Hand Surgery, Cork University Hospital, Wilton Road, Cork, Ireland. Electronic address: siunmurphy@gmail.com.
authors.forename: Siun M
authors.initials: SM
authors.lastname: Murphy
authors.forename: Katherine
authors.initials: K
authors.lastname: Browne
authors.forename: David J
authors.initials: DJ
authors.lastname: Tuite
authors.forename: Michael
authors.initials: M
authors.lastname: O'Shaughnessy
mesh_terms: D001859:Bone Neoplasms / Q000150:complications* / Q000601:surgery; D019299:Decompression, Surgical; D005260:Female; D005542:Forearm / Q000294:innervation*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008475:Median Nerve; D020423:Median Neuropathy / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000209:etiology* / Q000601:surgery; D019635:Neurosurgical Procedures; D015831:Osteochondroma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D010524:Peripheral Nervous System Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014457:Ulna / Q000000981:diagnostic imaging
keywords: Lipoma; Median nerve; Osteochondroma; Proximal compression