Reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of etonogestrel contraceptive implant: a case report
Abstract Nexplanon is an etonogestrel contraceptive implant that comes with an applicator, making it easier to insert and remove. Complications related to insertion and removal procedures, such as neural-vascular injuries, are rare. We describe a case of reversible median nerve neuropathy and local...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | Contraception and Reproductive Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40834-023-00257-5 |
| _version_ | 1797413730053521408 |
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| author | Siraphat Fungtammasan Natchanika Sinthuchai Kawee Pataradool Unnop Jaisamrarn Somsook Santibenchakul |
| author_facet | Siraphat Fungtammasan Natchanika Sinthuchai Kawee Pataradool Unnop Jaisamrarn Somsook Santibenchakul |
| author_sort | Siraphat Fungtammasan |
| collection | DOAJ |
| description | Abstract Nexplanon is an etonogestrel contraceptive implant that comes with an applicator, making it easier to insert and remove. Complications related to insertion and removal procedures, such as neural-vascular injuries, are rare. We describe a case of reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of an iatrogenically migrated implant. The patient presented with an unusual pain at the surgical site along with abnormal sensations and numbness in her left hand that worsened after blind attempts to remove the implant. Radiographs revealed that the rod was 3 cm from her insertion scar and deeply embedded in her left arm. The patient then underwent left arm exploration and implant removal under fluoroscopic guidance by an orthopedic surgeon. The rod was placed intramuscularly, adjacent to the median nerve under the basilic vein. The abnormal sensations and numbness in her left hand could be attributed to median nerve involvement, while the atypical pain at the surgical site could be a result of local irritation from the intramuscularly migrated implant from attempts at removal. The symptoms gradually resolved after surgery. This indicates that patients with impalpable contraceptive implants should be referred for implant removal by specialists familiar with the procedure to prevent further deterioration of adjacent structures from iatrogenic implant migration. |
| first_indexed | 2024-03-09T05:22:33Z |
| format | Article |
| id | doaj.art-c86ebcda0c244d0fb4fa88ae0c3fa3ca |
| institution | Directory Open Access Journal |
| issn | 2055-7426 |
| language | English |
| last_indexed | 2024-03-09T05:22:33Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Contraception and Reproductive Medicine |
| spelling | doaj.art-c86ebcda0c244d0fb4fa88ae0c3fa3ca2023-12-03T12:39:35ZengBMCContraception and Reproductive Medicine2055-74262023-12-01811510.1186/s40834-023-00257-5Reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of etonogestrel contraceptive implant: a case reportSiraphat Fungtammasan0Natchanika Sinthuchai1Kawee Pataradool2Unnop Jaisamrarn3Somsook Santibenchakul4Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn UniversityDepartment of Epidemiology, Harvard T.H. Chan School of Public HealthDepartment of Orthopedics, Faculty of Medicine, Chulalongkorn UniversityDepartment of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn UniversityDepartment of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn UniversityAbstract Nexplanon is an etonogestrel contraceptive implant that comes with an applicator, making it easier to insert and remove. Complications related to insertion and removal procedures, such as neural-vascular injuries, are rare. We describe a case of reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of an iatrogenically migrated implant. The patient presented with an unusual pain at the surgical site along with abnormal sensations and numbness in her left hand that worsened after blind attempts to remove the implant. Radiographs revealed that the rod was 3 cm from her insertion scar and deeply embedded in her left arm. The patient then underwent left arm exploration and implant removal under fluoroscopic guidance by an orthopedic surgeon. The rod was placed intramuscularly, adjacent to the median nerve under the basilic vein. The abnormal sensations and numbness in her left hand could be attributed to median nerve involvement, while the atypical pain at the surgical site could be a result of local irritation from the intramuscularly migrated implant from attempts at removal. The symptoms gradually resolved after surgery. This indicates that patients with impalpable contraceptive implants should be referred for implant removal by specialists familiar with the procedure to prevent further deterioration of adjacent structures from iatrogenic implant migration.https://doi.org/10.1186/s40834-023-00257-5Etonogestrel contraceptive implantDeep insertionMedian nerve neuropathyDifficult removalCase report |
| spellingShingle | Siraphat Fungtammasan Natchanika Sinthuchai Kawee Pataradool Unnop Jaisamrarn Somsook Santibenchakul Reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of etonogestrel contraceptive implant: a case report Contraception and Reproductive Medicine Etonogestrel contraceptive implant Deep insertion Median nerve neuropathy Difficult removal Case report |
| title | Reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of etonogestrel contraceptive implant: a case report |
| title_full | Reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of etonogestrel contraceptive implant: a case report |
| title_fullStr | Reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of etonogestrel contraceptive implant: a case report |
| title_full_unstemmed | Reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of etonogestrel contraceptive implant: a case report |
| title_short | Reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of etonogestrel contraceptive implant: a case report |
| title_sort | reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of etonogestrel contraceptive implant a case report |
| topic | Etonogestrel contraceptive implant Deep insertion Median nerve neuropathy Difficult removal Case report |
| url | https://doi.org/10.1186/s40834-023-00257-5 |
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