High-resolution ultrasound as an aid in the diagnosis and treatment of post-brachioplasty injury to the medial brachial and the medial antebrachial nerves – Two case reports()

INTRODUCTION: Injury to the medial brachial and the medial antebrachial nerves may occur after brachioplasty and may lead to severe pain. We report on two cases to demonstrate that high-resolution ultrasound may be used as an aid in the diagnosis and treatment of post-brachioplasty injury to these small cutaneous nerves. CASE REPORTS: We report on two cases. The first case was a 29-year old female with severe arm pain secondary to a neuroma of the right medial brachial nerve. The diagnosis of a neuroma was done using high-resolution ultrasound and proximal nerve block led to immediate complete relief of pain. Recurrent but milder pain occurred and this was treated with multiple nerve blocks. The second case was a 34-year-old female with severe arm/forearm pain secondary to entrapment of the left medial antebrachial cutaneous nerve by a suture in the middle arm. The diagnosis was reached using high-resolution ultrasound and proximal nerve block led to immediate complete relieve of pain. Recurrent but milder pain occurred and this was treated by surgical nerve decompression. DISCUSSION: Previous literature confirms that high-resolution ultrasound can accurately identify small sensory nerves of the arm and forearm. CONCLUSION: We demonstrate that high resolution ultrasound may be used as an aid in the diagnosis and treatment of post-brachioplasty injury to the medial brachial and the medial antebrachial nerves. Proximal nerve block is extremely effective to relief the severe pain in these patients. However, recurrence of pain is expected and further management may be done by a trial of repeated injections or by surgical exploration.