Ulnar neuropathy after tube thoracostomy for pneumothorax

Chest tube placement is a frequently required surgical procedure among patients in the emergency department. Although the procedure is often simple, occasionally there are known complications, including unresolved pneumothorax or hemopneumothorax, extrathoracic placement of the tube, and damage to the intercostal neurovascular bundle.

We report an unusual yet noteworthy complication of ulnar neuropathy after chest tube placement for pneumothorax. Awareness of the association between acute ulnar neuropathy and chest tube placement will alert the physician to reposition the tube and prevent ongoing compression.

A 43-year-old man developed right-sided rib fractures (6-9 and 12) and a pneumothorax from blunt trauma to the right chest wall. Upon insertion of a 36 French chest tube, the patient reported immediate ulnar nerve distribution paresthesias of the ipsilateral arm. The tube was subsequently repositioned with improvement of symptoms. He was later discharged with occupational therapy outpatient follow-up.

Ulnar neuropathy is a rare, though significant, complication associated with tube thoracostomy. Management of persistent symptoms is expectant, with early upper extremity range of motion and strength exercise.