Etonogestrel implants - case studies of median nerve injury following removal

The etonogestrel implant has been available in Australia since 2001. General practitioners routinely insert and remove these implants in their rooms under local anaesthetic. We report two cases of significant median nerve injury following inappropriate dissection of the arm to remove this device when impalpable. These cases illustrate the need to follow the product guidelines and to refer impalpable or deeply placed implants for imaging and subsequent removal under ultrasound guidance or by a qualified surgeon.