Multiple peripheral nerve entrapment in Forestier's disease (diffuse idiopathic skeletal hyperostosis)

Area of Science:

• Orthopedics
• Neurology
• Rheumatology

Background:

• Diffuse idiopathic skeletal hyperostosis (DISH) is a common skeletal disorder characterized by extraskeletal ossification.
• Nerve entrapment syndromes are frequently encountered in clinical practice, often associated with anatomical variations or external compression.

Observation:

• A patient presented with clinical and radiological features typical of diffuse idiopathic skeletal hyperostosis.
• Characteristic new bone formation was noted around the elbows, consistent with DISH.

Findings:

• The patient exhibited bilateral ulnar nerve entrapment at the elbows, directly attributable to the bony proliferation associated with DISH.
• Median nerve compression was also identified at the wrist, suggesting a potential multifocal nerve involvement in this patient.

Implications:

• This case underscores the potential for diffuse idiopathic skeletal hyperostosis to cause significant peripheral nerve entrapment.
• Clinicians should consider DISH as a potential underlying etiology in patients presenting with ulnar or median nerve compression, particularly those with characteristic spinal or extraskeletal ossification.