Double crushing weakness of the right hand: A case report with coexistence melorheostosis and cerebral palsy

Herein, we reported a case of right median nerve injury due to concurrent melorheostosis in an 11-year-old male patient followed for right hemiplegic cerebral palsy (CP). The patient was diagnosed with CP at 17 months of age due to weakness on the right side. During follow-up, melorheostosis, a bone dysplasia, was detected on radiographs taken due to the progressive contractures in the right hand. When the patient was four years old, electromyography was performed due to complaints of progressive weakness and pain in the right hand, and total axonal damage was detected in the median nerve. The patient's follow-ups were interrupted due to the coronavirus disease 2019 (COVID-19) pandemic. Although the pain decreased with splint and exercise treatments, functional progress could not be achieved. The patient was referred to hand surgery. However, the patient, who was not considered for surgery, continued to be managed with splint and exercise. Diagnosis of nerve injury due to melorheostosis can be difficult in an extremity affected by CP, as the motor deficits associated with CP can mask or complicate the recognition of additional nerve damage. Electrodiagnostic and ultrasonographic evaluations may be required in addition to physical examination. In cases of CP where new symptoms and motor skill loss develop, close monitoring and appropriate differential diagnosis are important.