Ulnar Nerve Stretch Injury Post Cervical Epidural Steroid Injection: A Case Report

For successful outcomes, interventional pain management procedures commonly require the patient to be prone under fluoroscopy. Nerve injuries can occur from stretching, compression, or direct nerve insult.

In this case report, we describe a patient receiving a cervical epidural steroid injection while prone over a 17-minute period. He immediately postoperatively reported one-sided severe hand pain and spasm in his lateral fingers. He initially reported cervical radicular pain on the contralateral side, which the patient said felt better immediately after being injected with a mixture of lidocaine, ropivacaine, and dexamethasone into the C5-C6 epidural space. He was sent to the emergency department to rule out a hematoma or any other new pathology; his cervical magnetic resonance image was identical to his baseline preprocedure magnetic resonance image. A variety of medications were administered, including a methylprednisolone dose pack, hydrocodone, gabapentin, and methocarbamol. He was seen in the clinic the following week. At that time he reported ongoing hand pain; an electromyography test was consistent with his physical examination, which showed ulnar dermatome pain and weakness. All symptoms resolved within 2 weeks, and all sensation and motor strength returned to baseline.

Brachial plexus injury can occur when a patient is prone. In order to minimize nerve injury, care should be taken when positioning patients about to receive an interventional pain management procedure..