Pediatric median mononeuropathies: a clinical and electromyographic study
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Published on: September 25, 2015
Insights
Pediatric median mononeuropathies (PMM) in children present differently than in adults. Causes and locations of PMM in children vary, with a significant portion being proximal and often linked to trauma.
Area of Science:
- Neurology
- Pediatric Neurology
- Electromyography
Background:
- Pediatric median mononeuropathies (PMM) are uncommon in children.
- Understanding PMM in pediatric populations is crucial for accurate diagnosis and management.
- Previous studies have primarily focused on adult median neuropathies, leaving a gap in pediatric-specific data.
Purpose of the Study:
- To characterize the clinical presentation, localization, and etiology of pediatric median mononeuropathies.
- To compare the findings in children with those observed in adult median neuropathies.
Main Methods:
- Retrospective review of 1809 electromyography (EMG) studies performed between 1979 and 1993.
- Identification of pediatric patients (aged 5-17 years) diagnosed with PMM.
- Analysis of PMM localization (proximal vs. distal) and underlying causes.
Main Results:
- Seventeen children were diagnosed with PMM, with 59% presenting as proximal neuropathies.
- Common causes included trauma (8 cases), idiopathic carpal tunnel syndrome (3 cases), and systemic conditions like mucolipidosis III and scleroderma.
- Five children had bilateral PMM, often associated with carpal tunnel syndrome or specific systemic illnesses.
- The etiological profile and localization of PMM in children differed significantly from adult cases.
Conclusions:
- Pediatric median mononeuropathies exhibit distinct characteristics compared to adult presentations.
- Trauma is a significant cause of proximal PMM in children.
- Systemic conditions and idiopathic carpal tunnel syndrome are important considerations in pediatric PMM evaluation.
Abstract:
Seventeen children, 6 girls and 11 boys, aged 5-17 years with pediatric median mononeuropathies (PMM) were identified among 1809 who had EMGs primarily in the electromyographic laboratory at The Children's Hospital, Boston, between 1979 and 1993. Electromyography documented the PMM to be at the wrist in 7 children, including 3 children with idiopathic carpal tunnel syndrome (CTS)--1 whose symptoms were accentuated by skiing--2 with a systemic illness (mucolipidosis III and scleroderma), and in 1 child each the distal PMM was secondary to a cast or laceration. A proximal PMM was identified in 10 children, including 8 with trauma, 1 with an osteoid osteoma, and 1 with juvenile cutaneous mucinosis. Five children (3 with CTS and 1 each with mucolipidosis III and juvenile cutaneous mucinosis) had bilateral disease. The localization (59% proximal) and cause of these PMMs differed greatly from our experience with adult median neuropathies.
