Abstract Details

Title Compression of Lateral Antebrachial Cutaneous Nerve (LACN) in Waitresses

Topic Peripheral Nerve

Presentation(s) P01 - (-)

Poster/Presentation
Number 128

Objective

Background BACKGROUND: LACN is a branch of Musculocutaneous nerve which provides sensory innervations to lateral forearm. Common causes of LACN involvement include venipuncture, elbow surgery and direct trauma.

Design/Methods DESIGN/METHODS: We encountered six cases of LACN neuropathy where three cases were noted in slim waitresses carrying heavy service trays. History, physical examination and forearm electrophysiologic studies (EPS) were performed at initial and follow up visit. Antidromic stimulation of the LACN was undertaken by Spindler and Felsenthal's technique. Latency, Amplitude and Conduction velocity were measured and compared with contralateral limb.

Results RESULTS: All patients were female waitresses from age 35 to 42 years who presented with painful paresthesias in the distal lateral forearm for three to six months which was worse during working hours. Tinel's sign at lateral cubital fossa was positive in all patients. EPS confirmed delayed latency (3.2, 2.9, 3 ms), low amplitude (8, 10, 6 [micro]v) and slow conduction velocity (40, 42, 40 m/s) of LACN on symptomatic side compared to contralateral side. All patients revealed electrophysiological abnormalities consistent with LACN compression likely due to direct pressure on nerve by heavy trays by slim waitresses and considered as occupational hazard. Treatment included Nortriptyline or Gabapentin and discontinuation of carriage of heavy trays. Clinical and EPS findings improved significantly over 6 months. One case did not follow up.

Conclusions CONCLUSIONS: We described three cases of LACN compression from sharp edges of heavy trays with typical symptoms and abnormal electrophysiological studies and improvement with avoiding persistent direct compression and analgesics. We propose the lack of adequate fatty tissue in antecubital fossa probably contributed to compression of LACN. None of our patient required surgical treatment.

Authors/Disclosures
Chilvana V. Patel, MBBS, FAAN PRESENTER	Dr. Patel has nothing to disclose.
S M. Vishnubhakat, MD (North Shore Uni. Hospital)	No disclosure on file
Sean D. Ruland, MD (Loyola University Medical Center)	Dr. Ruland has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Up to Date. Dr. Ruland has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Law Firms.

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