American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2019, 7(3), 36-40
DOI: 10.12691/ajmcr-7-3-2
Open AccessCase Report

Desmoid Fibromatosis in the Brachial Plexus Mimicking an Ulnar Nerve Entrapment

Emelie Styring1, , Marie Ahlström2, Pehr Rissler3, Fredrik Mertens4, Kasim Abul-Kasim5 and Lars B. Dahlin6, 7

1Lund University, Skane University Hospital, Department of Orthopedics, 221 85 Lund, Sweden

2Lund University, Skane University Hospital, Department of Hematology, Oncology and Radiophysics, 221 85 Lund, Sweden

3Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pathology, 221 85 Lund, Sweden

4Lund University, Skane University Hospital, Division of clinical genetics, 221 85 Lund, Sweden

5Department of Radiology, Division of Neuroradiology, Lund University and Skane University hospital, 205 01 Malmö, Sweden

6Department of Translational Medicine – Hand Surgery, Lund University, 205 01 Malmö, Sweden

7Department of Hand Surgery, Skane university Hospital, 205 01 Malmö, Sweden

Pub. Date: March 14, 2019

Cite this paper:
Emelie Styring, Marie Ahlström, Pehr Rissler, Fredrik Mertens, Kasim Abul-Kasim and Lars B. Dahlin. Desmoid Fibromatosis in the Brachial Plexus Mimicking an Ulnar Nerve Entrapment. American Journal of Medical Case Reports. 2019; 7(3):36-40. doi: 10.12691/ajmcr-7-3-2

Abstract

Introduction: Ulnar nerve entrapment is a common cause of sensory disturbance and weakness in the upper extremity, especially in patients with diabetes mellitus. However, if the symptoms are atypical and the patient has severe pain other differential diagnoses should be considered. Case report: A 37-year-old man with type 1 diabetes mellitus was referred to the hand surgery unit due to increasing pain, numbness and weakness in his right arm developing over more than one year. An ulnar nerve neurography was inconclusive and the patient had a frozen shoulder on the right side. Due to the pain, the patient required high doses of opioids. At examination, the clinical presentation did not correspond to an ulnar nerve entrapment why other causes were considered. A chest X-ray revealed a lesion in the apical part of the right lung. Consequtive CT scan, MRI and fine and core needle biopsies led to the diagnosis of a desmoid tumor. Surgery was deemed to be too mutilating and treatment was initiated with doxorubicin. Due to tumor and symptom progression the therapy was changed to PegIntron, then antiestrogen and NSAID and finally tyrosine kinase inhibitor (sorafenib) resulting in tumor shrinkage. Conclusion: Although nerve entrapment is a common cause of discomfort and impaired function in the upper extremities different etiologies, including various tumors, have to be considered when the symptoms are atypical and if the patient has severe pain. For these patients, the diagnostic work-up has to be broadened.

Keywords:
ulnar entrapment desmoid radiating pain paresthesia

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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