gms | German Medical Science

Objectives/Interrogation: There are very atypical cases in the upper limb pathology and the neurological pathology in particular, can have polymorphous manifestations. This was also the case of a healthy young man without any medical history that presented with choreoathetosis of the right upper limb, which started a few hours after an injury of the ipsilateral elbow. Despite the advanced investigations, the patient could not benefit from a diagnosis or effective treatment for four months. Our aim was to find similar cases in the literature and any possible physiopathological mechanism for this situation.

Methods: We present the diagnostic route before, during and after the admission to our hospital, of a healthy young man without any medical history that presented with persistent choreiform movements of the right upper limb, which started after an injury of the elbow. We also studied the available literature, in order to identify the mechanisms that could trigger this situation.

About six hours after two consecutive injuries of the right elbow, the patient started to have intense pain and fixed extension of the right forearm that developed, during the next days, into pain and paresthesia of the whole upper limb, the inability to control the limb, progressive choreiform movements and temporary paralysis. The etiology of the disorder was unclear and in spite of the several inconclusive investigations, multidisciplinary approach, aggressive neuroleptic treatment, the patient remained undiagnosed and without any effective treatment. Eventually, exploratory elbow surgery was decided, where we found a small intramuscular haematoma that was compressing the ulnary nerve right at its entrance in the cubital tunnel. We performed external neurolysis of the ulnary nerve and all the symptoms subsided immediately.

In our literature review we found no similar case and very few reports of localized choreiform movements of one single limb.

Results and Conclusions: As a result of the decompression surgery performed, the patient is now free of symptoms.

The reports that we found in the literature regarding choreiform movements localized in one extremity were scarce and resumed in situations like autoimmune diseases, paraneoplastic syndrome, stroke or injury of the brachial plexus. It is unclear to us how the choreiform movements were triggered by a peripheral nerve compression and together with the lack of data available on this topic we were encouraged to draw the attention to this case.