A woman in her fifties with a lump in the palm of her hand. / En kvinne i 50-årene med kul i håndflaten.

A previously healthy woman in her fifties contacted her general practitioner due to a troublesome lump on her hand that had progressed over the course of a year. The final diagnosis surprised those involved and serves as a reminder to both general practitioners and specialists.

Major nerve injury in association with use of contraceptive implants. / Alvorlige nerveskader ved bruk av p-stav.

BACKGROUND: Subcutaneous contraceptive implants are recommended to be placed in the medial upper arm. Here, the implant lies close to important neurovascular structures. CASE PRESENTATION: We have treated two women with ulnar nerve injuries after removal of such implants. Patient 1 sustained a near complete nerve injury. Despite nerve grafting and a distal nerve transfer, she had a poor outcome. Patient 2 had a partial injury and has made a reasonable recovery after neurolysis of the ulnar nerve that was entrapped in scar tissue. INTERPRETATION: Prognosis after peripheral nerve injuries in the upper arm in adults is poor, and as such these injuries are particularly serious. Any patient with an implant that is not readily palpable in the subcutaneous tissue should be referred to a hand surgeon who has training in exploring peripheral nerves. If emergent nerve injury is suspected, referral to a department of hand surgery is vital.

Supercharging of the ulnar nerve: clinical and neurophysiological assessment at 2 years for nine proximal injuries.

LEVEL OF EVIDENCE: II.