Anesth Pain Med.  2017 Apr;12(2):103-110. 10.17085/apm.2017.12.2.103.

Upper limb nerve injuries caused by intramuscular injection or routine venipuncture

• Kim HJ
• Park SK
• Park SH

• KMID: 2379728
• DOI: http://doi.org/10.17085/apm.2017.12.2.103

Abstract

The reported cases of upper limb nerve injury followed by needle procedure such as intramuscular injection or routine venipuncture are rare. However, it should not be overlooked, because neurological injury may cause not only minor transient pain but also severe sensory disturbance, hand deformity and motor dysfunction with poor recovery. Recognizing competent level of anatomy and adept skill of needle placement are crucial in order to prevent this complication. If a patient notices any experience of abnormal pain or paresthesia during the needle procedures, an administrator should be alert to the possibility of nerve injury and should withdraw the needle immediately. Careful monitoring of the injection site for hours is required for early detection of nerve injury.

Keyword

Intramuscular injections; Median neuropathy; Peripheral catheterization; Peripheral nerve injuries; Radial neuropathy; Ulnar neuropathies

MeSH Terms

Administrative Personnel
Catheterization, Peripheral
Hand Deformities
Humans
Injections, Intramuscular*
Median Neuropathy
Needles
Paresthesia
Peripheral Nerve Injuries
Phlebotomy*
Radial Neuropathy
Ulnar Neuropathies
Upper Extremity*

Figure

• 

  Fig. 1 The deltoid muscle and surrounding structures. It is important to raise the awareness of at-risk structures from a deltoid intramuscular injection (axillary nerve, subdeltoid bursa and circumflex humeral arteries).

• 

  Fig. 2 The site for deltoid intramuscular injection. The recommended intramuscular injection site is approximately 3–5 cm below the lower edge of the acromion on midway between acromion and deltoid tuberosity.

• 

  Fig. 3 The course of radial nerve. The intramuscular injection should be given into the deltoid muscle due to the superficiality of the radial nerve in the mid-third of the arm. The superficial branch of the radial nerve enters subcutaneous plan in the posterior aspect of the distal forearm closely to the cephalic vein, so the nerve is vulnerable to injury during venipuncture around the wrist.

• 

  Fig. 4 Veins and cutaneous nerves in the antecubital fossa. Median cubital vein near the cephalic vein is the first choice for a routine venipuncture to cause nerve damage least likely.

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