Disclosures: Gary B. Allen: No financial relationships or conflicts of interest

Case Diagnosis: Ulnar Mononeuropathy following COVID-19 infection.

Case Description or Program Description: A 44-year-old male with history of morbid obesity presented with coronavirus disease 2019 (COVID-19) infection resulting in a prolonged hospitalization of 37 days. While admitted he was largely proned, however never required intubation. While hospitalized, he developed numbness, tingling, and weakness in digits 4-5 of his left hand exacerbated by pressure on the elbow. No symptoms were present in the contralateral arm.

Setting: Academic Acute Care Hospital

Assessment/Results: Magnetic resonance imaging of the brain and cervical spine were unremarkable. Physical examination of digits 4-5 in the left hand revealed reduced sensation to light touch, an inability to fully extend the digits, and 4/5 strength with abduction. Electrodiagnostic testing demonstrated absent left ulnar sensory nerve action potential when recorded from the left 5th digit and reduced motor conduction velocity across the elbow (39m/s) compared to the below-elbow segment (53m/s) when recorded from the left ulnar abductor digiti minimi, consistent with conduction block. He declined needle electromyography due to potential pain. His hemoglobin A1c was 7.3%.

Discussion (relevance): Peripheral nerve injuries (PNIs) may occur in up to 14.5% of patients with COVID-19 who undergo prone positioning, and the ulnar nerve is the most frequently affected. We present a case of ulnar mononeuropathy during COVID-19 hospitalization. Etiology is likely multifactorial, with prone positioning, similar risk factors, or direct pathogenicity contributing. Compressive injuries of the ulnar nerve have been associated with improper prone positioning. Additionally, PNI shares risk factors with severe COVID-19, namely obesity and diabetes in this patient. The hyperinflammatory state associated with COVID-19 also increases the risk of PNI. Lastly, COVID-19 invades cells by binding angiotensinogen converting enzyme-2 receptors, which are present in the nervous system.

Conclusions: COVID-19 infection may be associated with an increased risk of peripheral nerve injuries through a multifactorial mechanism. Further research is needed to establish the association.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ulnar-neuropathy-during-covid-19-infection-a-case-report/