Clinical Scorecard: Ultrasound-Assisted Extraction of a Non-Palpable Etonogestrel Implant Adhering to the Ulnar Nerve: A Case Study

At a Glance

Key Highlights

• Etonogestrel implants can migrate and become non-palpable, complicating removal.
• Fluoroscopy guidance was successfully used after unsuccessful ultrasound attempts.
• The implant was located adjacent to the ulnar nerve, posing a risk for nerve injury.
• Patient reported resolution of transient tingling sensation post-procedure.
• Accurate localization and specialist referral are critical for safe removal.
• Imaging techniques are essential for localization of non-palpable implants.

Guideline-Based Recommendations

Diagnosis

• Use imaging techniques for localization of non-palpable implants, such as ultrasound or fluoroscopy.

Management

• Consider fluoroscopy guidance for removal of deeply placed or migrated implants.

Monitoring & Follow-up

• Continuous neurological monitoring during surgical procedures near critical structures.

Risks

• Potential for neuropathy, vascular injury, and other complications from migration.

Patient & Prescribing Data

Women with a history of etonogestrel implant placement and complications.

Fluoroscopy-guided removal is effective when conventional methods fail.

Clinical Best Practices

• Avoid epinephrine in local anesthesia to prevent ischemia near neurovascular structures, as it can constrict blood vessels and reduce blood flow.
• Utilize hydrodissection cautiously to protect adjacent nerves during dissection.
• Employ intermittent fluoroscopy to minimize radiation exposure during procedures.

Related Resources & Content

• Case Study