Median nerve neuropathy resulting from blind removal attempts of etonogestrel contraceptive implant: A case report

Abstract

Abstract Nexplanon is an etonogestrel contraceptive implant that comes with an applicator, making it easier to insert and remove. Complications related to insertion and removal procedures, such as neural-vascular injuries, are rare. We describe a case of median nerve neuropathy resulting from blind removal attempts of an iatrogenically migrated implant. The patient presented with an unusual pain and an abnormal sensation in her left arm that worsened after blind attempts to remove the implant. Radiographs revealed that the rod was 3 cm from her insertion scar and deeply embedded in her left arm. The patient then underwent left arm exploration and implant removal under fluoroscopic guidance by an orthopedic surgeon. The rod was placed adjacent to the median nerve under the basilic vein. The symptoms gradually resolved after surgery. This indicates that patients with impalpable contraceptive implants should be referred for implant removal by specialists familiar with the procedure to prevent further deterioration of adjacent structures from iatrogenic implant migration.