Wallis and colleagues did not find any cases of nerve injury relating to contraceptive implant insertion/removal in the New Zealand claims dataset. However, such injuries were first reported more than 20 years ago with the 6-rod Norplant and frequently lead to litigation. I have seen 11 such cases in my medicolegal practice. The site for such injuries is the sulcus between biceps and triceps in the upper arm, 8–10 cm above the medial epicondyle. Three nerves run in a neurovascular bundle just below the fascia: the median, ulnar, and medial cutaneous nerve of the forearm. All three have been injured at the time subdermal implant procedures are performed.2–6 These injuries continue to happen, despite the recommended site for insertion having been moved away from the sulcus in 2008. The injuries generally occur when blind instrumentation is performed during attempts to remove implants that are situated deeply or are tethered. Some women have suffered permanent neurological deficit, despite undergoing neurolysis procedures. In my view, routine removals should only be carried out by the ‘pop-out’ technique (for a nice demonstration of this, see this videoclip: bjgplife.com/popout). Attempts at removal should be abandoned if not straightforward or if the woman complains of sensory symptoms.
- © British Journal of General Practice 2018
