Vest restraint palsy

Abstract

Objective: Evaluate by electrophysiologic methods the cause of arm weakness and numbness in an agitated patient who struggled against a vest restraint garment. Case Presentation: An agitated patient with encephalitis required vest restraint and developed bilateral numbness of hands and weakness of distal upper extremity muscles. He was of thin stature and had abrasions in the axilla from the restraint straps. Routine nerve conduction and needle electromyographic needle studies were used to document bilateral conduction block of ulnar and median nerves between the elbow and Erb's point with minimal denervation. Intervention: After identification of the vest restraint as the cause of neuropraxic palsies, adjustments were made to the vest straps. Results: The symptoms and clinical signs began to resolve with adjustment of the vest restraint straps and completely resolved after the patient was no longer encephalopathic and was discharged from the hospital. Conclusions: Compressive nerve lesions in the axilla should be recognized as a potential complication of vest restraint, especially in combative patients.