Can Nexplanon Cause Numbness and Wrist Pain?
Yes, Nexplanon can cause numbness and wrist pain, though these are rare complications typically related to improper insertion technique or nerve injury during placement or removal rather than systemic effects of the medication itself.
Mechanism of Nerve Injury
The numbness and wrist pain associated with Nexplanon are primarily complications of the insertion or removal procedure, not pharmacological effects of etonogestrel:
Transient nerve injury is a recognized but rare complication of Nexplanon insertion, occurring when the device is placed too deeply or in an incorrect location in the upper arm 1.
Peripheral nerve injury can occur during removal attempts, particularly when the implant is deeply placed, non-palpable, or has migrated from its original insertion site 2.
Ulnar nerve injury has been specifically documented in case reports, resulting in nerve palsy requiring surgical intervention including neuroma excision and nerve grafting 2.
Clinical Presentation
When nerve injury occurs with Nexplanon:
Symptoms typically include numbness, tingling, or pain radiating down the arm, potentially affecting the wrist and hand 2.
The injury pattern depends on which nerve is affected during insertion or removal - ulnar, median, or radial nerve involvement can all cause wrist-area symptoms 2.
Symptoms may appear immediately after insertion/removal or develop gradually if the implant migrates closer to nerve structures 2.
Risk Factors and Prevention
Deep insertion is the primary risk factor for nerve complications, which is why Nexplanon contains barium sulfate to make it radiographically visible 1.
The implant should be inserted 6 to 8 cm above the elbow in the inner aspect of the non-dominant upper arm to minimize nerve injury risk 1.
Only trained clinicians who have completed requisite training should perform insertions and removals 1.
Management Approach
If a patient with Nexplanon develops numbness and wrist pain:
Immediate evaluation is required to determine if symptoms are related to the implant location or represent nerve injury 2.
Imaging should be obtained before attempting removal if the device is non-palpable, deep, or potentially migrated 2.
Prompt referral to a peripheral nerve surgeon is indicated for any patient with persistent neurologic symptoms after placement or attempted removal 2.
Formal surgical exploration may be necessary rather than in-office removal attempts if nerve injury is suspected 2.
Important Caveats
These complications are rare - the overall safety profile of Nexplanon shows that only 7% of reported adverse events are serious, with most being related to insertion/removal difficulties rather than nerve injury 3.
The incidence of insertion-related complications decreased with Nexplanon compared to the earlier Implanon formulation (0.92 vs 1.31 per 1000 patients) due to improved visibility 3.
Wrist pain could also be unrelated to the Nexplanon and represent a separate musculoskeletal condition requiring independent evaluation 4.