A Special type of non-traumatic posterior interosseous nerve compression syndrome.

The posterior interosseous nerve (PIN) is the terminal branch of the radial nerve. The symptoms of PIN palsy vary markedly according to its types. In this report, we present the case of a 61-years-old male patient with an unusual manifestation of non-traumatic novel type of PIN palsy. A complicated course was involved in the diagnosis of this disease. The operation was performed after verification of PIN palsy. Recovery of symptoms was observed in a follow-up conducted three years later. Additionally, the electromyography examination returned to normal.

Post-operative rehabilitation in a traumatic rare radial nerve palsy managed with tendon transfers: a case report.

Radial nerve is a frequently injured nerve. Radial nerve palsy result from direct trauma, neuropathies, and fracture over the humerus, malignant tumor and neuritis. A case of 26-year male is presented in this report who had a road traffic accident resulting in injury over the right shoulder, wrist joint and diagnosed of radial nerve palsy, consequently was operated with soft tissue reconstruction with tendon transfers which resulted into pain over wrist joint and loss of extensors muscle function of the wrist joint, which led to difficulty in performing activities of daily living. Surgical history and rehabilitation is mentioned in the case report. We report that there were significant improvements in muscle strength, range of motion, relief from pain, and exceptional improvements in the patient´s functional independence with physiotherapy interventions post-operative tendon transfers.

Analyzing the functional effects of dynamic and static splints after radial nerve injury.

The radial nerve is a commonly injured upper extremity peripheral nerve. The inability to extend the wrist results in a loss of hand function and dexterity that affects patients' ability to perform their activities of daily living. There is no strong evidence to support a particular splint design for improving dexterity. This cohort study compared whether a static or dynamic splint can improve hand dexterity when assessed with the 9-hole peg test (9-HPT) after radial nerve injury. Thirty-four subjects with radial nerve palsy participated in the study. The test was repeated three times for each subject, first without the splint, and then while wearing the control static wrist splint, and finally while wearing the dynamic splint. The 9-HPT was used as the outcome measure. The 9-HPT times were 36.4±4.8seconds without a wrist splint and improved when using the static and the dynamic splints to 33.5±4.5seconds (P<0.01) and 25.7±3.5seconds (P<0.01) respectively. The use of a dynamic splint after radial nerve palsy can provide the patient with greater manual dexterity when compared to using no splint or a static splint.

Radial palsy in an individual with high-level chronic spinal cord injury.

INTRODUCTION: Prolonged compression is a common cause of radial neuropathy in able-bodied individuals but has not been reported in individuals with chronic SCI. This is despite the fact that individuals with SCI may be at increased risk of peripheral nerve injuries due to wheelchair mobility and baseline sensory deficits. Furthermore, diagnosis of peripheral nerve injury poses a unique challenge in this population because symptoms and signs are superimposed on pre-existing central deficits. CASE PRESENTATION: We present the case of a 48-year-old man with a C6 AIS A SCI from a motor vehicle accident 22 years earlier who had a new onset compressive radial neuropathy. At initial assessment he complained of paresthesia along his lateral right arm accompanied by new onset wrist-drop. Subsequent radial nerve conduction studies revealed severe reductions in amplitude for sensory and motor action potentials. The patient was managed with mobility exercises and vitamin B supplementation and showed full recovery of motor and sensory function to baseline levels on follow-up 4 months after the injury. DISCUSSION: The electrophysiologic profile of this patient is illustrative of severe nerve compression for an extended time period. Unlike able-bodied individuals who can reposition themselves to alleviate nerve compression, individuals with SCI may be unaware of nerve compression or unable to reposition themselves. This highlights the need for precautionary measures such as maneuvers and devices to provide trunk and limb stability along with the use of medical alert devices that allow individuals to access timely help when unattended.

New Functional Evaluation Scheme - Modality of the Results of Forearm Tendon Transfers Evaluation in Cases of Irreparable Radial Nerve Injury.

INTRODUCTION: There are several evaluation schemes for the results of tendon transfers in case of radial nerve paralysis, and the most logical and commonly used are evaluation schemes that use the range of active joint movements to evaluate the results. AIM: Present an original evaluation scheme for tendon transfer results based on functional wrist and fingers joint movements. The aim of the article is to present the advantages of our own Functional scheme in comparison with other schemes, its simplicity and applicability in the evaluation of all clinical cases of different postoperative outcome of the variables being evaluated, and to present the ease of comparison of the achieved results with other authors who would possibly use our scheme because it minimizes the subjective error of the examiner. The secondary aim is to compare the results of flexor carpi radialis (FCR) vs. flexor carpi ulnaris (FCU) tendon transfers (TT). METHODS: The study was conducted as clinical and retrospective. The study included 60 patients with isolated radial nerve palsy operated by two tendon transfer surgical methods (FCR and FCU) over a 10-year period. The evaluation of the results was performed by using Zachary, Neimann-Pertecke, Tajima evaluation schemes, our own Functional Evaluation Scheme as well as subjective patient evaluation. RESULTS: The time elapsed from injury to surgery ranged from 105 to 956 days in case of FCR tendon transfer and from 109 to 712 days in cases of FCU tendon transfer. The overall average age of patients is 36.71 years. A statistically significant difference in values with t -test based on the Functional Evaluation Scheme was found in the variables of ulnar deviation (p=0.000731), extension of the MP fingers joints II-V (p=0.04610) and extension of the MP of the thumb joint (p=0.0475). Evaluation of the total results with t-test (p=0.007532) and with U-test (p=0,00433) showed statistically better FCR tendon transfer results. A statistically significant difference in value measured by the t-test was found in the evaluation of the overall results (p=0.022) with Zachary and Neumann-Pertecke schemes and by the Tajima evaluation Scheme (p=0.042) in favor of better FCR tendon transfer results. With a use of Functional Evaluation Scheme, it is possible to evaluate all the results unlike most available schemes. CONCLUSION: The functional evaluation scheme is based on the functional joint movements evaluated and incorporating radial and ulnar deviation of the wrist (RD and UD), extension of the metacarpophalangeal (MCP) joint and flexion of the intephalangeal (IP)joint of the thumb in the final evaluation becomes completely original. A functional evaluation scheme is simply applicable for the evaluation of all clinical cases of different postoperative outcome of the variables being evaluated. FCR tendon transfer achieves better results than FCU TT.

Radial motor nerve conduction studies in the upper arm.

INTRODUCTION: The main goal of this study was to determine the contribution of the anterior forearm muscles to the compound muscle action potential (CMAP) recorded from the extensor digitorum (ED) after proximal stimulation. METHODS: Twenty-one healthy volunteers and 114 patients with compressive and traumatic radial neuropathies were examined. Stimulation was carried out at six different points: distal third of the upper arm; Erb's point; axilla; medial upper arm; antecubital fossa; and ulnar groove. RESULTS: In the control group, Erb's CMAP area was significantly greater than the distal CMAP area. In compressive neuropathy, there was conduction block, but no change in conduction velocity. There were no differences in Erb's CMAP latencies between the control group and the neuropathies group. DISCUSSION: CMAPs recorded over the ED with stimulation at the brachial plexus represent the sum of the motor unit action potentials of the posterior and anterior forearm muscles.

Acute compressive radial neuropathy and wrist drop due to the repetitive overuse of the arm.

OBJECTION: Entrapment neuropathies are common in clinical practice. Early diagnosis and management of nerve compression is necessary to maintain limb function and to improve the patient's quality of life. CASE REPORT: In this article, we reported a woman presenting with wrist drop as a result of acute radial nerve compression following strenuous activity involving the arms. The diagnosis was based on clinical and ultrasonographic findings. Once the diagnosis was made, activity modifications and systemic steroid were prescribed, and the patient made a near-complete recovery. CONCLUSION: Patients with acute wrist drop and sensorial loss should be examined in terms of arm overuse, and radial nerve compression should be confirmed by peripheral nerve ultrasound.

An Unusual Radial Neuropathy.

A 23-year-old woman presented to her physician for left forearm pain of insidious onset, inability to extend the wrist, and numbness in the dorsal hand. An electromyogram (EMG) and nerve conduction study (NCS) demonstrated radial neuropathy, while magnetic resonance imaging (MRI) of the left elbow/forearm, performed 2 months later, revealed edema and atrophy of the wrist extensor muscles, but no compressive lesion. Following a lack of improvement and consultation with an orthopaedic surgeon, a second, more detailed EMG/NCS was performed, revealing a severe radial motor and sensory neuropathy, with compression between the lateral and long heads of the triceps. J Orthop Sports Phys Ther 2019;49(7):558. doi:10.2519/jospt.2019.7927.

Outcome Assessment of Z-shaped Osteotomy in the Management of Humeral Shaft Nonunion Secondary to Failed Plate Osteosynthesis.

Restoration of fracture alignment by osteotomy is crucial for the management of humeral nonunion. In the present study, we introduced a new way of osteotomy (Z-shaped) in treating humeral shaft nonunion secondary to failed plate osteosynthesis. Clinical data of 24 patients with humeral shaft nonunion following implant failure (from 2010 to 2014) were retrospectively evaluated. These patients underwent Z-shaped osteotomy in revision surgery after the initial surgery, plate osteosynthesis, was failed. Outcomes were evaluated using visual analogue scale (VAS) and Constant and Murley score. Repeated analysis of variance (ANOVA) was used for statistical analysis. Patients were followed up for a minimum of 24 months (26.83±4.33 months). The operative time was 102.33±10.16 min, and hospital stay averaged 9.75±2.13 days. All patients achieved clinical union at the latest follow-up. Complications included radial palsy (n=1) and superficial wound infection (n=1). The postoperative VAS scores decreased significantly compared to preoperative score (F=257.99, P<0.01). Constant and Murley score increased and reached 81.33±0.95 at 24 months' follow-up (F=247.35, P<0.01). Among all the cases, 15 cases were graded as "excellent", and 9 as "good". In conclusion, Z-shaped osteotomy was easy to perform, and it provided additional medial support with more bone contact areas. Revision surgery using locking plate and Z-shaped osteotomy achieved high union rate and improved functional outcome. It was a reasonable and safe option for treating humeral nonunion following implant failure.

Superficial radial nerve compression due to fibroma of the brachioradialis tendon sheath: A case report.

Fibroma of the tendon sheath (FTS) is a rare benign tumour that usually develops in the upper extremity, particularly in the fingers, hands and wrists. Herein, we present the case of a patient with an unusually localised FTS compressing the superficial branch of the radial nerve. A 62-year-old woman presented with a superficial radial nerve compression due to FTS of the brachioradialis. Histopathological diagnosis was confirmed as a FTS after marginal excision. The patient who had compression-related symptoms in the superficial branch of the radial nerve recovered completely at one month after surgery. One year later, the patient remained free of symptoms and no recurrence was observed.

Effect of dry needling on radial tunnel syndrome: A case report.

This case report describes a 45-year-old male who presented with chronic right lateral elbow pain managed unsuccessfully with conservative treatment that included anti-inflammatory medication, injection, massage, exercise, bracing, taping, electro-physical agents, and manual therapy. Diagnosis of radial tunnel syndrome (RTS) was based on palpatory findings, range of motion testing, resisted isometrics, and a positive upper limb neural tension test 2b (radial nerve bias). Conventionally, the intervention for this entrapment has been surgical decompression, with successful outcomes. This is potentially a first-time report, describing the successful management of RTS with dry needling (DN) using a recently published DN grading system. Immediate improvements were noted in all the outcome measures after the first treatment, with complete pain-resolution maintained at a 6-month follow-up. A model is proposed describing the mechanism by which DN could be used to intervene for nerve entrapment interfaces.

Reversible reddish skin color change in a patient with compressive radial neuropathy.

BACKGROUND: The motor and sensory symptoms caused by compressive radial neuropathy are well-known, but the involvement of the autonomic nervous system or the dermatologic symptoms are less well known. We report an unusual case of compressive radial neuropathy with reversible reddish skin color change. CASE PRESENTATION: A 42-year-old man was referred for left wrist drop, finger drop and a tingling sensation over the lateral dorsum of the left hand. Based on clinical information, neurologic examinations and electrophysiologic studies, he was diagnosed with compressive radial neuropathy. In addition, a reddish skin color change was observed at the area of radial sensory distribution. After two weeks of observation without specific treatment, the skin color had recovered along with a marked improvement in weakness and aberrant sensation. CONCLUSIONS: Compressive radial neuropathy with a reversible reddish skin color change is unusual and is considered to be due to vasomotor dysfunction of the radial autonomic nerve. Compressive radial neuropathy is presented with not only motor and sensory symptoms but also autonomic symptoms; therefore, careful examination and inspection are needed at diagnosis.

Development and validation of a new patient-reported outcome measure for peripheral nerve disorders of the hand, the I-HaND© Scale.

Following guidelines from the Patient-Centred Outcomes Research Institute and using a mixed methods study, a new patient-reported outcome measure (PROM) for both nerve trauma and compression affecting the hand, the Impact of a Hand Nerve Disorders (I-HaND) Scale, was developed. Face-to-face interviews with 14 patients and subsequent pilot-testing with 61 patients resulted in the development of the 32-item PROM. A longitudinal validation study with 82 patients assessed the psychometric properties of the I-HaND. Content and construct validity was confirmed by cognitive interviews with patients and through principal component analysis. The I-HaND has high internal consistency (α = 0.98) and excellent test-retest reliability (intraclass correlation coefficient = 0.97). Responsiveness statistics showed that the I-HaND can detect change over 3 months and discriminate between improvers and non-improvers. We conclude that the I-HaND can be used as a PROM for people with a range of hand nerve disorders.

Ultrasound-guided perineural injection with dextrose for treatment of radial nerve palsy: A case report.

RATIONALE: Perineural injection with dextrose could be a novel intervention for peripheral entrapment neuropathy. However, this intervention has not been reported for treating radial nerve palsy (RNP). Here, we present a case with RNP having outstanding improvement after 2 sessions of ultrasound-guided perineural injection with 5% dextrose (D5W). PATIENT CONCERNS: A 62-year-old woman presented with difficulty and weakness in extension of her left wrist and fingers after she slept with the arm compressed against her body. DIAGNOSES: On the basis of the findings of electrophysiological study and ultrasonography, the RNP with axonal injury was diagnosed. INTERVENTIONS: Initially, the patient received 2-months conservative treatments without any improvement. Two sessions of ultrasound-guided perineural injection with total 15cc D5W with an interval of 1 month were performed 2 months after symptom onset. OUTCOMES: A noteworthy improvement in sensory and motor functions was observed after ultrasound-guided perineural injection with D5W. LESSONS: This case shows that ultrasound-guided perineural injection with D5W may be an effective and novel intervention for RNP.

Electrophysiologic Features of Radial Neuropathy in Childhood and Adolescence.

BACKGROUND: We analyzed the clinical and electrophysiologic patterns of nerve injury in pediatric patients with radial neuropathy. METHODS: This is a retrospective analysis of 19 children and adolescents with radial neuropathy. RESULTS: The mean subject age was 12 years (range one month to 19 years), 56% were female, and 53% had traumatic etiologies. Weakness in the finger and wrist extensors was the prevailing complaint (82%). Predominant localization was at the posterior interosseous nerve (37%), followed by the radial nerve below the spiral groove (32%), the radial nerve at the spiral groove (26%), and the radial nerve above the spiral groove (5%). Extensor indicis proprius compound muscle action potential amplitude was reduced in 86% of cases when tested, with a median axon loss estimate of 78%. The radial sensory nerve action potential amplitude was reduced in 53% of all cases, and in 83% of cases affecting the main radial trunk with a median axon loss estimate of 100%. For neuropathy affecting the main radial trunk, there was a high correlation of extensor indicis proprius median axon loss estimate and radial sensory nerve action potential median axon loss estimate (r = 0.72, P = 0.02). Neurogenic changes were seen in the extensor indicis proprius, extensor digitorum communis, extensor carpi radialis, and brachioradialis in 88%, 94%, 60%, and 44% of cases, respectively. Pathophysiology was demyelinating in 10%, axonal in 58%, and mixed in 32%. CONCLUSIONS: In contrast to adults, where localization at the spiral groove predominates, radial neuropathy in children and adolescents is commonly localized at the posterior interosseous nerve or at the distal main radial trunk. Pediatric radial neuropathy is frequently of traumatic etiology and axonal pathophysiology.

Electrophysiological examination and high frequency ultrasonography for diagnosis of radial nerve torsion and compression.

This study aims to evaluate the value of electrophysiological examination and high frequency ultrasonography in the differential diagnosis of radial nerve torsion and radial nerve compression.Patients with radial nerve torsion (n = 14) and radial nerve compression (n = 14) were enrolled. The results of neurophysiological and high frequency ultrasonography were compared.Electrophysiological examination and high-frequency ultrasonography had a high diagnostic rate for both diseases with consistent results. Of the 28 patients, 23 were positive for electrophysiological examination, showing decreased amplitude and decreased conduction velocity of radial nerve; however, electrophysiological examination cannot distinguish torsion from compression. A total of 27 cases showed positive in ultrasound examinations among all 28 cases. On ultrasound images, the nerve was thinned at torsion site whereas thickened at the distal ends of torsion. The diameter and cross-sectional area of torsion or compression determined the nerve damage, and ultrasound could locate the nerve injury site and measure the length of the nerve.Electrophysiological examination and high-frequency ultrasonography can diagnose radial neuropathy, with electrophysiological examination reflecting the neurological function, and high-frequency ultrasound differentiating nerve torsion from compression.