Intraneural Nodular Fasciitis of the Radial Nerve: A Case Report.

CASE: We report a case of intraneural nodular fasciitis in the forearm initially suspected as a schwannoma, emphasizing the importance of accurate diagnosis. A 40-year-old woman presented with mass on the lateral aspect of her right forearm and radial neuropathy symptoms for 2 months. An excisional biopsy and histopathological examination confirmed nodular fasciitis. Postoperative evaluation at 4.5 years found no pain, paralysis, or recurrence. CONCLUSION: Awareness of nodular fasciitis is crucial to prevent misdiagnosis and unnecessary treatment. Despite its rapid growth, nodular fasciitis generally has an excellent prognosis without long-term consequences.

Central Tendon Tenotomy for Management of Extrinsic Extensor Tightness of the Hand: Surgical Technique and Case Reports.

CASE: We present a 67-year-old woman with long finger extrinsic extensor tightness and a 56-year-old man with limited index finger flexion due to extrinsic extensor tightness secondary to tendon transfers for radial nerve palsy. Both patients underwent prior surgical procedures that led to limited range of motion (ROM). Subsequently, they elected for central tendon tenotomy (CTT), which demonstrated postoperative ROM improvement and satisfactory patient outcomes. CONCLUSION: Surgical management of extrinsic extensor tendon tightness of the hand is generally addressed by performing tenolysis to improve tendon excursion. We present a novel and simple technique of CTT with pertinent anatomy, descriptive cases, and a cadaveric video.

Superficial thrombophlebitis in the forearm leading to entrapment of the radial nerve branch: a first case report and literature review.

This article reports a case of a female patient admitted with swelling and subcutaneous mass in the right forearm, initially suspected to be multiple nerve fibroma. However, through preoperative imaging and surgery, the final diagnosis confirmed superficial thrombophlebitis. This condition resulted in entrapment of the radial nerve branch, leading to noticeable nerve entrapment and radiating pain. The surgery involved the excision of inflammatory tissue and thrombus, ligation of the cephalic vein, and complete release of the radial nerve branch. Postoperative pathology confirmed the presence of Superficial Thrombophlebitis. Through this case, we emphasize the importance of comprehensive utilization of clinical, imaging, and surgical interventions for more accurate diagnosis and treatment. This is the first clinical report of radial nerve branch entrapment due to superficial thrombophlebitis.

Rare Variant of the Radial Artery Causing Compression of the Superficial Radial Nerve: A Case Report.

CASE: This case report describes a patient with paresthesia in the distribution of the superficial sensory branch of the radial nerve that was treated with surgery. Intraoperatively, there was a unique cause of internal compression by a rare superficial radial artery variant running adjacent to it. The nerve was mobilized from the artery with fascial releases. The patient had symptom resolution postoperatively. CONCLUSION: To our knowledge, this cause of compression has not been described before and should be considered in a differential diagnosis. In addition, clinicians should be aware of this anatomical variant during venipunctures and surgical approaches.

Ancient Schawanoma of radial nerve: a rare case report.

Soft tissue swellings on the forearm can present with a range of clinical and histopathological diagnosis. Ancient Schawanoma is a rare benign condition that can develop over the flexor surface of the forearm as a cystic swelling and can involve the median or the ulnar nerve. However, the presentation of this condition on the extensor surface with involvement of the radial nerve is an extremely uncommon diagnosis. A 69 year old female presented at the outpatient department with a swelling on the extensor aspect of her right forearm for the past 2 years. Ultrasound examination showed a mixed cystic solid mass and MRI report revealed a complex predominantly cystic mass in the extensor compartment of the forearm, measuring 4.3 x 5.3 x 7.2 cm size. After obtaining informed consent, the patient was operated under tourniquet control and the mass was removed sparing the radial nerve that was adherent to its capsule. The final histopathological report confirmed the diagnosis as Ancient Schawanoma.

Radial Nerve Palsy in the Setting of Humeral Shaft Fracture.

The upper limb has a complex anatomy comprised of many nerve and vascular structures, making humeral shaft fractures extremely important. Injury to the humeral shaft commonly occurs due to trauma and affects younger male or older female patients. The radial nerve travels along the spiral groove of the humerus, placing it at an increased risk of damage in humeral shaft fractures. If injured, there are a variety of classifications of radial nerve injury, different indications for exploration, and treatment methods that orthopedic surgeons have available in treating these injuries. This review aims to discuss the etiology of humeral shaft fracture-associated radial nerve palsy, tools for diagnosis, and treatment.

Demystifying the Radial Nerve The Management of Radial Nerve Palsy in the Setting of Humeral Shaft Fracture.

The association of radial nerve palsy and humeral shaft fracture is well known. Primary exploration and fracture fixation is recommended for open fractures and vascular injury while expectant management remains the standard of care for closed injuries. In the absence of nerve recovery, exploration and reconstruction is recommended 3 to 5 months following injury. When direct repair or nerve grafting is unlikely to achieve a suitable outcome, nerve and tendon transfers are potential options for the restoration of wrist and finger extension.

Current concepts of surgical approach for radial nerve entrapment around the elbow.

Radial nerve entrapment is an uncommon diagnosis. The entrapment can occur at any location within the course of the nerve distribution, but the most frequent location of entrapment occurs around the elbow and involves the posterior interosseous nerve. Several potential sites of radial nerve entrapment around the elbow are identified: the capsular tissue of the radiocapitellar joint; hypertrophic crossing branches of leash of henry; the leading proximal tendinous and medial edge of extensor carpi radialis brevis; the arcade of Frohse and distal border of the supinator between its two heads. The arcade of Frohse is the most common site of compression. The aim of this manuscript is to describe the common surgical methods to approach the radial nerve entrapments around the elbow and define the preferred surgical approach based on the site of compression.

A postoperative heterotopic ossification leading to radial palsy.

We report the case of a 58-year-old man who developed radial palsy three months after surgical reinsertion of the distal biceps brachii through a single anterior approach. Radiographs and ultrasound examinations revealed heterotopic ossification compressing the deep branch of the radial nerve. Surgical excision and neurolysis were performed. At the two-month follow-up, the patient was asymptomatic. Practitioners and orthopedic surgeons should be aware of the risk of heterotopic ossification after distal biceps reinsertion and its possible atypical clinical presentation.

Triple transferencia tendinosa en la parálisis radial alta. A propósito de un caso / Triple tendinous transference in high radial paralysis. Apropos of a case

RESUMEN La parálisis del nervio radial producida por lesiones a nivel del brazo es considerada una parálisis alta, y se caracteriza por presentar la muñeca y los dedos flexionados y el pulgar en aducción con imposibilidad para la extensión de los mismos (muñeca y dedos). Todos los autores coinciden en que, para la extensión de la muñeca, el músculo de elección a transferir es el pronador redondo para el segundo radial. Sin embargo, hay diversidad de criterios sobre la utilización del palmar mayor o del cubital anterior para el extensor común de los dedos, y del palmar menor para el extensor largo del pulgar. Se presentó el caso de un paciente de 31 años de edad, con antecedente de accidente de tránsito y diagnóstico de parálisis radial alta de 18 meses de evolución, en el que se decide tratamiento quirúrgico utilizando el músculo cubital anterior después de una rehabilitación exitosa, obteniéndose excelentes resultados (AU).

ABSTRACT The radial nerve paralysis produced by lesions at the level of the arm is considered a high paralysis, and is characterized by presenting the wrist and fingers flexed and the thumb in adduction with impossibility of extending them (wrist and fingers). All consulted authors agree that, for wrist extension, the elective muscle to transfer is the round pronator for the second radial. However, there are different criteria on the use of the palmar major or anterior ulnar for the common finger extender, and the palmar minor for the long thumb extender. We presented the case of a 31-year-old patient, with a history of traffic accident and diagnosis of 18-month high radial paralysis, in which surgical treatment using the anterior ulnar muscle after a successful rehabilitation was decided, obtaining excellent results (AU).

No todo dolor de codo es epicondilitis / Not every elbow pain is epicondylitis

Pain located in the lateral aspect of the elbow is a common cause of consultation in the trauma consultation. The most common cause is "lateral epicondylitis," however there are several differential diagnoses that may require different management. There is a case of radial tunnel syndrome secondary to extrinsic compression, with an emphasis on its diagnosis and surgical technique.

Síndrome del tunel radial. Hallazgos y tratamiento en 17 pacientes / Radial tunnel syndrome. Findings and treatment in 17 patients

Introducción: El síndrome del túnel radial es un cuadro que se debe al atrapamiento intermitente del nervio interóseo posterior entre la masa superficial y profunda del músculo supinador corto y estructuras adyacentes, como vasos y fascias. El propósito de este trabajo fue identificar las estructuras anatómicas que producían la eventual compresión, establecer y comunicar las diferencias en cuanto a la percepción subjetiva del dolor antes de la liberación del nervio interóseo posterior en el túnel radial y después de ella. Materiales y Métodos: Entre 2009 y 2014, 17 pacientes fueron sometidos a cirugía mediante liberación del nervio interóseo posterior. Se utilizó la vía de abordaje entre el primer radial externo y el supinador largo. Se evaluó a los pacientes mediante la escala analógica visual para intensidad del dolor antes de la cirugía y a las 6 semanas, y según los criterios funcionales de Roles y Maudsley. Resultados: Las causas de compresión del nervio interóseo posterior fueron: banda fibrosa (arcada de Frõhse) (7 casos), vasos recurrentes (4 casos), compresión por la masa del fascículo superficial del supinador corto (2 casos) y compresión por tendón del segundo radial externo (4 casos). Los resultados fueron excelentes (4 pacientes), buenos (10 pacientes) y regulares (3 pacientes). Los pacientes atendidos a través de la Aseguradora de Riesgos de Trabajo obtuvieron peores resultados que aquellos fuera de este sistema. Conclusiones: El síndrome del túnel radial es una patología que debe ser tenida en cuenta ante un cuadro de epicondilalgia lateral resistente al tratamiento; tiene una incidencia marcada en pacientes con conflicto laboral, lo que puede sesgar el resultado terapéutico final. Nivel de evidencia: IV.

Introduction: Radial tunnel syndrome is a condition secondary to the intermittent entrapment of the posterior interosseous nerve between superficial and deep mass of short supinator adjacent structures, such as vessels and fascias. The purpose of this study was to identify the anatomical structures that produce the eventual compression, to establish and communicate the differences in the subjective pain perception before and after the release of the posterior interosseous nerve in the radial tunnel. Methods: Between 2009 and 2014, 17 patients underwent surgical treatment by posterior interosseous nerve release. We used the approach between the first external radial and brachioradialis. Patients were assessed by visual analogue scale for pain intensity before surgery and at week 6, and according to the Roles and Maudsley functional criteria. Results: The causes of posterior interosseous nerve compression were fibrous band of short supinator (arcade of Frohse) (7 cases), recurrent vessels (4 cases), compression by the mass of the superficial portion of the short supinator muscle (2 cases) and secondary compression by extensor carpi radialis brevis tendon (4 cases). Results were excellent (4 patients), good (10 patients) and fair (3 patients). Patients treated through the Labor Risk Insurance had worse outcomes than those who were not covered by this system. Conclusions: Radial tunnel syndrome is a condition that must be taken into account when there is refractory lateral epicondylalgia. This disease has a marked effect in patients with labor conflict, which may bias the outcome of treatment. Level of evidence: IV.

Transposición tendinosa con el palmar mayor para restablecer la extensión de los dedos en la parálisis del nervio radial / Tendinous transposition with palmaris major to restore the fingers extension in the radial nerve paralysis

INTRODUCCIÓN: Cuando se realizan transferencias tendinosas para restablecer la extensión de los dedos por parálisis del nervio radial ha sido motivo de controversia entre la decisión de que músculo a utilizar, el cubital anterior o palmar mayor. El objetivo de esta investigación es mostrar nuestra experiencia con el empleo del músculo palmar mayor. MÉTODOS: Se realizó un estudio longitudinal, en 39 pacientes con el diagnóstico de parálisis del nervio radial, donde se evaluó los resultados funcionales de las transposiciones tendinosas para restablecer la extensión de los dedos. El palmar mayor fue empleado en 27 pacientes, 15 por vía subcutánea y 12 a través de la membrana ánteríor ósea, y se utilizó cubital anterior en 12 pacientes como grupo control. RESULTADOS: La evaluación de la extensión de las articulaciones metacarpofalángicas de los dedos fue excelente y buena en 37 de los 39 pacientes sin que existiera asociación estadística en relación al músculo empleado. La fuerza muscular flexora de la muñeca después de la cirugía disminuyó a grado 3 en 11 de los 12 pacientes en que se utilizó el cubital anterior a diferencia de los que utilizaron el palmar mayor en los que la fuerza fue de grado 4 en 17 de los 27. La complicación más frecuente fue la desviación radial de la muñeca que se presentó en 4 pacientes, en todos se habÝa utilizado el cubital anterior. CONCLUSIONES: El músculo palmar mayor es la alternativa más recomendada para restablecer la extensión de los dedos en las parálisis del nervio radial

INTRODUCTION: When tendinous transfers are carried out to restore the finger extension due to radial nerve paralysis, there are controversies in the decision of which muscle be used, the anterior cubital one or the palmaris major. The objective of present research is to show our experience with the use of the palmaris major muscle. METHODS: A longitudinal study was conducted in 39 patients diagnosed with radial nerve paralysis, where we assessed the functional results of tendinous transpositions to restore the finger extension. The palmaris major was used in 27 patients, 15 by subcutaneous route and 12 through the interosseous membrane and the anterior cubital one was used in 12 patients as control group. RESULTS: The assessment of the extension of fingers metacarpophalangeal joints was excellent and good in 37 of the 39 patients without statistic association in relation to the muscle used. The flexor muscular strength of wrist after surgery decreased at grade 3 in 11 of the 12 patients in which we used the anterior cubital one unlike those used the palmaris major where the strength was of grade 4 in 17 of the 27 patients. The more frequent complication was the wrist radial deviation present in 4 patients in which we used the anterior cubital one. CONCLUSIONS: The palmaris major muscle is the more recommended alternative to restore the fingers extension in radial nerve paralyses