Radial neuropathy.

Radial neuropathy is the third most common upper limb mononeuropathy after median and ulnar neuropathies. Muscle weakness, particularly wrist drop, is the main clinical feature of most cases of radial neuropathy, and an understanding of the radial nerve's anatomy generally makes localizing the lesion straightforward. Electrodiagnosis can help confirm a diagnosis of radial neuropathy and may help with more precise localization of the lesion. Nerve imaging with ultrasound or magnetic resonance neurography is increasingly used in diagnosis and is important in patients lacking a history of major arm or shoulder trauma. Radial neuropathy most often occurs in the setting of trauma, although many other uncommon causes have been described. With traumatic lesions, the prognosis for recovery is generally good, and for patients with persistent deficits, rehabilitation and surgical techniques may allow substantial functional improvement.

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.

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.

Radial nerve palsy in the newborn combined with congenital radial head dislocation: Case report and literature review.

RATIONALE: Radial nerve palsy in the newborn and congenital radial head dislocation (CRHD) are both rare disorders, and early diagnosis is challenging. We reported a case of an infant with concurrent presence of these 2 diseases and provide a comprehensive review of the relevant literature. The purpose of the study is to share diagnostic and treatment experiences and provide potentially valuable insights. PATIENT CONCERNS: A newborn has both radial nerve palsy and CRHD, characterized by limited wrist and fingers extension but normal flexion, normal shoulder and elbow movement on the affected side, characteristic skin lesions around the elbow, and an "audible click" at the radial head. The patient achieved significant improvement solely through physical therapy and observation. DIAGNOSES: The patient was diagnosed with radial nerve palsy in the newborn combined with CRHD. INTERVENTIONS: The patient received regular physical therapy including joint function training, low-frequency pulse electrical therapy, acupuncture, paraffin treatment, as well as overnight splint immobilization. OUTCOMES: The child could actively extend the wrist to a neutral position and extend all fingers. LESSONS: If a neonate exhibits limited extension in the wrist and fingers, but normal flexion, along with normal shoulder and elbow movement, and is accompanied by skin lesions around the elbow, there should be a high suspicion of radial nerve palsy in the newborn.

The Epidemiology of Radial Tunnel Syndrome and Its Overlap With Lateral Epicondylitis.

PURPOSE: Radial tunnel syndrome (RTS) is characterized by nerve compression affecting the posterior interosseous nerve branch in the forearm, and its symptoms often overlap with those of lateral epicondylitis (LE). The purpose of this study was to examine the epidemiology of RTS, frequency of injections and surgical release, and overlap of RTS with LE. METHODS: We queried the PearlDiver database to identify RTS in patients older than 18 years. Demographic data, diagnostic or therapeutic injection within 30 days of diagnosis, surgical release within 1 year of diagnosis, and 90-day postoperative complication rates were evaluated. Using International Classification of Diseases, 10th Revision, laterality codes, we also determined the number of patients who had same-side RTS and LE and the proportion of patients who subsequently underwent simultaneous RT release and LE debridement. RESULTS: The prevalence of RTS in a representative United States insurance database was 0.091%, and the annual incidence was 0.0091%. There were 75,459 patients identified with an active RTS diagnosis. The mean age at the time of diagnosis was 52 years (range, 18-81 years), 55% were women, and 1,833 patients (2.4%) underwent RT release within 1 year. Fewer than 3% of the patients received an injection within 30 days of RTS diagnosis. The 90-day postoperative complication rates were low: 5% of the patients required hospital readmission and 2.1% underwent revision surgery. Approximately 5.7% of the patients with RTS also had a diagnosis of LE on the same side within 6 months of RTS diagnosis. In patients with ipsilateral RTS and LE who underwent surgery, 59.1% underwent simultaneous RT release and LE debridement, whereas 40.9% underwent isolated radial tunnel release. CONCLUSIONS: The analysis of a large insurance database showed that the diagnosis of RTS is rarely assigned, suggesting that the incidence of this nerve compression is low. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.

Radial Tunnel Syndrome: Review and Best Evidence.

Radial tunnel syndrome (RTS) is caused by compression of the posterior interosseous nerve and consists of a constellation of symptoms that have previously been characterized as aspects of other disease processes, as opposed to a distinct diagnosis. First described in the mid-20th century as "radial pronator syndrome," knowledge regarding the anatomy and presentation of RTS has advanced markedly over the past several decades. However, there remains notable controversy and ongoing research regarding diagnostic imaging, nonsurgical treatment options, and indications for surgical intervention. In this review, we will discuss the anatomic considerations of RTS, relevant physical examination findings, potential diagnostic modalities, and outcomes of several treatment options.

[RADIAL TUNNEL SYNDROME].

INTRODUCTION: The radial tunnel syndrome (RTS) is an entrapment of the radial nerve in the forearm. It is characterized by pain focused on the trapping area in the proximal forearm as well as pain radiated down the forearm. The syndrome is more common in men and in our estimation, there is a circumstantial connection to the continuous use of the computer keyboard. Radial tunnel syndrome is a consequence of nerve entrapment in the tunnel, which is formed from a covering consisting of the supinator muscle and the distal margins of this muscle. There is a clear association between radial tunnel syndrome and the occurrence of tennis elbow. The sensitivity in nearby locations along with the lack of familiarity of some of the clinicians with RTS lead to misdiagnosis and therefore, even to mistreatment in some cases. The physical examination is the most important means of making the correct diagnosis. The treatment of radial tunnel syndrome is divided into the conservative one in which emphasis is placed on physiotherapy and mobilizations of the nerve and the surgical one during which decompression of the radial canal is performed and in fact release of pressure at the exact anatomical location.

Radial Tunnel Syndrome: Case Report and Comprehensive Critical Review of a Compression Neuropathy Surrounded by Controversy.

Radial tunnel syndrome (RTS) is an uncommon controversial entity thought to cause chronic lateral proximal forearm pain due to compression of the deep branch of the radial nerve, without paralysis or sensory changes. Diagnostic confusion for pain conditions in this region results from inconsistent definitions, terminology, tests, and descriptions in the literature of RTS and "tennis elbow," or lateral epicondylitis. A case of bilateral RTS with signs discordant with traditionally used clinical diagnostic tests was successfully relieved with surgical decompression and led us to perform a comprehensive critical review of the condition. We delineate the controversy surrounding its diagnosis and aim to facilitate appropriate management and identify other areas for further study in this controversial condition. Clinical validity and evidence of anatomical rationale for the traditionally used Maudsley's provocative test is unclear in diagnosis of RTS or in chronic lateral elbow pain, if at all. Neither imaging nor electrophysiological studies contribute to a clinical diagnosis which is supported by short-term improvement after an injection with long-acting local anesthetic and corticosteroid. Accurate diagnosis and treatment of RTS can significantly improve quality of life, but validity and evidence for traditional clinical tests and definitions must be clarified.

Treatment of Radial Nerve Palsy in Paediatric Humeral Shaft Fractures. STROBE-Compliant Investigation.

Background and Objectives:Due to the rarity of radial nerve palsy in humeral shaft fractures in the paediatric population and the lack of data in the literature, the purpose of our study was to report the treatment results of six children who sustained a radial nerve injury following a humeral shaft fracture. Materials and Methods: We treated six paediatric patients with radial nerve palsy caused by a humeral shaft fracture in our department from January 2011 to June 2022. The study group consisted of four boys and one girl aged 8.6 to 17.2 (average 13.6). The mean follow-up was 18.4 months. To present our results, we have used the STROBE protocol designed for retrospective observational studies. Results:We diagnosed two open and four closed humeral shaft fractures. Two simple transverse AO 12A3c; one simple oblique AO 12A2c; two simple spiral AO 12A1b/AO 12A1c and one intact wedge AO 12B2c were recognized. The humeral shaft was affected in the distal third five times and in the middle third one time. In our study group, we found two cases of neurotmesis; two entrapped nerves within the fracture; one stretched nerve over the bone fragments and one case of neuropraxia. We found restitution of the motor function in all cases. For all patients, extensor muscle strength was assessed on the grade M4 according to the BMRC scale (except for a patient with neuropraxia-M5). The differences in patients concerned the incomplete extension at the radiocarpal and metacarpophalangeal (MCP) joints. Conclusions: In our small case series, humeral shaft fractures complicated with radial nerve palsy are always challenging medical issues. In paediatric patients, we highly recommend an US examination where it is possible to be carried out to improve the system of decision making. Expectant observation with no nerve exploration is reasonable only in close fractures caused by low-energy trauma. Early surgical nerve exploration related with fracture stabilisation is highly recommended in fractures after high-energy trauma, especially in open fractures and where symptoms of nerve palsy appear at any stage of conservative treatment.

Radial nerve entrapment after fracture of the supracondylar humerus: a rare case of a 6-year-old.

Supracondylar fracture of the humerus is one of the most common fractures seen in children, and posteromedial displacement of the distal fragment in extension-type supracondylar humerus fractures can cause injury to the radial nerve. A 6-year old girl who presented with symptoms of radial nerve injury after a supracondylar fracture of the right humerus with complete posteromedial displacement of the distal fragment (Gartland type III) underwent surgery where closed reduction and percutaneous pinning was performed. The patient was routinely followed up and at 6 months postoperatively no neurological improvement was seen. Exploratory surgery revealed complete discontinuation of the radial nerve at the fracture site and entrapment of the nerve stumps in healed bone callus. A gap of 2 cm was observed between nerve stumps, and sural nerve cable grafting was performed with good results. If neurological symptoms do not improve over time, appropriate differential diagnosis and, if necessary, exploratory surgery should be considered. Despite limited reports and their conflicting outcomes, sural nerve cable grafting could be a useful option to bridge the gap of discontinued nerve injury. Level of Evidence: Level IV, Case Report.

Some Misconceptions in the Treatment of Cubital Tunnel Syndrome, Radial Tunnel Syndrome, and Median Nerve Compression in the Forearm.

This article discusses ulnar, median, and radial nerve compression in the proximal forearm and elbow and some possible common misconceptions. In particular, the ligament of Struthers extremely rarely causes ulnar neuropathy. Lacertus syndrome and flexor superficialis-pronator syndrome can be diagnosed separately. Surgical release can be through a small incision. Acronyms for compression to radial nerve in proximal forearm can be simplified to radial tunnel syndrome, which includes a mild type (classical radial tunnel syndrome) and a severe type (posterior interosseous nerve (PIN) compression).

Parálisis del nervio radial neonatal: relato de un caso / Isolated radial nerve palsy in a newborn: case report

La parálisis radial neonatal aislada (PRNA) es un cuadro clínico infrecuente que debe distinguirse de otras entidades más frecuentes, como la parálisis braquial obstétrica (PBO). Debemos sospechar una PRNA en neonatos que presentan incapacidad para la extensión de muñeca y de dedos, pero mantienen intacta la función del deltoides, del bíceps, y del tríceps, así como la flexión de muñeca y de dedos. Mientras la PBO tiene una evolución clínica variable dependiendo de la extensión de la lesión neurológica, la PRNA presenta una resolución espontánea, independientemente del grado de afectación inicial. Presentamos el caso de un recién nacido con PRNA cuyo diagnóstico inicial fue de PBO.

Isolated radial nerve palsy (IRNP) in the newborn is a rare clinical condition that must be distinguished from entities that are more common, such brachial plexus birth palsy (BPBP). It should be suspected in newborns presenting with absent wrist and digital extension but intact deltoid, biceps, and triceps function, as well as wrist and digital flexor function. Whereas BPBP is highly variable depending on the extent of the neurological involvement, IRNP resolves spontaneously, regardless of the severity of the initial presentation. We herein present a case of newborn with IRNP whose initial diagnosis was of BPBP.

Atraumatic proximal radial nerve entrapment. Illustrative cases and systematic review of literature.

PURPOSE: The aims of the present study were to describe atraumatic proximal radial nerve entrapment (PRNE) and potential strategies for management. MATERIALS AND METHODS: We performed a comprehensive search of 4 electronic databases for studies pertaining to patients with atraumatic PRNE. Studies published between 1930 and 2020 were included. Clinical presentation, nerve conduction studies, electromyography, and treatment methods were reviewed. In order to outline management strategies, 2 illustrative cases of acute PRNE were presented. RESULTS: We analyzed 12 studies involving 21 patients with 22 PRNE (15 acute and 7 progressive). Sudden or repetitive elbow extension with forceful muscle contraction (n = 16) was the primary mechanism of injury. The two main sites of entrapment were the fibrous arch (n = 7) and hiatus of the lateral intermuscular septum (n = 7). Conservative treatment was performed in 4 patients and allowed for complete clinical recovery in all cases. The remaining 18 patients underwent epineurolysis (n = 16) or resection/repair of hourglass-like constriction (n = 2) between 1.5- and 120-months following diagnosis. Twelve patients experience complete recovery, while partial or no clinical recovery was reported in 1 and 4 cases, respectively; the outcome was unknown in 1 case. CONCLUSIONS: Atraumatic PRNE is rare and remains challenging with respect to diagnosis and treatment. Current literature suggests that primary sites of entrapment are the fibrous arch and hiatus of the radial nerve at the time of forceful elbow extension. LEVEL OF EVIDENCE: Case series (IV) & systematic review (I).

Posterior interosseous neuropathy: distinguishing from a proximal radial neuropathy.

The posterior interosseous nerve is the terminal motor branch of the radial nerve that innervates the extensor carpi ulnaris and the extensors of the thumb and fingers. We describe a case of a posterior interosseous neuropathy presenting with the typical 'finger drop' and partial 'wrist drop'. We focus on the clinical signs that distinguish it from a more proximal radial neuropathy, clarified by nerve conduction studies and needle electromyography. Multimodal imaging of the forearm did not identify a compressive lesion. Persistent symptoms prompted surgical exploration 5 years after initial onset. It identified compression of the posterior interosseous nerve in the region of the arcade of Frohse and leash of Henry. The sites were decompressed and concurrent salvage secondary reconstructive tendon transfers were required in view of the severe axonal loss with minimal chance of functional reinnervation.

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).

Atrapamiento del nervio radial a nivel del canal de torsión humeral. Bloqueos nerviosos como arma diagnóstica y terapéutica / Radial nerve entrapment in the spiral groove. Nerve block as a diagnostic and therapeutic tool

El nervio radial tiene un recorrido largo y sinuoso por el miembro superior que abarca desde la axila hasta la mano y dedos. En este camino puede presentar varias zonas de compresión, siendo la más frecuente a nivel de arcada de Frohse con atrapamiento de su rama terminal, el nervio interóseo posterior. Presentamos un caso clínico de una paciente con atrapamiento del nervio radial a nivel del canal de torsión humeral y cómo la ecografía y los bloqueos nerviosos pueden ser útiles tanto para su diagnóstico como su tratamiento, con la particularidad de que en nuestro caso fue insuficiente con el bloqueo del tronco principal del nervio radial, siendo necesario en una segunda intervención actuar también sobre su rama el nervio cutáneo braquial lateroinferior para obtener un óptimo resultado clínico (AU)

The radial nerve has a long and sinuous course in the upper limb from the axilla to the hand and fingers. There are several possible areas of compression along this trajectory, the most frequent being on the Arcade of Frohse, with entrapment of its terminal nerve, the posterior interosseous nerve. We report the case of a patient with radial nerve entrapment in the spiral groove and describe how ultrasound and nerve blocks could be useful in diagnosis and treatment. In our patient, nerve block at the main radial nerve in the spiral groove was insufficient. A second nerve block was needed in the inferior lateral cutaneous nerve of the arm to achieve an optimal clinical result (AU)

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.

[Radial nerve entrapment in the spiral groove. Nerve block as a diagnostic and therapeutic tool]. / Atrapamiento del nervio radial a nivel del canal de torsión humeral. Bloqueos nerviosos como arma diagnóstica y terapéutica.

The radial nerve has a long and sinuous course in the upper limb from the axilla to the hand and fingers. There are several possible areas of compression along this trajectory, the most frequent being on the Arcade of Frohse, with entrapment of its terminal nerve, the posterior interosseous nerve. We report the case of a patient with radial nerve entrapment in the spiral groove and describe how ultrasound and nerve blocks could be useful in diagnosis and treatment. In our patient, nerve block at the main radial nerve in the spiral groove was insufficient. A second nerve block was needed in the inferior lateral cutaneous nerve of the arm to achieve an optimal clinical result.

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.