Clinical efficacy analysis of minimally invasive intramedullary nailing in the treatment of humeral shaft fractures combined with radial nerve injury.

OBJECTIVE: The aim of this study was to research the therapeutic effectiveness of radial nerve damage paired with a humeral shaft fracture and intramedullary nailing. PATIENTS AND METHODS: Retrospective research was performed on the medical records of 58 individuals who had humeral shaft fractures and radial nerve injuries. The admission period was between June 1, 2020, and June 31, 2022. All study subjects that satisfied the requirements for inclusion were separated, using the random number table approach, into two groups: one for internal fixation (group N), which included 29 cases, and one for minimally invasive procedures (group W), which included 29 patients. Group W received minimally invasive intramedullary nail treatment, and group N received internal fixation with compression plates. The changes in the clinical effects, surgery-related indicators, joint function, nerve function, and levels of stress indicators of the two groups of treatment were analyzed. The changes in adverse reactions and satisfaction of patients were compared. RESULTS: The effective rate of group W was 89.66% (26/29), and that of group N was 72.41% (21/29). Although group W's effective rate was higher than group N's, there was no discernible disparity between the two groups (p>0.05). Surgical blood loss and incision length were much smaller in group W than in group N, and overall operation duration and length of stay were considerably shorter in group W than in group N (p<0.05). The excellent and good rate of elbow joint function in group W was 93.10% (27/29), whereas the excellent and good rate of group N was 65.52% (19/29). The excellent and good rate of elbow joint function in group W was considerably greater than that of group N (p<0.05). In group W, the excellent and good rate of shoulder joint was 96.55% (28/29), and that in group N was 68.97% (20/29), and group W had a considerably greater probability of excellent shoulder joint function than group N (p<0.05); the excellent and good rate of neurological function was 82.76% (24/29) in group W and 58.62% (17/29) in group N, and group W had much greater rates of excellent and good neurological function than group N (p<0.05). prostaglandin E-2 (PGE2), C-reactive protein (CRP) and Substance P (SP) levels in the W group and the N group were substantially higher after the surgery than they were prior to it (p<0.05), and in the W group, the aforementioned stress markers were much lower than they were in the N group (p<0.05). Group W experienced a 3.45% (1/29) rate of adverse events, while group N saw a 24.14% (7/29) incidence. The incidence of adverse responses was substantially lower in group W than in group N (p<0.05). The contentment rate of group W was 93.10% (27/29), and that of group N was 72.41% (21/29). Group W had a much greater contentment percentage than group N (p<0.05). CONCLUSIONS: Minimally invasive intramedullary nailing is a successful therapeutic approach for humeral shaft fractures with radial nerve damage, which may successfully enhance patients' shoulder and elbow joint function and nerve function, reduce patients' stress response, and has the characteristics of minimal adverse responses and high contentment, which is worthy of popularization and deployment.

Anatomical considerations for nerve transfer in axillary nerve injury.

This study investigated the anatomical details of the axillary and radial nerves in 50 upper limbs from 29 adult formalin-embalmed cadavers, and ten fresh upper limbs. The focus was on understanding the course, division, and ramifications of these nerves to improve treatment of shoulder dysfunction caused by axillary nerve damage. The axillary nerve divided anteriorly and posteriorly before passing the quadrangular space in all specimens, with specific distances to the first ramifications. It was found that the deltoid muscle's clavicular and acromial parts were always innervated by the anterior division of the axillary nerve, whereas the spinous part was variably innervated. The longest and thickest branches of the radial nerve to the triceps muscles were identified, with no statistically significant differences in fiber numbers among triceps branches. The study concludes that nerve transfer to the anterior division of the axillary nerve can restore the deltoid muscle in about 86% of shoulders, and the teres minor muscle can be restored by nerve transfer to the posterior division. The medial head branch and long head branch of radial nerve were identified as the best donor options.

Rare Median Nerve and Digital Nerve Tumor Resection and Distal Nerve Transfers: A Report of 2 Cases.

CASES: We present 2 cases of median nerve reconstruction using distal nerve transfers after resection of unusual benign median nerve tumors. Critical sensation was restored in case 1 by transferring the fourth common digital nerve to first web digital nerves. Thumb opposition was regained by transferring the abductor digiti minimi ulnar motor nerve branch to the recurrent median motor nerve branch. Critical sensation was restored in case 2 by transferring the long finger ulnar digital nerve to the index finger radial digital nerve. CONCLUSION: Distal nerve transfers, even with short grafts, are reliable median nerve deficit treatments, sparing the need for larger autologous nerve grafts and late tendon opponensplasties.

Neuropathic pain of the superficial branch of the radial nerve - Factors influencing surgical outcome and patient satisfaction.

BACKGROUND: Due to its partially superficial course, the superficial branch of the radial nerve is vulnerable to injury by trauma or surgery, potentially leading to painful neuroma. Surgical treatment is difficult. Among other factors, smoking and duration of pain before revision surgery have been suggested as risk factors for persistent pain after surgical revision, without concrete evidence. The aim of this study was therefore to identify factors influencing the outcome of revision surgery in SBRN neuropathic pain in our department. METHODS: All 51 patients receiving revision surgery of the superficial branch of the radial nerve for neuropathic pain from 2010 to 2020 were contacted; 19 agreed to return for assessment. A medical chart review was performed to collect patient-, pain- and treatment-specific factors. Outcomes were recorded. In an outpatient consultation, clinical follow-up was performed and patients filled out the DASH, MHQ and painDETECT questionnaires. RESULTS: After revision surgery, all patients experienced persistent pain. On multivariate logistic regression evaluating the risk of persistent pain, only smoking emerged as an independent risk factor. Age, gender, dominant side, location, time between trigger and surgery or diagnosis did not emerge as risk factors. No predictor for successful return to work could be identified. CONCLUSIONS: Treatment of painful neuroma of the superficial branch of the radial nerve is a challenge. Patients with neuropathic pain should be coached toward smoking cessation before neuroma surgery. Surgery can show benefit even after long symptom duration. No correlations between study clinical variables or test results and return to work could be identified, suggesting that other factors play a role in return to work.

Comparison of nerve versus tendon transfer for radial nerve palsy.

OBJECTIVE: This study aims to investigate the choice of intervention time and operation mode between nerve and tendon transfer for the treatment of radial nerve palsy (RNP). METHODS: 46 RNP patients underwent nerve transfer (n = 22) and tendon transfer (n = 24). The intraoperative blood loss, main incision length, operation duration, and length of hospital stay and follow-up period of patients in these two groups were recorded and compared. The range of motion (ROM) of the elbow, wrist, fingers, and thumb, the hand grip and pinch strength, the Disabilities of Arm, Shoulder, and Hand (DASH) and the 36-Item Short Form Health Survey (SF-36) scores were measured and compared preoperatively and postoperatively between the two groups. RESULTS: The ROM of thumb and the hand grip strength of patients in the nerve transfer group were greater than that in the tendon transfer (P < 0.05). Both of the two groups indicated significant improvements in the ROM of elbow, wrist, finger, thumb and the hand grip and pinch strength (P < 0.05) postoperatively. The DASH scores decreased significantly at 6 months (P < 0.05) and 12 months (P < 0.05) after surgery in both groups, while the postoperative SF-36 scores significantly increased (P < 0.05). There was no significant difference in postoperative DASH and SF-36 scores between the two groups (P > 0.05). CONCLUSION: In summary, both nerve and tendon transfer techniques are effective treatments for RNP. Nerve transfer is particularly advantageous for early RNP, while tendon transfer is suitable for patients with radial nerve injury more than one year.

Anatomy of the Superficial Radial Nerve and Its Target Nerves for Targeted Muscle Reinnervation: An Anatomical Cadaver Study.

BACKGROUND: Targeted muscle reinnervation (TMR) is a surgical procedure for treating symptomatic neuroma, in which the neuroma is removed and the proximal nerve stump is coapted to a donor motor branch innervating a nearby muscle. This study aimed to identify optimal motor targets for TMR of the superficial radial nerve (SRN). METHODS: Seven cadaveric upper limbs were dissected to describe the course of the SRN in the forearm and motor nerve supply-number, length, diameter, and entry points in muscle of motor branches-for potential recipient muscles. RESULTS: The radial nerve provided three (three of six) motor branches, two (two of six) motor branches, or one (one of six) motor branch to the brachioradialis muscle, entering the muscle 21.7 ± 17.9 to 10.8 ± 15 mm proximal to the lateral epicondyle. One (one of seven), two (three of seven), three (two of seven), or four (one of seven) motor branches innervated the extensor carpi radialis longus muscle, with entry points 13.9 ± 16.2 to 26.3 ± 14.9 mm distal from the lateral epicondyle. In all specimens, the posterior interosseous nerve gave off one motor branch to the extensor carpi radialis brevis, which divided into two or three secondary branches. The distal anterior interosseus nerve was assessed as a potential recipient for TMR coaptation and had a freely transferable length of 56.4 ± 12.7 mm. CONCLUSIONS: When considering TMR for neuromas of the SRN in the distal third of the forearm and hand, the distal anterior interosseus nerve is a suitable donor target. For neuromas of the SRN in the proximal two-thirds of the forearm, the motor branches to the extensor carpi radialis longus, extensor carpi radialis brevis, and brachioradialis are potential donor targets.

Rehabilitation Following a Triceps Branch to Axillary Motor Nerve Transfer-A Pragmatic Therapy Guide.

Peripheral motor nerve transfer surgery is a technique that may be used to restore motor function to paralyzed muscles. Motor nerve transfer involves harvesting an expendable motor nerve branch, and transfer to the motor branch of the denervated target muscle, using microsurgical coaptation. To date, a standardized rehabilitation protocol does not exist. The 6 stages of rehabilitation after motor nerve transfer surgery were outlined by colleagues in the Birmingham Peripheral Nerve Injury service in 2019. This article aims to provide a practical therapy perspective on the rehabilitation stages of motor nerve transfer surgery outlined in that paper, focusing on the radial to axillary nerve transfer. Timeframes for each stage along with exercise prescription and rationale are provided.

A Fresh Cadaver Study on the Innervation of Brachioradialis and Extensor Carpi Radialis Longus Muscles.

PURPOSE: Distal nerve transfers have revolutionized peripheral nerve surgery by allowing the transfer of healthy motor nerves to paralyzed ones without causing additional morbidity. Radial nerve branches to the brachialis (Ba), brachioradialis (Br), and extensor carpi radialis longus (ECRL) muscles have not been investigated in fresh cadavers. METHODS: The radial nerve and its branches were dissected in 34 upper limbs from 17 fresh cadavers. Measurements were taken to determine the number, origin, length, and diameter of the branches. Myelinated fiber counts were obtained through histological analysis. RESULTS: The first branch of the radial nerve at the elbow was to the Ba muscle, followed by the branches to the Br and ECRL muscles. The Ba and Br muscles consistently received single innervation. The ECRL muscle showed varying innervation patterns, with one, two, or three branches. The branches to the Br muscles originated from the anterior side of the radial nerve, whereas the branches to the Ba and ECRL muscles originated from the posterior side. The average myelinated fiber counts favored the nerve to Br muscle over that to the ECRL muscle, with counts of 542 versus 350 and 568 versus 302 observed in hematoxylin and eosin and neurofilament staining, respectively. CONCLUSIONS: This study provides detailed anatomical insights into the motor branches of the radial nerve to the Ba, Br, and ECRL muscles. CLINICAL RELEVANCE: Understanding the anatomy of the radial nerve branches at the elbow is of utmost importance when devising a reconstructive strategy for upper limb paralysis. These findings can guide surgeons in selecting appropriate donor or recipient nerves for nerve transfer in cases of high tetraplegia and lower-type brachial plexus injuries.

Anterior transposition of the radial nerve to achieve primary suture for its reconstruction: Anatomical feasibility study.

INTRODUCTION: Radial nerve palsy after humeral shaft fractures is often associated with formation of a neuroma in continuity. The current standard of treatment is neuroma resection and nerve grafting with contentious results. Anterior transposition of the radial nerve may reduce the length of its path, allowing reconstruction by primary suture. The aim of this study was to determine the maximum length of radial nerve defect that can be treated by the anterior transposition to allow primary suture to be performed. METHODS: We use 10 arms from five fresh cadavers. The radial nerve was dissected in the lateral inter-muscular septum and along the anterior aspect of the forearm. The radial nerve was transected at the level of the spiral groove and both stumps were than transposed anterior to the medial inter-muscular septum. The length of tension-free overlap that could be achieved was measured. RESULTS: The average length of the overlap at zero degrees of elbow flexion was 10.00 ± 1.84 mm. Theoretically, this will allow a defect of 20 ± 3.69 mm SD to be treated by primary suture. CONCLUSION: Our results suggest that anterior transposition can be used for radial nerve defects up to 2 cm; however, dissection of both stumps proved to be challenging.

Axillary to Radial Nerve Transfer for Recovery of Elbow Extension After Spinal Cord Injury.

BACKGROUND AND OBJECTIVES: Cervical spinal cord injuries (SCI) result in severe loss of function and independence. Nerve transfers have become a powerful method for restoring upper extremity function, the most critical missing function desired by this patient population. Recovery of active elbow extension allows for expansion of one's workspace to reach for objects and stabilizes control at the elbow joint. Without triceps function, a patient with a cervical SCI is rendered entirely helpless when in the supine position. Our objective was to provide a concise description of the transfer of branches of the axillary nerve (AN) to the long head of the triceps branch of the radial nerve (RN) for restoration of elbow extension after cervical SCI. METHODS: An anterior, axillary approach is used for the transfer of the nerve branches of the AN (which may include branches to the teres minor, posterior deltoid, or even middle deltoid) to the long head of the triceps branch of the RN. Preoperative assessment and intraoperative stimulation are demonstrated to direct optimal selection of axillary branch donors. RESULTS: The axillary approach provides full access to all branches of the AN in optimal proximity to triceps branches of the RN and allows for tension-free coaptation to achieve successful recovery of elbow extension. Final outcomes may not be achieved for 18 months. Of our last 20 patients with greater than 12-month follow-up, 13 have achieved antigravity strength in elbow extension, 4 are demonstrating ongoing progression, and 3 are definitive failures by 18 months. CONCLUSION: The axillary to RN transfer is an important intervention for recovery of elbow extension after cervical SCI, which significantly improves quality of life in this patient population. Further large population outcomes studies are necessary to further establish efficacy and increase awareness of these procedures.

[Secondary surgical procedures following motor nerve injuries]. / Sekundäre operative Verfahren bei Verletzungen motorischer Nerven.

BACKGROUND: The functional deficits that develop after a peripheral nerve injury mean a considerable reduction in the quality of life for the affected patients. However, interventions on the injured nerve are not always possible or effective. In this case, secondary procedures, e.g. tendon transfers, are a feasible option for functional reconstruction. OBJECTIVES: An overview of the most common secondary surgical procedures for functional reconstruction after peripheral nerve injuries. METHODS: Presentation and discussion of the most common secondary surgical procedures with emphasis on tendon transfers. Illustration of the primary functions that need to be reconstructed depending on the respective nerve lesion. RESULTS: The basic principle of secondary surgical procedures after nerve injuries is the transposition of a healthy tendomuscular unit to replace a lost function following a loss of muscle or tendon or if an intervention on the nerve is not promising. For example, by transferring flexor forearm muscles, wrist, finger and thumb extension can be reconstructed after radial nerve injury. By transposing the tibialis posterior muscle, dorsiflexion in the talocrural joint can be restored to enable the affected patient to walk safely without an orthosis. CONCLUSIONS: Secondary surgical procedures are a valuable option for functional reconstruction after nerve injury.

Advantages of simultaneous radial nerve and tendon reconstruction - a case report.

Transection of the radial nerve is frequently associated with humeral shaft fractures that are part of a very complex upper extremity injury. In the presented case, a 19-year-old man with a 10-cm radial nerve defect with a need for nerve grafting to recover complete sensory and motor deficit of the radial nerve. In our case, at the same time we provided the tendon transfer of musculus (m.) pronator teres to m. extensor carpi radialis brevis, m. flexor carpi ulnaris to m. extensor digitorum communis, m. palmaris longus to m. extensor pollicis longus, and long sural nerve graft because of an extensive zone of the injury. The assumption was that if these two procedures are performed in one surgery, it will accelerate overall recovery, restore the functionality of the upper limb more quickly, and thus enable a faster recovery.

Spontaneous radial nerve palsy with hourglass-like constriction.

Hourglass-like constriction (HLC) is an uncommon spontaneous mononeuropathy that is typically characterised by a sudden onset of pain followed by palsy, affecting branches of the radial (posterior interosseous nerve) and median nerves (anterior interosseous nerve). HLC of the radial nerve (RN) is rare, with only a few reported cases. Here, we report a case of a man who presented with acute wrist and finger drop due to the HLC of the RN. Surgery was recommended 5 months after clinical observation, when the lesion was resected and primarily repaired, resulting in satisfactory recovery. There is still much that remains unknown about HLC, especially for RN. The current understanding points out an inflammatory disease that should be treated conservatively for 3-7 months. The surgical technique depends mostly on the severity and extent of constriction; however, considering only RN constrictions, primary repair by neurorrhaphy or nerve grafts resulted in better functional outcomes.

Proximal forearm nerve branching patterns: an anatomical study and its clinical significance.

OBJECTIVE: The aim of this study was to add to the understanding of nerve branching patterns in the proximal forearm and consider optimal nerve transfer options to address the various injuries that affect the function of the upper extremity. METHODS: Eleven upper-extremity cadaveric specimens were dissected to expose the radial, median, and ulnar nerves in the proximal forearm. The site of origin of nerve branches from the major nerves was assessed, with measurements made in reference to the lateral epicondyle for the radial nerve branches and the medial epicondyle for the median and ulnar nerve branches. The distances to where these branches entered their respective muscles (muscle entry point) were assessed using the same landmarks. To plan a transfer, the length of the nerve branches was then calculated as the difference from the apparent origin from the main nerve trunk to the location where the nerve entered the muscle. Importantly, the nerve branch origin was established as the location of obvious separation from the main nerve trunk without additional fascicular dissection from the major nerve trunk. The number of branches was determined, and the diameter for each branch was measured using a Vernier caliper. RESULTS: The radial nerve branch to the extensor carpi radialis brevis (ECRB) muscle had an average length of 50.7 mm and average diameter of 1.6 mm. The mean medial and lateral lengths of the radial branches to the supinator muscle were found to be 22.2 mm (diameter 1.4 mm) and 15.3 mm (diameter 1.3 mm), respectively. The anterior interosseous nerve (AIN) branch of the median nerve was found 67.8 mm distal to the medial epicondyle with a diameter of 2.3 mm. The flexor carpi ulnaris (FCU) muscle innervation from the ulnar nerve was provided by 3 or 4 branches in most specimens. The second and third of these branches were the longest, with means of 30.5 mm (diameter 1.4 mm) and 30.7 mm (diameter 1.3 mm), respectively. CONCLUSIONS: While there is variability of the nerve branching pattern in the proximal forearm between specimens, the authors provide evidence of commonalities (branching patterns and distances) that can facilitate planning for upper-extremity nerve reconstructions. Importantly, all measurements are provided with reference to easily identified bony landmarks and to their muscle entry points to aid operative decision-making. These data complement the growing practice of nerve transfers in the upper extremity for a variety of pathologies.

Tendon Transfer for Correction of the Radial Deviation Deformity of the Wrist and Centralization in Posterior Interosseous Nerve Palsy.

There are very few descriptions of tendon transfers designed specifically to address the reconstruction of posterior interosseous nerve palsy (PINP). Unlike a radial nerve palsy (RNP), a patient with a PINP is able to extend their wrist but in radial deviation, because of the preserved innervation of the extensor carpi radialis longus (ECRL). Tendon transfers to restore finger and thumb extension in PINP have been extrapolated from tendon transfers to restore these functions in RNP, specifically using flexor carpi radialis, not flexor carpi ulnaris, so as not to further exacerbate the distinctive radial deviation deformity of the wrist. However, the standard pronator teres to extensor carpi radialis brevis transfer for a RNP fails to address or correct the radial deviation deformity in PINP. We present a simple tendon transfer specifically to address this radial deviation deformity in a PINP, by performing a side-to-side tenorrhaphy of the ECRL tendon to the extensor carpi radialis brevis tendon, followed by transection of the ECRL insertion onto the base of the index finger metacarpal distal to the tenorrhaphy. This technique converts a functioning ECRL from a radially deforming force, transferring its vector of pull onto the base of the middle finger metacarpal and so producing centralization of wrist extension in axial alignment with the forearm.

Volar versus dorsal approach for supinator to posterior interosseous nerve transfer: An anatomical study in cadavers.

INTRODUCTION: Supinator to posterior interosseous nerve (SPIN) transfer allows reconstruction of finger/thumb extension and thumb abduction for low radial nerve palsy, incomplete C6 tetraplegia, and brachial plexus injury affecting C7-T1. No study has compared dorsal versus volar approach to perform SPIN transfer. This comparison is studied in the present work, assessing supinator motor branch length and ability to achieve nerve transfer from either approach. METHODS: Ten fresh frozen cadavers were randomly allocated to receive either a dorsal or volar approach to PIN and supinator radial and ulnar branches (RB = radial, UB = ulnar). Supinator head innervation patterns were documented. RB and UB lengths, forearm lengths measured from ulnar styloid to olecranon, visualization of extensor carpi radialis brevis (ECRB) motor nerve without additional dissection, and ability to perform tension-free nerve transfer were assessed. RESULTS: Nine of 10 specimens had supinator branches innervating both heads. The ECRB nerve was visualized in all volar but only one dorsal approach. No significant differences in forearm length were found. Volar with elbow extended: mean RB length was 35 ± 7.8 mm and UB was 37.8 ± 9.3 mm. Dorsal with elbow extended: mean RB length was 30 ± 4.1 mm and UB was 38.8 ± 7.3 mm. Dorsal with elbow flexed 90°: RB was 25.6 ± 3.8 mm and UB was 34.8 ± 4.8 mm. No significant differences were found in branch lengths between approaches (dorsal vs. volar UB, p = .339; dorsal vs. volar RB, p = .117). All limbs achieved tension-free coaptation. CONCLUSION: Neither approach demonstrated superiority in achieving tension-free nerve transfer. Volar permitted immediate identification of ECRB nerve whereas this was only visualized in one dorsal specimen without additional dissection. Overall, the volar approach allows direct coaptation in elbow extension, mimicking maximal physiologic tension for neurorrhaphy. It simultaneously permits additional procedures for pinch reconstruction via single exposure, circumventing limb/microscope maneuvering, dorsal dissection, and increased operative time. Ultimate choice of approach should depend on surgeon familiarity and potential need for additional simultaneous transfers.

[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.

Decompression with Brachioradialis Tenotomy Improves Pain and Quality of Life in Patients with Radial Sensory Nerve Compression.

BACKGROUND: Decompression of the superficial sensory branch of the radial nerve (SBRN) with complete brachioradialis tenotomy may treat pain in both simple and complex cases of SBRN compression neuropathy. METHODS: A retrospective chart review was performed of consecutive patients undergoing this procedure between 2008 and 2020 including postoperative outcomes within 90 days. Data were collected and analyzed, including patient and injury demographics, pain descriptors, and patient-reported pain questionnaire, including reported pain severity and impact on quality of life using visual analogue scale (VAS) instruments. Within-group presurgical and postsurgical analyses and between-group statistical analyses were performed. RESULTS: Thirty-three of 58 patients met inclusion criteria. Median time from symptom onset to surgery was 300 days, and median postoperative follow-up time was 37 days. Twenty-five percent of patients ( n = 8) underwent isolated SBRN decompression. The remainder had concomitant decompression of another radial [ n = 16 (48%) or peripheral [ n = 12 (36%)] entrapment point. Ten of 33 patients (30%) had resolution of pain at final follow-up ( P = 0.004). Median change in worst pain over the previous week was -4 ( P < 0.001), and average pain over the last month was -2.75 ( P < 0.001) on the VAS. The impact of pain on quality of life showed a median change of -3 ( P < 0.001) on the VAS. CONCLUSION: Decompression of the sensory branch of the radial nerve including a complete brachioradialis tenotomy improves pain and quality-of-life VAS scores in patients with both simple compression neuropathy syndrome and complex nerve compression syndrome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Radial nerve compression: anatomical perspective and clinical consequences.

The radial nerve is the biggest branch of the posterior cord of the brachial plexus and one of its five terminal branches. Entrapment of the radial nerve at the elbow is the third most common compressive neuropathy of the upper limb after carpal tunnel and cubital tunnel syndromes. Because the incidence is relatively low and many agents can compress it along its whole course, entrapment of the radial nerve or its branches can pose a considerable clinical challenge. Several of these agents are related to normal or variant anatomy. The most common of the compressive neuropathies related to the radial nerve is the posterior interosseus nerve syndrome. Appropriate treatment requires familiarity with the anatomical traits influencing the presenting symptoms and the related prognoses. The aim of this study is to describe the compressive neuropathies of the radial nerve, emphasizing the anatomical perspective and highlighting the traps awaiting physicians evaluating these entrapments.