Ultrasound unveils deep radial nerve entrapment due to elbow capsule distension in a case with rheumatoid arthritis.

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Ultrasound-Guided Hydrodissection Provides Complete Symptom Resolution in Radial Tunnel Syndrome: A Case Series and Scoping Review on Hydrodissection for Radial Nerve Pathology.

ABSTRACT: This study analyzes the effectiveness of ultrasound-guided hydrodissection (HD) perineural as a treatment for radial tunnel syndrome (RTS). A literature search was performed along with retrospective analysis of local cases to assess outcomes and safety of this procedure. In the case series, surgical candidates, defined as cases with over 80% but temporary relief after diagnostic injection, were treated with ultrasound-guided HD. Of 22 patients who received ultrasound-guided diagnostic injections, 11 proceeded to HD. All HD patients experienced complete and lasting symptom resolution for a minimum of 2 years, and none required surgery. Thorough literature review provided seven studies, which fulfilled inclusion criteria. Sixty-one patients are represented in the literature. All studies reported significant benefit to pain symptoms with HD of radial nerve, with five specifying over 90% improvement. No adverse effects from HD were noted in any study. Ultrasound-guided HD of the radial tunnel has potential to be a surgery sparing treatment for RTS.

Radial nerve palsy: If in doubt, use ultrasound.

Sonographic demonstration of radial nerve compression by a strict permanent suture, with intra-operative correlation.

Surgical treatment of hourglass-like radial nerve constrictions.

INTRODUCTION: Spontaneous radial nerve palsy with the surgical revelation of an hourglass-like constriction is a complicated condition. In general, the surgical strategy is decided in accordance with the results of surgical exploration. This study aimed to investigate the efficacies of various choices of surgical methods in the treatment of hourglass-like radial nerve constrictions. MATERIAL AND METHODS: Ten patients with spontaneous radial nerve palsy undergoing surgical exploration with the revelation of hourglass-like constrictions between November 2010 and December 2018 were reviewed in our hospital. Preoperative physical, electrophysiological and ultrasound examinations were performed for all patients. Varying levels, degrees and numbers of radial nerve constrictions were shown by surgical exposure. Epineurectomy and interfascicular neurolysis were performed in 4 cases with incomplete constrictions; resection and primary suture repair in 2 radial nerves with neurotmesis; resection and autologous nerve grafting in 4 patients with nerve defect>2cm. Both motor and sensory evaluations were performed at a follow-up visit. RESULTS: Ten patients underwent different history before the onset of symptom. Nerve ultrasound demonstrated swelling as well as constrictions of the radial nerve. All patients who were followed up presented with good to excellent recovery of motor function. The effectiveness of suture and autograft repair tended to be better than that of simple neurolysis. CONCLUSION: The etiology of hourglass-like fascicular constrictive neuropathy of radial nerve involve with torsional factors. Nerve ultrasound is an important and useful measurement in diagnosing the pathology of spontaneous radial nerve palsy and in helping determine surgical approach. The surgical intervention is beneficial for the patients who do not recover in 4 weeks after onset of symptoms and for severe hourglass-like constrictions that are confirmed by preoperative ultrasound imaging. We recommend that nerve grafting be a suitable method in confrontation of nerve defect>2cm.

The Efficacy of Ultrasound for Visualizing Radial Nerve Lesions with Coexistent Plate Fixation of Humeral Shaft Fractures.

INTRODUCTION: Ultrasound has been commonly employed for depicting the morphology of the lesions in patients with radial nerve neuropathy, including entrapment, tumor, trauma, and iatrogenic injury. However, few studies have evaluated the efficacy of ultrasound for visualizing radial nerve lesions with coexistent plate fixation of humeral shaft fractures. This study aimed to address this special clinical issue. METHODS: We retrospectively examined the efficacy of ultrasound for visualizing radial nerve lesions with coexistent plate fixation of humeral shaft fractures based on intraoperative findings in patients who were treated in our hospital from January 2007 to June 2019. RESULTS: Forty-six patients were included, and there was a 100% concordance between the ultrasound and intraoperative findings on radial nerve lesions. Ultrasonography revealed four types of lesions: radial nerve in continuity in thirty-one patients, neuroma in continuity in four patients, radial nerve stuck under the plate in three patients, and radial nerve transection in eight patients. The lesion radial nerve in continuity comprised two situations according to intraoperative electrodiagnostic test results, which could not be differentiated by ultrasonography, radial nerve in continuity treated with neurolysis in twenty-five patients and radial nerve in continuity treated with nerve graft in six patients. CONCLUSION: Ultrasonography can accurately depict radial nerve lesions with coexistent plate fixation of humeral shaft fractures. It provides a basis for determining the extent of nerve damage in all patients except those with the lesion radial nerve in continuity, which is conducive to making treatment decisions as early as possible.

Cuando lo central parece periférico: síndrome del interóseo posterior como manifestación aislada de ictus hemorrágico / Posterior interosseous nerve syndrome as an isolated symptom of haemorrhagic stroke: The central mimicking the peripheral

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Delayed Radial Nerve Palsy After Nonoperative Treatment of Humeral Shaft Fractures: A Report of 2 Cases.

CASE: Two patients who developed radial nerve palsy at least 6 weeks after injury during nonoperative treatment of humeral shaft fractures. This complication was associated with external bracing, progressive varus angulation during treatment, and excess callus formation. CONCLUSION: Delayed radial nerve palsy may develop during nonoperative treatment of humeral shaft fractures when functional bracing fails to maintain alignment and stability at the fracture site.

Effectiveness of ultrasonographic evaluation under general anesthesia for radial nerve palsy associated with humeral fractures during the first operation.

PURPOSE: To evaluate the effectiveness of sonographic evaluation of the radial nerve at the first operation for closed humeral fracture cases. METHODS: Seventeen cases of closed humeral fractures were included in this study. These cases were categorized into two groups: Group P, consisting of seven cases with complete radial nerve palsy after the injuries; and Group C, consisting of ten cases without radial nerve palsy after the injuries. Sonographic evaluation of the condition of the radial nerve was performed before or after open or closed reduction and internal fixation (ORIF or CRIF) during the first operation. RESULTS: Five of seven Query ID="Q2" Text=" As keywords are mandatory for this journal, please provide 3-6 keywords." cases in Group P showed entrapment or compression of the radial nerve at fracture sites with sonography. Simultaneous radial nerve exploration (SRNE) confirmed sonographic findings in these five cases. The other two cases showed no abnormal sonographic findings except swelling of the radial nerve. CLIF without SRNE was selected and additional sonographic reevaluation of the nerve after CRIF confirmed there were no iatrogenic nerve injuries in these two cases. All of the ten cases in Group C showed no abnormal sonographic findings of the radial nerve. Five of these ten cases selected ORIF, exposed the nerve at the time of approaching the fracture site, and matched sonographic findings. The other five cases without exposure of the nerve confirmed no iatrogenic radial nerve injuries with additional sonographic reevaluation after ORIF or CRIF. All cases in Group P had complete resolution of radial nerve palsy within 4 months postoperatively, and no case in Group C had postoperative iatrogenic radial nerve palsy. CONCLUSIONS: Sonographic evaluation of the radial nerve at the first operation was a useful method to detect conditions of the nerve which can prevent compression or entrapment of the nerve and the need for secondary nerve exploration.

Radial Nerve Palsy After Intercondylar Distal Humerus Fracture: A Case Report.

CASE: A 30-year-old man sustained an injury to the right elbow after a fall from a bike. On clinical examination, he had preoperative radial nerve palsy with radiological diagnosis of the intercondylar distal humerus fracture. Intraoperatively, the patient had the radial nerve entrapped between the proximal metaphyseal fragment and distal lateral condyle of the humerus. CONCLUSION: Preoperative radial nerve palsy associated with the intercondylar distal humerus fracture is very rare. Fractures with the significant anterolateral displacement of the proximal metaphyseal fracture segment may entrap the course of the radial nerve in the anterior compartment of the distal humerus and thus manifest as radial nerve palsy.

Ultrasound-Guided Hydraulic Release Associated With Corticosteroids in Radial Tunnel Syndrome: Description of Technique and Preliminary Clinical Results.

The aim of this study was to describe a perineural ultrasound-guided infiltration technique for management of radial tunnel syndrome and to report its preliminary results in 54 patients. A mixture of a saline solution, a local anesthetic, and a corticosteroid solution was infiltrated in the perineural region at the arcade of Frohse. Pain was reported in 100% of patients before the procedure versus 1.9% after the procedure. Scratch collapse and Cozen test results were positive in 98.1% and 66.7% of patients before infiltration, respectively, versus 5.6% and 9.2% after infiltration. All variables had statistically significant differences between preprocedure and postprocedure evaluations (P < .01).

Secondary Neurolymphomatosis of the Radial Nerve: A Diagnostic Challenge.

BACKGROUND Secondary neurolymphomatosis is a rare clinical condition that may be observed in patients with hematologic malignancies. Clinical findings can overlap with other conditions. Diagnosis can be obtained by magnetic resonance imaging (MRI) and imaging with positron emission tomography (PET) and confirmed by biopsy. CASE REPORT A 55-year-old male patient with known previous history of periocular non-Hodgkin's lymphoma mucosa-associated lymphoid tissue (MALT) type presented reporting he had a focal soft-tissue swelling mass on the external side of the right arm, suspected for lipoma. US, MRI, and FDG PET/CT were performed, revealing malignant imaging characteristics of the lesion, suspected to be a neurolymphoma. A biopsy confirmed the nature of the lesion. No further sites of malignancy were detected on whole-body PET/CT. CONCLUSIONS Lymphomatous involvement of peripheral nerves may clinically overlap with other, more common, benign conditions; therefore, although it is rarer, this diagnosis has to be considered in patients with a clinical history of hematologic malignancies.

Ultrasound Evaluation of Radial Nerve Palsy Associated with Humeral Shaft Fractures to Guide Operative Versus Non-Operative Treatment.

OBJECTIVE: To determine the effectiveness of diagnostic ultrasound (US) at evaluating the condition of the radial nerve in the setting of humeral shaft fractures. MATERIALS AND METHODS: An observational study was performed of 18 patients with radial nerve palsy associated with humeral shaft fractures who underwent US examination to assess the condition of the radial nerve. RESULTS: Six patients with humeral shaft fractures treated nonoperatively in a functional brace had US findings consistent with contusion or stretch radial nerve injury. Twelve patients ultimately underwent surgery either because US showed an entrapped or lacerated radial nerve, or for other operative indications. There was a 92% concordance (11/12 patients) between US and intraoperative findings with regards to the condition and location of the radial nerve, with the remaining case being complicated by delayed surgical treatment secondary to patient factors. CONCLUSION: Our study demonstrates that US is an effective diagnostic tool in evaluating radial nerve injuries in the setting of humeral shaft fractures and can aid in clinical decision making by differentiating between patients with nerve laceration or entrapment who may benefit from surgery from those with neurapraxia managed nonoperatively.

A method of ultrasound diagnosis for unilateral peripheral entrapment neuropathy based on multilevel side-to-side image contrast.

Individual variations have been reported in the existing methods for examining peripheral entrapment neuropathy, by which limited sites can be examined. In this study, the patients with unilateral carpal tunnel syndrome (CTS), cubital tunnel syndrome (CuTS) and radial nerve compression (RNC) were selected as research subjects and an ultrasound technique was proposed based on multilevel side-to-side image contrast for the diagnosis of unilateral peripheral entrapment neuropathy. According to the statistical analysis of 62 patients with CTS, CuTS or RNC, the diagnostic thresholds of the cross-sectional area swelling ratio (CSASR) for diagnosis of CTS, CuTS or RNC were 1.22, 1.51 and 1.50, respectively. The surgical therapeutic thresholds of CSASR for the treatment of CTS, CuTS and RNC were 1.48, 1.67 and 3.04, respectively. When the maximal CSASR of the diseased nerve was greater than or equal to the diagnostic threshold, the nerve compression could be diagnosed. If it was less than the diagnostic threshold, nerve compression was excluded. Conservative treatment was indicated when the maximal CSASR of the diseased nerve was less than the therapeutic threshold. When the maximal CSASR was greater than or equal to the therapeutic threshold, surgical treatment was indicated, and the nerve release procedure was selected. The novel multilevel side-to-side image contrast ultrasound technique proposed in this study can substantially reduce the impact of individual variation and explore the full course of the diseased nerve. It is a novel approach for diagnosis, treatment selection, and determination of treatment sites of unilateral peripheral entrapment neuropathy.