Anatomical variations of the superficial branch of the radial nerve and the dorsal branch of the ulnar nerve: a detailed electrophysiological study

We assessed the proximity of neurological structures to arthroscopic portals in a cadaveric study and through a systematic review. Arthroscopy was performed on ten cadaveric wrists. Subsequently the specimens were dissected to isolate the superficial branch of the radial nerve, the dorsal branch of the ulnar nerve, the posterior interosseous nerve and the extensor tendons. We measured the distances from the nerves to common portals. For the systematic review Pubmed and EMBASE were searched on the 31 May 2014 for cadaveric studies reporting the proximity of neurological structures to any arthroscopic wrist portal. In the cadaveric study, partial injuries were seen to six extensor tendons and one posterior interosseous nerve; it was assumed this was due to creation of the portals. Seven published studies were included in the systematic review. The dorsal sensory branch of the ulnar nerve was found to be at risk by performing the 6 Ulnar, 6 Radial and ulnar midcarpal portals, the sensory branch of the radial nerve by the 1–2 and 3–4 portals and the posterior interosseous nerve by the 3–4 and 4–5 portals. Level of evidence: V

Download Full-text

Sensory Nerve Transfer for Lower Roots Brachial Plexus Injury: Superficial Radial Nerve to the Dorsal Cutaneous Branch and the Superficial Branch of the Ulnar Nerve

Journal of Hand and Microsurgery ◽

10.1055/s-0039-1685545 ◽

2019 ◽

Vol 11 (03) ◽

pp. 178-180

Author(s):

Feiran Wu ◽

Chye Yew Ng

Keyword(s):

Brachial Plexus ◽

Ulnar Nerve ◽

Radial Nerve ◽

Brachial Plexus Injury ◽

Donor Site ◽

Sensory Nerve ◽

Nerve Transfer ◽

Superficial Radial Nerve ◽

Superficial Branch ◽

Cutaneous Branch

AbstractIn the treatment of brachial plexus injury to lower nerve roots, the priority is to restore motor function to the paralyzed hand. In addition, it is also important to consider sensory reconstruction, which is crucial to the optimal restoration of prehensile function. We report the surgical technique and sensory recovery of a nerve transfer in a case in which the superficial radial nerve was transferred to the dorsal cutaneous branch and the superficial branch of the ulnar nerve in a patient with C7, C8, and T1 roots injury. The nerve transfer successfully restored sensation in the ulnar one and a half digits as well as the ulnar border of the hand, with minimal donor site deficit. This technique provides a useful sensory reconstructive option in patients with brachial plexus injury to lower roots.

Download Full-text

Treatment of End-Neuromas, Neuromas-in-Continuity and Scarred Nerves of the Digits by Proximal Relocation

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2004.01.005 ◽

2004 ◽

Vol 29 (4) ◽

pp. 338-350 ◽

Cited By ~ 52

Author(s):

A. HAZARI ◽

D. ELLIOT

Keyword(s):

Pain Relief ◽

Ulnar Nerve ◽

Radial Nerve ◽

Nerve Repair ◽

Primary Site ◽

Crush Injury ◽

Spontaneous Pain ◽

Results Of Treatment ◽

Dorsal Branch ◽

Direct Pressure

This paper reports the results of treatment by proximal relocation of 104 painful nerves in 57 digits in 48 patients. These included 86 digital nerves and 18 terminal branches of the superficial radial nerve and the dorsal branch of the ulnar nerve. Eighty-three were end-neuromas and 14 were neuromas-in-continuity, of which nine followed nerve repair and five occurred following a closed crush injury. Seven were painful as a result of tethering in scarred tissue. Eighty nerves (77%) required a single relocation and 24 (23%) required more than one operation. Ninety-eight per cent of nerve relocations achieved complete pain relief at the primary site. One patient had mild pain on pressure at the primary site after relocation of two nerves from this site. Over 90% of the nerves had no spontaneous pain, pain on movement or hypersensitivity of the overlying skin at the final site of relocation. However, the incidence of mild or no pain on direct pressure at the site of nerve relocation was lower at 83% as relocated nerves, although traumatized less often at the sites chosen for relocation, can still be painful on direct pressure.

Download Full-text

Robert Wartenberg Syndrome and Sign: A Review Article

The Open Orthopaedics Journal ◽

10.2174/1874325002115010013 ◽

2021 ◽

Vol 15 (1) ◽

pp. 13-16

Author(s):

Stuart H. Kuschner ◽

Haben Berihun

Keyword(s):

Ulnar Nerve ◽

Radial Nerve ◽

Nerve Palsy ◽

Sensory Nerve ◽

Surgical Decompression ◽

Activity Restriction ◽

Ulnar Nerve Palsy ◽

Superficial Branch ◽

Wartenberg’S Syndrome ◽

Little Finger

Background: Robert Wartenberg, a European-American neurologist, was born in 1887 and died in 1956. His description of radial sensory nerve compression at the forearm is memorialized as Wartenberg’s syndrome. He recognized that involuntary abduction of the little finger could be caused by ulnar nerve palsy - a finding often called Wartenberg’s sign Syndrome and signs are reviewed, and a brief biography is presented. Objective: To review Wartenberg’s sign and Wartenberg’s syndrome. Discussion: Compression of the superficial branch of the radial nerve, often called Wartenberg’s syndrome, is characterized by pain, paresthesia, and dysesthesia along the dorsoradial distal forearm. Non-operative treatment can include activity restriction and anti-inflammatory medication. If symptoms persist, surgical decompression of the radial nerve is an option. The abducted posture of the little finger - Wartenberg’s sign - can result from a low ulnar nerve palsy. Tendon transfer can be performed to correct this deformity. Conclusion: Compression of the superficial branch of the radial nerve and abducted posture of the little finger were described by Robert Wartenberg and carry his name as eponymous syndrome and sign, respectively.

Download Full-text

Management of cubital tunnel syndrome by anterior trans-muscular transposition of the ulnar nerve

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-019-0067-2 ◽

2019 ◽

Vol 34 (1) ◽

Author(s):

Ahmed Shawky Ammar ◽

Mohamed Ahmed El Tabl ◽

Dalia Salah Saif

Keyword(s):

Clinical Outcome ◽

Ulnar Nerve ◽

Visual Analog Scale ◽

Electrophysiological Study ◽

Cubital Tunnel Syndrome ◽

Nerve Entrapment ◽

Cubital Tunnel ◽

Analog Scale ◽

Tunnel Syndrome ◽

Dash Questionnaire

Abstract Background Various surgical options are used for the treatment of ulnar nerve entrapment at the elbow. In this study, anterior trans-muscular transposition of the ulnar nerve was used for the treatment of cubital tunnel syndrome. Objectives To evaluate the surgical results of anterior trans-muscular transposition technique for the treatment of cubital tunnel syndrome with particular emphasis on clinical outcome. Methods Forty patients with cubital tunnel syndrome were operated using anterior trans-muscular transposition technique. Patients were classified into post-operative clinical outcome grades according to the Wilson & Krout criteria, and they were followed up by visual analog scale (VAS), the Disability of Arm Shoulder and Hand (DASH) questionnaire, electrophysiological study, and post-operative clinical evaluation. Results Forty patients with cubital tunnel syndrome who underwent anterior trans-muscular transposition of the ulnar nerve show a significant clinical improvement at 24 months post-surgery regarding visual analog scale (VAS), the Disability of Arm Shoulder and Hand (DASH) questionnaire, electrophysiological study, and the Wilson & Krout grading as 87.5% of the patients recorded excellent and good outcome. Conclusion Anterior transmuscular transposition of the ulnar nerve is a safe and effective treatment for ulnar nerve entrapment at the elbow.

Download Full-text

Transfer of a Motor Fascicle From the Ulnar Nerve to the Branch of the Radial Nerve Destined to the Long Head of the Triceps for Restoration of Elbow Extension in Brachial Plexus Surgery

Neurosurgery ◽

10.1227/neu.0b013e31822ac120 ◽

2011 ◽

Vol 70 (2) ◽

pp. E516-E520 ◽

Cited By ~ 11

Author(s):

Leandro Pretto Flores

Keyword(s):

Computed Tomography ◽

Brachial Plexus ◽

Ulnar Nerve ◽

Radial Nerve ◽

Nerve Transfer ◽

Elbow Flexion ◽

Shoulder Abduction ◽

Elbow Extension ◽

Long Head ◽

Brachial Plexus Surgery

Abstract BACKGROUND AND IMPORTANCE: Restoration of elbow extension has not been considered of much importance regarding functional outcomes in brachial plexus surgery; however, the flexion of the elbow joint is only fully effective if the motion can be stabilized, what can be achieved solely if the triceps brachii is coactivated. To present a novel nerve transfer of a healthy motor fascicle from the ulnar nerve to the nerve of the long head of the triceps to restore the elbow extension function in brachial plexus injuries involving the upper and middle trunks. CLINICAL PRESENTATION: Case 1 is a 32-year-old man sustaining a right brachial extended upper plexus injury in a motorcycle accident 5 months before admission. The computed tomography myelogram demonstrated avulsion of the C5 and C6 roots. Case 2 is a 24-year-old man who sustained a C5-C7 injury to the left brachial plexus in a traffic accident 4 months before admission. Computed tomography myelogram demonstrated signs of C6 and C7 root avulsion. The technique included an incision at the medial border of the biceps, in the proximal third of the involved arm, followed by identification of the ulnar nerve, the radial nerve, and the branch to the long head of the triceps. The proximal stump of a motor fascicle from the ulnar nerve was sutured directly to the distal stump of the nerve of the long head of the triceps. Techniques to restore elbow flexion and shoulder abduction were applied in both cases. Triceps strength Medical Research Council M4 grade was obtained in both cases. CONCLUSION: The attempted nerve transfer was effective for restoration of elbow extension in primary brachial plexus surgery; however, it should be selected only for cases in which other reliable donor nerves were used to restore elbow flexion.

Download Full-text