scholarly journals Right radial nerve decompression for refractory radial tunnel syndrome

2021 ◽  
Vol 12 ◽  
pp. 507
Author(s):  
Rohin Singh ◽  
Yeonsoo Sara Lee ◽  
Pelagia E. Kouloumberis ◽  
Shelley S. Noland
Keyword(s):  
Radial Nerve ◽  
Sensory Nerve ◽  
Nerve Decompression ◽  
Supinator Muscle ◽  
History Of ◽  
Tunnel Syndrome ◽  
The Right ◽  
Patient’S History ◽  
Extensor Carpi Radialis ◽  
Radial Tunnel Syndrome

Background: Radial tunnel syndrome arises due to compression of the radial nerve through the radial tunnel.[1,5] The radial nerve divides into superficial and deep branches in the forearm. The deep branch travels posteriorly through the heads of the supinator where compression commonly occurs.[3,9,7] This syndrome results in pain in the hand and forearm with no motor weakness.[8] This condition can be treated conservatively with splinting and anti-inflammatory medication.[2,4,6] For cases of refractory radial tunnel syndrome, surgical management can be considered. Herein, we have presented a step-by-step video guide on how to perform a radial nerve decompression with a review of the relevant anatomy and surgical considerations. Case Description: A 68-year-old right-handed woman presented to the Mayo Clinic (Scottsdale, AZ) with the right elbow pain which radiated to the forearm causing significant difficulties with daily tasks. She had been dealing with worsening symptoms for 4 months. The patient’s history of gardening and clinical presentation allowed for diagnosis of radial tunnel syndrome. After conservative measures failed and other differential diagnoses were excluded, surgical decompression was recommended to treat her symptoms. The patient’s right arm was marked preoperatively between the brachioradialis and extensor carpi radialis longus (ECRL) muscles. The posterior cutaneous nerve of the forearm was identified which allowed for the determination of the interval between the brachioradialis and ECRL. Separation of the two muscles allowed for the identification of the radial sensory nerve. A nerve stimulator was used to confirm the sensory nature of this nerve. The nerve to the extensor carpi radialis brevis (ECRB) was identified and retracted with a vessel loop. Dorsal to the nerve to the ECRB is the posterior interosseous nerve (PIN), which was identified and retracted with a vessel loop. The fascia of the ECRB was divided both longitudinally and transversely and the supinator below was identified. The supinator muscle was carefully divided to further decompress the PIN. Informed consent for publication of this material was obtained from the patient. Conclusion: The patient tolerated the procedure well and reported significantly reduced pain at 7-month follow-up. To the best of our knowledge, video tutorials on this procedure have not been published. This video can serve as an educational guide for peripheral nerve specialists dealing with similar lesions.

Radial Tunnel Syndrome

1995 ◽  
Vol 20 (4) ◽  
pp. 454-459 ◽  
Author(s):  
T. LAWRENCE ◽  
P. MOBBS ◽  
Y. FORTEMS ◽  
J. K. STANLEY
Keyword(s):  
Radial Nerve ◽  
Tennis Elbow ◽  
Free Edge ◽  
Wrist Pain ◽  
Duration Of Symptoms ◽  
Supinator Muscle ◽  
Prolonged Duration ◽  
Tunnel Syndrome ◽  
Manual Tasks ◽  
Radial Tunnel Syndrome

Radial tunnel syndrome results from compression of the radial nerve by the free edge of the supinator muscle or closely related structures in the vicinity of the elbow joint. Despite numerous reports on the surgical management of this disorder, it remains largely unrecognized and often neglected. The symptoms of radial tunnel syndrome can resemble those of tennis elbow, chronic wrist pain or tenosynovitis. Reliable objective criteria are not available to differentiate between these pathologies. These difficulties are discussed in relation to 29 patients who underwent 30 primary explorations and proximal decompressions of the radial nerve. Excellent or good results were obtained in 70%, fair results in 13% and poor results in 17% of patients. The results can be satisfactory despite the prolonged duration of symptoms. We believe that a diagnosis of radial tunnel syndrome should always be born in mind when dealing with patients with forearm and wrist pain that has not responded to more conventional treatment. Patients with occupations requiring repetitive manual tasks seem to be particularly at risk of developing radial tunnel syndrome and it is also interesting to note that 66% of patients with on-going medico-legal claims had successful outcomes following surgery.

scholarly journals Is Dry Needling of the Supinator a Safe Procedure? A Potential Treatment for Lateral Epicondylalgia or Radial Tunnel Syndrome. A Cadaveric Study

2021 ◽  
Vol 18 (17) ◽  
pp. 9162
Author(s):  
César Fernández-de-las-Peñas ◽  
Carlos López-de-Celis ◽  
Jacobo Rodríguez-Sanz ◽  
César Hidalgo-García ◽  
Joseph M. Donnelly ◽  
...  
Keyword(s):  
Radial Nerve ◽  
Cadaveric Study ◽  
Safe Procedure ◽  
Dry Needling ◽  
Needle Penetration ◽  
Filiform Needle ◽  
Supinator Muscle ◽  
Lateral Epicondylalgia ◽  
Tunnel Syndrome ◽  
Radial Tunnel Syndrome

The supinator muscle is involved in two pain conditions of the forearm and wrist: lateral epicondylalgia and radial tunnel syndrome. Its close anatomical relationship with the radial nerve at the arcade of Frohse encourages research on dry needling approaches. Our aim was to determine if a solid filiform needle safely penetrates the supinator muscle during the clinical application of dry needling. Needle insertion of the supinator muscle was conducted in ten cryopreserved forearm specimens with a 30 × 0.32 mm filiform needle. With the forearm pronated, the needle was inserted perpendicular into the skin at the dorsal aspect of the forearm at a point located 4cm distal to the lateral epicondyle. The needle was advanced to a depth judged to be in the supinator muscle. Safety was assessed by measuring the distance from the needle to the surrounding neurovascular bundles of the radial nerve. Accurate needle penetration of the supinator muscle was observed in 100% of the forearms (needle penetration:16.4 ± 2.7 mm 95% CI 14.5 mm to 18.3 mm). No neurovascular bundle of the radial nerve was pierced in any of the specimen’s forearms. The distances from the tip of the needle were 7.8 ± 2.9 mm (95% CI 5.7 mm to 9.8 mm) to the deep branch of the radial nerve and 8.6 ± 4.3 mm (95% CI 5.5 mm to 11.7 mm) to the superficial branch of the radial nerve. The results from this cadaveric study support the assumption that needling of the supinator muscle can be accurately and safely conducted by an experienced clinician.

scholarly journals Morphological Classification of Arch of Frohse and Its Implication in Compression of Deep Branch of Radial Nerve

2021 ◽  
Vol 10 (31) ◽  
pp. 2412-2415
Author(s):  
Syed Rehan Hafiz Daimi ◽  
Srinivasa Rao Bolla ◽  
Moizuddin Jawaduddin Khwaja ◽  
Sanket Dadarao Hiware ◽  
Shajiya Sarwar Moosa ◽  
...  
Keyword(s):  
Radial Nerve ◽  
Inferior Margin ◽  
Deep Branch ◽  
Supinator Muscle ◽  
Essential Components ◽  
Arcade Of Frohse ◽  
Tunnel Syndrome ◽  
Supinator Syndrome ◽  
Superior Margin ◽  
Radial Tunnel Syndrome

BACKGROUND Arcade of Frohse (AF) is a tendinous superior margin of superficial layer of supinator muscle which was first described by Frohse and Frankel in 1908. Since then it has been studied by many authors and held accountable as one of the essential components for compression of deep branch of radial nerve (DBRN) which leads to radial tunnel syndrome. Considering AF as an important element of compression, we made an attempt to classify it on the basis of its shape and to find out if any particular shape has a predominant role in compression of the nerve. We also observed the structure of superior and inferior margin of the supinator muscle. METHODS This study was conducted among 80 (70 males and 10 females) formalin fixed upper limbs present in the Department of Anatomy. The limbs were maintained in supine with slightly flexed position and dissection was performed to expose the supinator muscle. The proximal and distal borders of supinator muscles were examined meticulously with the help of magnified lens. The morphometric measurements were taken with the help of a digital caliper. RESULTS The FA is classified into four categories as loop, high arc, low arch and linear shaped. The most frequent shape observed was arch shaped (high and low arch) about 66%, followed by loop shaped (30%) and least was linear shaped (2.5%). On the basis of structure, the proximal and distal margin of supinator muscle was reported to be tendinous in majority of the cases. The distance of the AF from the fixed reproducible anatomical landmark like inter epicondylar line (IEL) was measured and the average distance found was 3.36 cm. CONCLUSIONS Knowledge of different shapes would aid surgeons and radiologists for better approach towards diagnosis and management of supinator syndrome. The morphometric finding can be useful for surgeons to locate the superior margin of supinator (AF) in surgical procedures for decompression of DBRN in supinator syndrome. KEY WORDS Arcade of Frohse, Inter Epicondylar Line, Supinator Muscle, Deep Branch of Radial Nerve and Radial Tunnel Syndrome

scholarly journals Humeral shaft fracture associated with radial nerve palsy -a case report

2021 ◽  
pp. 54-55
Author(s):  
Rishitha M ◽  
Akasha Sindhu M
Keyword(s):  
Radial Nerve ◽  
Nerve Palsy ◽  
Wrist Joint ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Loss Of Function ◽  
History Of ◽  
The Right

Radial nerve palsy was induced by radial nerve compression, which was often caused by humerus bone fracture. This leads to pain, weakness, or loss of function mostly in the wrist, hand, and fingers. We reported a case of a 24-year-old male patient with complaints of swelling of the right-hand wrist joint and pain during extension and flexion while moving. He had a three-month history of mild displaced humeral shaft fracture from a traffic accident and an intramedullary Ender nailing was performed. He now has been admitted with swelling in his right wrist joint and pain while moving his hand. The case was diagnosed as Radial nerve palsy. Surgery was performed, the proximal and distal ends of the radial nerve were separated at the humeral bone's surface. The radial nerve stumps were enough long to be sutured. Our one-month follow-up shows no complications. The majority cases of radial nerve palsy will resolve within a few weeks after surgery, as our patient did, and the most prominent is patient education.

scholarly journals Median to radial nerve transfer after traumatic radial nerve avulsion in a pediatric patient

2019 ◽  
Vol 24 (2) ◽  
pp. 209-214 ◽  
Author(s):  
Ellen L. Larson ◽  
Katherine B. Santosa ◽  
Susan E. Mackinnon ◽  
Alison K. Snyder-Warwick
Keyword(s):  
Pediatric Patient ◽  
Radial Nerve ◽  
Sensory Nerve ◽  
Nerve Transfer ◽  
Orthopedic Procedures ◽  
Pronator Teres ◽  
Nerve Transfers ◽  
Muscle Groups ◽  
Flexor Digitorum ◽  
Extensor Carpi Radialis

This case report describes an isolated radial nerve avulsion in a pediatric patient, treated by combination sensory and motor median to radial nerve transfers. After traumatic avulsion of the proximal radial nerve, a 12-year-old male patient underwent end-to-end transfer of median nerve branches to flexor carpi radialis and flexor digitorum superficialis to the posterior interosseous nerve and extensor carpi radialis nerve, respectively. He underwent end-to-side sensory transfer of the superficial radial sensory to the median sensory nerve. Pronator teres to extensor carpi radialis brevis tendon transfer was simultaneously performed to power short-term wrist extension. Within months after surgery, the patient had regained 9–10/10 sensation in the hand and forearm. In the following months and years, he regained dexterity, independent fine-finger and thumb motions, and 4–5/5 strength in all extensors except the abductor pollicis longus muscle. He grew 25 cm without extremity deformity or need for secondary orthopedic procedures. In appropriate adult and pediatric patients with proximal radial nerve injuries, nerve transfers have advantages over tendon transfers, including restored independent fine finger motions, regained sensation, and reinnervation of multiple muscle groups with minimal donor sacrifice.

The Innervation Pattern of the Radial Nerve at the Elbow and in the Forearm

1998 ◽  
Vol 23 (2) ◽  
pp. 167-169 ◽  
Author(s):  
G. BRANOVACKI ◽  
M. HANSON ◽  
R. CASH ◽  
M. GONZALEZ
Keyword(s):  
Radial Nerve ◽  
Sensory Nerve ◽  
Extensor Digitorum ◽  
Sensory Nerves ◽  
Posterior Interosseous Nerve ◽  
Extensor Pollicis Longus ◽  
Abductor Pollicis Longus ◽  
Extensor Carpi Ulnaris ◽  
Wide Variability ◽  
Extensor Carpi Radialis

Sixty paired cadaver forearms were dissected to examine the distribution of the radial nerve branches to the muscles at the elbow and forearm. Emphasis was placed on the innervation of the extensor carpi radialis brevis and the supinator muscles because of discrepancies in the literature concerning these muscles. The most common branching pattern (from proximal to distal) was to brachioradialis, extensor carpi radialis longus, superficial sensory, extensor carpi radialis brevis, supinator, extensor digitorum/extensor carpi ulnaris, extensor digiti minimi, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus and extensor indicis. The branch to extensor digitorum and extensor carpi ulnaris came off as a common stem often with the branch to extensor digiti minimi. The branch to the ECRB muscle was noted to arise from the posterior interosseous nerve in 45%, superficial sensory nerve in 25% and at the bifurcation of the posterior interosseous and superficial sensory nerves in 30% of specimens. The supinator had an average of 2.3 branches from the posterior interosseous nerve (range 1–6). The branches to the supinator showed a wide variability proximal to and within the supinator.

scholarly journals Carpal tunnel syndrome and manual milking: nerve conduction studies in 43 cases

2006 ◽  
Vol 64 (3b) ◽  
pp. 747-749 ◽  
Author(s):  
João Aris Kouyoumdjian ◽  
Rogério Gayer Machado de Araújo
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Sensory Nerve ◽  
Nerve Conduction Studies ◽  
Left Hand ◽  
Tunnel Syndrome ◽  
The Mean ◽  
The Right ◽  
Mean Time

From 1989 to 2004, 3125 consecutive patients had electrodiagnosis of carpal tunnel syndrome (CTS); from these 43 cases (1.38%) were associated to manual milking; mean age was 44.9 years and 88.4% were male. The mean time in the milking profession was 247 months; the mean daily milking time was 146 minutes; symptoms referred at electrodiagnostic consultation had lasted on average 34 months, 83% were bilateral. The median sensory nerve conduction study was abnormal in 75.6% to the right and 66.7% to the left hand. The median nerve motor distal latency (MDL) was abnormal in 92.1% to the right and in 80.0% to the left hand. There were no differences between right and left for all electrophysiological parameters. In CTS related to manual milking most cases were men, with the MDL more affected than the sensory distal latencies and the electrophysiological abnormalities were found to be symmetric. Manual milking could be a natural model for occupational CTS. In contrast to idiopathic CTS, there was a greater involvement of motor fascicles; this finding is remarkable for CTS.

scholarly journals Segmental Schwannomatosis of the Upper Extremity

2018 ◽  
Vol 4 ◽  
pp. 2513826X1876946 ◽  
Author(s):  
Lauren Wright ◽  
Thomas W. Bauer ◽  
William H. Seitz
Keyword(s):  
Upper Extremity ◽  
Radial Nerve ◽  
Sensory Nerve ◽  
Definitive Diagnosis ◽  
Diagnosis And Treatment ◽  
Microsurgical Approach ◽  
The Right ◽  
Multiple Schwannomas ◽  
Uncommon Tumor

Schwannomatosis is characterized by the development of multiple schwannomas without evidence of vestibular tumors. Segmental schwannomatosis is defined as being limited to 1 limb or 5 or fewer contiguous segments of the spine. We report a case of a 38-year-old male with multiple, painful masses of the right upper extremity with associated numbness and paresthesia in the ulnar and radial nerve distribution. An open, microsurgical approach provided definitive diagnosis and treatment. Twenty-one cases of segmental schwannomatosis of the upper extremity have been reported in the literature, making this case the 22nd. It is 1 of 5 cases of segmental schwannomatosis to have simultaneous tumors in the forearm and hand. We are the first to report multiple schwannomas of the ulnar and ulnar sensory nerve and the second to report multiple schwannomas of the radial sensory nerve. We additionally review the literature regarding pathogenesis, diagnosis, and treatment of this uncommon tumor.

scholarly journals Communication between radial nerve and medial cutaneous nerve of forearm

2010 ◽  
Vol 01 (01) ◽  
pp. 49-50 ◽  
Author(s):  
S. Yogesh ◽  
RR Marathe ◽  
SR Mankar ◽  
M Joshi ◽  
YA Sontakke
Keyword(s):  
Brachial Plexus ◽  
Radial Nerve ◽  
Cutaneous Nerve ◽  
Upper Arm ◽  
Male Cadaver ◽  
Lateral Cutaneous Nerve ◽  
The Right ◽  
Extensor Carpi Radialis

ABSTRACTRadial nerve is usually a branch of the posterior cord of the brachial plexus. It innervates triceps, anconeous, brachialis, brachioradialis, extensor carpi radialis longus muscles and gives the posterior cutaneous nerve of the arm, lower lateral cutaneous nerve of arm, posterior cutaneous nerve of forearm; without exhibiting any communication with the medial cutaneous nerve of forearm or any other nerve. We report communication between the radial nerve and medial cutaneous nerve of forearm on the left side in a 58-year-old male cadaver. The right sided structures were found to be normal. Neurosurgeons should keep such variations in mind while performing the surgeries of axilla and upper arm.

scholarly journals The Diagnosis of Carpal Tunnel Syndrome

1997 ◽  
Vol 22 (1) ◽  
pp. 34-37 ◽  
Author(s):  
L.-G. GUNNARSSON ◽  
A. AMILON ◽  
P. HELLSTRAND ◽  
P. LEISSNER ◽  
L. PHILIPSON
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Gold Standard ◽  
Nerve Conduction Velocity ◽  
Sensory Nerve ◽  
Study Group ◽  
Atypical Symptoms ◽  
History Of ◽  
Tunnel Syndrome ◽  
History Of Pain

The study group consisted of 100 persons referred with suspected carpal tunnel syndrome. Clinical and neurophysiological examinations were performed blinded from each other. The gold standard for the carpal tunnel syndrome (CTS) diagnosis was based on the results of these examinations but relief of CTS symptoms after surgery was also required. The sensitivity and specificity for the combined results of the clinical examinations were 94% and 80% respectively, and for the neurophysiological examinations, 85% and 87%. Of the neurophysiological methods used, the quotient of sensory nerve conduction velocity between palm to wrist and wrist to elbow was best and the cut-off for this test was studied by means of an ROC-curve. According to our results clinical examination by an experienced doctor seems to be sufficient if there are typical symptoms of carpal tunnel syndrome, but if there is a history of pain, atypical symptoms or earlier fractures in the arm, wrist or hand, it is important to add a neurophysiological examination.

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