Management of Radial Nerve Lesions after Trauma or Iatrogenic Nerve Injury: Autologous Grafts and Neurolysis

Background: Proximal radial nerve lesions located between the brachial plexus and its division into the superficial and deep branches are rare but severe injuries. The majority of these lesions occur in association with humerus fractures, directly during trauma or later during osteosynthesis for fracture treatment. Diagnostics and surgical interventions are often delayed. The best type of surgical treatment and the outcome to be expected often is uncertain. Methods: Twelve patients with proximal radial nerve lesions due to trauma or prior surgery were included in this study and underwent neurolysis (n = 6) and sural nerve graft interposition (n = 6). Retrospective analysis of the collected patient data was performed and the postoperative course was systematically evaluated. The Disabilities of the Arm, Shoulder, and Hand (DASH) and the LSUHS (Louisiana State University Health Sciences) scores were used to determine regeneration after surgery. Comparison between the patients’ and calculated normative DASH scores was performed. Results: All patients had a traumatically or iatrogenically induced proximal radial nerve lesion and underwent secondary treatments. The average time from radial nerve lesion occurrence to surgical intervention was approximately four months (1.5–10 months). Eight patients (66.67%) had a humeral fracture. During follow up, no statistically significant difference between the calculated normative and the patients’ DASH scores was observed. The LSUHS scores were at least satisfactory. Conclusions: Neurolysis or sural nerve graft interposition performed within a specific period of time are the primary treatment options for radial nerve lesions. They should be performed depending on the lesion type. Regeneration to a satisfactory degree was observed in all patients, and the majority achieved full recovery of sensory and motor functions. This was the first study to highlight the efficiency of neurolysis and sural nerve graft interposition as secondary treatment interventions, especially for radial nerve lesions.

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Iatrogenic Peripheral Nerve Injury

10.1093/med/9780190617127.003.0028 ◽

2018 ◽

Author(s):

Christian Heinen ◽

Thomas Kretschmer

Keyword(s):

Radial Nerve ◽

Humeral Fracture ◽

General Information ◽

Clinical Approach ◽

Nerve Lesion ◽

Delayed Presentation ◽

Nerve Reconstruction ◽

Nerve Lesions ◽

Radial Nerve Lesion

Iatrogenic nerve lesions are frequently neglected. The chapter stresses the importance of adequate assessment, surgical timing, surgical strategies, follow-up, and results. Using the example of a radial nerve lesion in discontinuity due to osteosynthesis after humeral fracture, the authors describe a typical patient history with delayed presentation, as well as the role of physical examination, electrophysiology, and high-resolution ultrasound in demonstrating substantial nerve damage incompatible with spontaneous recovery. Surgical findings are demonstrated, along with a stepwise approach for nerve reconstruction via sural nerve graft. Clinical approach and surgery for traumatic radial nerve lesions are detailed, as well as general information on iatrogenic nerve lesions.

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Case 12

10.1093/med/9780190603434.003.0016 ◽

2018 ◽

Author(s):

Bashar Katirji

Keyword(s):

Radial Nerve ◽

Close Contact ◽

Nerve Lesion ◽

Posterior Interosseous Nerve ◽

Nerve Lesions ◽

The Third ◽

Needle Electromyography ◽

Long Course ◽

Wrist Drop ◽

Radial Nerve Lesion

Radial nerve lesion is the third most common mononeuropathy of the upper extremity seen in clinical practice, often presenting with wrist drop. The radial nerve has a long course in the arm with close contact to the humerus, which renders it susceptible to compression and trauma. This case highlights the clinical and electrodiagnostic findings of radial nerve lesion. The radial nerve has well distributed motor branches along its course which renders it a well suited nerve for localization by needle electromyography. This case also distinguishes radial nerve lesions from posterior interosseous nerve lesions, posterior cord plexus lesions, and lower cervical radiculopathies.

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