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PubMed1978

A new method of nerve repair: repair of a lesion of the radial nerve with a branch to the triceps muscle.

Regeneration of the radial nerve following a new technique of nerve anastomosis in the humeral spiral groove is reported. Neurorrhaphy was performed by anastomosing a branch supplying the medial head of the triceps to the distal cut end of the radial nerve at the level of the lateral intermuscular septum. The progress of the nerve is detailed and has been confirmed by electromyographic studies showing regeneration of the radial nerve 3 years after operation and 4 years after injury. This technique for repair of the radial nerve has not been previously described.

Adult↗
PubMedDate not supplied

A comparison of injection at the ulnar and the radial nerve in axillary block using triple stimulation.

BACKGROUND AND OBJECTIVES: A triple-stimulation technique for axillary block consists of the localization and injection of 2 nerves, median and musculocutaneous, which lie superior to the axillary artery, and of 1 nerve, the radial, which lies inferior. However, in some patients, the ulnar nerve is located first during the search for the radial nerve. The aim of this study was to verify if an ulnar motor response could be considered a satisfactory endpoint as a radial motor response. METHODS: This study was a prospective, randomized, double-blinded study. Ninety patients received a triple-injection axillary brachial plexus block in which the radial nerve (group RAD) or the ulnar nerve (group ULN) was located and injected inferior to the axillary artery. Patients were assessed for sensory and motor block by a blinded investigator at 5-minute intervals over 30 minutes. RESULTS: A statistically significant higher overall block success rate was recorded in group RAD (91% vs. 73%), and this result was related to a larger success rate for anesthetizing the radial nerve (95% vs. 77%). A statistically significant shorter onset time of sensory block for the radial nerve was recorded in group RAD versus group ULN (9 +/- 5 min vs. 16 +/- 7 min), whereas the reverse was true for the ulnar nerve (13 +/- 7 min for group RAD vs. 10 +/- 3 min for group ULN). The time to perform the block was slightly but statistically significantly shorter in group ULN (6.5 +/- 1.7 min vs. 7.8 +/- 1.8 min). CONCLUSIONS: Local anesthetic injection at the ulnar nerve significantly reduces the efficacy and prolongs the onset time of the radial-nerve block when triple-stimulation axillary block is performed.

Adult↗
PubMed2003

Changes in median nerve somatosensory transmission and motor output following transient deafferentation of the radial nerve in humans.

OBJECTIVE: To determine if transient anaesthetic deafferentation of the radial nerve would lead to alterations in processing of early somatosensory evoked potentials (SEPs) from the median nerve or alter cortico-motor output to the median nerve innervated abductor pollicis brevis (APB) muscle. METHODS: Spinal, brainstem, and cortical SEPs to median nerve stimulation were recorded before, during and after ipsilateral radial nerve block with local anaesthesia. Motor evoked potentials (MEPs) and motor cortex output maps were recorded from the APB muscle. RESULTS: There were no significant changes to most early SEP peaks. The N30 peak, however, showed a significant increase in amplitude, which remained elevated throughout the anaesthetic period, returning to baseline once the anaesthetic had completely worn off. MEP amplitude of the median nerve innervated APB muscle was significantly decreased during the radial nerve blockade. There was also a significant alteration in the APB optimal site location, and a small but significant decrease in the silent period during the radial nerve blockade. CONCLUSIONS: Transient anaesthetic deafferentation of the radial nerve at the elbow leads to a rapid modulation of cortical processing of median nerve input and output. These changes suggest an overall decrease in motor cortex output to a median nerve innervated muscle not affected by the radial nerve block, occurring concomitantly with an increased amplitude of the median nerve generated N30 SEP peak, thought to represent processing in the supplementary motor area (SMA). Independent subcortical connections to the SMA are thought to contribute to the N30 response observed in this study. Unmasking of pre-existing but latent cortico-cortical and/or thalamo-cortical connections may be the mechanism underlying the cortical SEP increases observed following radial nerve deafferentation. SIGNIFICANCE: Transient deafferentation of the radial nerve, which supplies wrist and hand extensor muscles, has been shown to alter sensory processing from and motor output to the median nerve innervated thenar muscles.

Adult↗
PubMed2002

Reduced sensory nerve conduction velocity of the distal part of the radial nerve among patients with vibration syndrome.

The present study was aimed at clarifying the effects of vibration syndrome (VS) on the distal part of the radial nerve, which is rarely affected by chronic entrapment. Thirty-one patients with VS due to previous exposure to vibration and 18 age-matched controls were examined for sensory nerve conduction velocities in the distal part of the radial nerve (SCV-DR) in the dorsal side of the hand. The patient group was divided into two subgroups, one of those with vibration-induced white finger (VWF) in the thumb or index finger where sensory nerves are innervated by the radial nerve (N = 21) and the other without VWF (N = 10). SCV-DR among the patients was significantly slower than in the controls (t = 3.55, p = 0.00138). The ANOVA of SCV-DR for the three groups showed F2, 46 = 5.25 (p = 0.0088). A significant difference was found between the controls and the VWF (+) group (p = 0.0233), but not between the controls and the VWF (-) group (p = 0.478) by multiple comparison using Scheffe's method. These findings suggest that VS affects the radial nerve with a direct vibration effect and/or a co-operative effect with direct circulatory disturbance manifested by VWF.

Action Potentials↗
PubMed1985

Evaluation of sensory nerve conduction velocity testing of the superficial radial nerve.

The purposes of this study were to evaluate the methods for examining the superficial radial nerve and to compare velocities and amplitudes of responses based on electrode shape and placement and site of stimulation. We selected 51 subjects with a mean age of 37 years from a healthy group. Twenty additional subjects with a mean age of 28 were also examined. Nerve conduction was done by stimulating over the dorsal forearm and lateral arm and recording from the superficial radial nerve where its branches cross the extensor pollicis longus tendon. The second group of subjects were stimulated at the same site and also at the elbow. Recording was done with a rectangular-shaped electrode placed in the area between the extensor pollicis longus and the extensor pollicis brevis tendons. We found a mean conduction velocity of 61 m/sec +/- 4.91 in the first group with a mean amplitude of response of 36.7 microV +/- 11.7 when we stimulated at the forearm site and 4.06 microV +/- 6.75 when we stimulated at the lateral arm site. In the second group of subjects, conduction velocity from lateral arm to forearm site was 63 m/sec +/- 4.50; from the lateral arm to elbow, 66 m/sec +/- 10.4; and from the elbow to the forearm site, 64 m/sec +/- 9.71. Amplitudes of response were 43.8 microV +/- 14.45 at the forearm stimulation site, 18.06 +/- microV +/- 7.37 at the elbow site, and 6.7 microV +/- 4.25 at the lateral arm site. We compared the mean velocities from the two methods and found no significant differences.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Axilla to elbow radial nerve conduction.

Numerous techniques that evaluate radial nerve conduction from the axilla or supraclavicular fossa to the elbow have been reported. A shortcoming of most protocols is determining the precise radial nerve length as it proceeds along the spiral groove. The present study dissected out and measured directly eight cadaver radial nerves from the axilla to the elbow. These values were compared with a new surface tape measurement technique from axilla to elbow across the bicep muscle, obstetrical calipers over this region, and a surface determination approximating the course of the radial nerve posteriorly in the spiral groove. The anterior surface tape-measuring procedure compared most favorably with the actual anatomic length. Nerve conduction velocities were then calculated in 20 volunteers using all 3 techniques and compared with the median nerve in the arm. The anterior and posterior tape measurements yielded a conduction velocity of 72.5 +/- 4.7 and 86.6 +/- 7.0 m/s, respectively, whereas the caliper resulted in 65.7 +/- 3.9 m/s. We conclude that proximal radial nerve length assessment employing an anterior tape measurement from axilla to elbow across the bicep musculature is precise and compares favorably with the actual anatomic length of the radial nerve.

Adult↗
PubMed2006

Sensory nerve conduction velocities of median, ulnar and radial nerves in patients with vibration syndrome.

OBJECTIVE: The present study aimed to clarify the range of involvement for hand-arm vibration syndrome (VS) in the median, ulnar and radial nerves of the hand. METHODS: Sensory nerve conduction velocities (SCVs) for 3 nerves in the hands and arms were examined for 34 patients with VS and 23 age-matched controls. Neuropathy types were classified by possible carpal tunnel syndrome (CTS), Guyon's syndrome and digital neuropathy in three nerves. RESULTS: SCV in the median nerve (middle finger, wrist-elbow) and ulnar nerve (little finger, wrist-elbow), and amplitudes of the median nerve (wrist-proximal and distal parts of the middle finger), ulnar nerve (wrist-proximal and distal parts of the little finger; forearm-proximal part of the little finger; upper arm-proximal part of the little finger) and radial nerve (dorsal side of the hand-thumb) were significantly reduced in VS patients compared with controls. According to subject classifications based on the results of SCV and amplitude of nerve action potential, 52.9% of VS patients displayed multi-focal neuropathy including digital neuropathy, possible CTS and/or Guyon's syndrome. CONCLUSION: These findings suggest that VS affects all three nerves in the hand. According to classification results, the main disorders of peripheral nerves comprise digital neuropathy.

Aged↗
PubMed1993

High radial nerve palsy in a tennis player.

High radial nerve palsy occurred in a 47-year-old athlete following muscular overexertion. Surgical exploration showed a fibrous arch coming from the long head of the triceps and causing entrapment of the radial nerve. Radial nerve entrapment following muscular overexertion has been reported to be caused by fibrous arches coming from the lateral head of the triceps. Fibrous arches can occur from either the lateral or long head of the triceps muscle. The neuropathy that occurs can be irreversible.

Humans↗
PubMed1981

Interfascicular suture with nerve autografts for median, ulnar and radial nerve lesions.

Interfascicular nerve suture with autografts is the operation of choice for repairing peripheral nerve injuries because it ensures more precise alignment of the fasciculi and so better chances of reinnervation of the sectioned nerve. The procedure as described by Millesi et al has been used at the Istituto Neurologico di Milano in 30 patients with traumatic lesions of the median, ulnar and radial nerves. All have been followed up for 2 to 7 years since operation. The results obtained are compared with those of other series obtained with interfascicular suture and with epineural suture. Microsurgery is essential. The best time to operate is discussed.

Adolescent↗
PubMed2007

Radial nerve contribution to brachialis in the UK Caucasian population: position is predictable based on surface landmarks.

The midline of the brachialis muscle is now regarded by many surgeons as an internervous plane, between the musculocutaneous nerve supply to the medial portion and a radial nerve contribution to the lateral portion, a principle applied in anterior approaches to the humerus. The radial nerve to brachialis has been described previously in East Asian specimens (Ip and Chang, 1968, Anat Rec 162:363-371; Mahakkanukrauh and Somsarp, 2002, Clin Anat 15:206-209). We sought to investigate the occurrence and character of this nerve in the UK Caucasian population. Dissection of the musculocutaneous nerve and radial nerve was carried out in Caucasian cadaveric arms (n = 42). The radial nerve was dissected from the spiral groove to the lateral epicondyle. Where a branch to brachialis was encountered, its course and level of origin relative to the length of the arm were noted. The musculocutaneous nerve innervated the brachialis in all specimens. Upon investigation 67% of specimens were found to have a radial nerve branch to brachialis. Sixty-one percent of these branches went straight into the muscle, 13% descended, and 26% recurred. The level of origin of the radial nerve branch to brachialis was at a mean of 23% of the distance between the lateral epicondyle and the acromion (n = 31, range 17-37%, SD = 5.3). In three specimens, two branches were observed. A radial nerve contribution to the innervation of the brachialis was present in 67% of UK Caucasian cadavers, which is less than that noted by others in East Asian specimens. The level of the origin of these branches is predictable based on surface landmarks. This fact may be of use during humeral surgery.

Aged↗
PubMed1990

Nerve conduction studies in the superficial radial nerve entrapment syndrome.

This report reviews the syndrome of entrapment of the superficial branch of the radial nerve (SBRN) in the forearm, and electrodiagnostic techniques to aid in diagnosis are presented. Normal mean radial sensory conduction in the forearm was found to be 61.4 +/- 3.1 m/sec. Three patients are presented. In two of these comparison of conduction in the SBRN to the lateral antebrachial cutaneous nerve (LACN) and contralateral SBRN was abnormal, whereas the absolute SBRN conduction appeared normal. Normal LACN-SBRN difference in the same arm was 1.9 +/- 1.6 m/sec, with a range of 0-7.0 m/sec; mean SBRN difference in opposite arms of the same subject was 1.8 +/- 1.6 m/sec.

Adult↗
PubMed1990

Sensory nerve conduction study in forearm segment of superficial radial nerve: standardization of technique.

Sensory nerve conduction velocity (SNCV) over the forearm segment of the superficial radial nerve was studied by an antidromic method in 76 nerves of 50 normal volunteers ranging in age from 16 to 70 years. The mean SNCVs were 53.3 +/- 3.6 m/sec (1 SD) and the mean amplitudes of sensory nerve action potentials were 15.2 +/- 9.8 microV (1 SD). This method of obtaining SNCV over the forearm segment of the superficial radial nerve is easily performed and the findings are consistent.

Action Potentials↗
PubMed1991

Anatomical basis of neurotisation of the median nerve in the hand by the radial nerve.

The sensory sequelae after lesions of the median nerve cause difficulties in treatment since few sensory transfers are available. Neurotisation of the median by sensory branches of the radial nerve have aroused little interest although they have already been used by some authors after anastomosis at the wrist or through the first or second interosseous spaces. Based on what was originally a purely anatomic study, our interest was directed to the possibilities of performing more distal neurotisation for the treatment of sensory disorders of limited extent. The chief object was to obtain faster sensory reinnervation. 30 hands were dissected and a radial branch was defined as suitable for neurotisation whose diameter approximated that of its palmar digital homolog. Only those findings constantly observed in analysis of the hands studied were taken into account. It is therefore possible to reliably define the type and site of the routes of approach as well as the sensory branches suitable for neurotisation.

Hand↗
PubMed1993

Radial nerve palsy caused by open humeral shaft fractures.

Although radial nerve palsy associated with a closed humeral shaft fracture may be managed by observation, it is our experience that an open humeral shaft fracture with radial nerve palsy requires exploration of the nerve. In a series of 14 patients with radial nerve palsy caused by an open humeral shaft fracture, 9 (64%) of the 14 patients had a radial nerve that was either lacerated or interposed between the fracture fragments. There was an equal incidence of radial nerve lacerations or entrapments in types I, II, and III open humeral shaft fractures. Epineural radial nerve repair, done primarily or secondarily, provided a satisfactory return of radial nerve function. Rigid fixation of the associated fracture is the recommended treatment.

Adolescent↗
PubMed2002

Current approach to radial nerve paralysis.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Identify all potential points of radial nerve compression and other likely causes of radial nerve injury. 2. Accurately diagnose both surgical and nonsurgical causes of radial nerve paralysis. 3. Define a safe and effective approach to the surgical release and reconstruction of the radial nerve. Radial nerve paralysis, which can result from a complex humerus fracture, direct nerve trauma, compressive neuropathies, neuritis, or (rarely) from malignant tumor formation, has been reported throughout the literature, with some controversy regarding its diagnosis and management. The appropriate management of any radial nerve palsy depends primarily on an accurate determination of its cause, severity, duration, and level of involvement. The radial nerve can be injured as proximally as the brachial plexus or as distally as the posterior interosseous or radial sensory nerve. This article reviews the etiology, prognosis, and various treatments available for radial nerve paralysis. It also provides a new classification system and treatment algorithm to assist in the management of patients with radial nerve palsies, and it offers a simple, five-step approach to radial nerve release in the forearm.

Algorithms↗