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PubMed1990

[Humeral fractures with paralysis of the radial nerve].

Forty fractures of the humerus associated with radial nerve palsy were reviewed after an average follow-up of 11 years. Early exploration of the radial nerve and internal fixation of the fracture was performed in 20 patients, while the other 20 patients were treated by closed reduction and immobilization in a plaster cast. In four patients of the latter group the radial nerve did not recover and a delayed exploration was performed. In each treatment group functional recovery of the radial nerve was observed in 16 patients (80%). On the basis of these results the authors suggest treating fractures of the humerus with radial nerve palsy by closed reduction. If there is no evidence of spontaneous recovery within 3-4 months, an exploration of the radial nerve should be performed.

Adolescent↗
PubMed1991

[Radial nerve paralysis--causes, site and diagnosis. Analysis of 103 cases].

The results of a retrospective analysis of 103 patients presenting with a radial nerve palsy are reported. Among the traumatic injuries of peripheral nerves the radial nerve is the one most frequently affected due to its exposed anatomic site with close neighbourhood to the long bones of the arm. Fractures of the shaft of the humerus (18%) and proximal radius (12%) are the main causes of traumatic lesions (55%). Among the non-traumatic peripheral nerve injuries the radial nerve is less frequently affected than the median and the ulnar nerves. The most frequent site of radial nerve lesions in these cases is the upper arm (22%), the most frequent cause is pressure palsy (21%) during unphysiological deep sleep ("Saturday night paralysis").

Arm↗
PubMed2005

Radial nerve excursion and strain at the elbow and wrist associated with upper-extremity motion.

PURPOSE: This study evaluated the excursion necessary to accommodate common motions of daily living and associated strain on the radial nerve. The radial nerve was evaluated at the wrist and proximal to the elbow before it bifurcated. METHODS: Five fresh-frozen transthoracic cadaver specimens (10 arms) were dissected; the radial nerve was exposed at the elbow and wrist only enough to be marked with a microsuture. Excursion was measured using a laser mounted on a caliper fixed to the bone and aligned in the direction of nerve motion. Strain was measured with a device applied to the nerve at the elbow. Nerve excursion associated with motion of the shoulder, elbow, wrist, and fingers (measured by a goniometer) was assessed at the wrist and elbow. RESULTS: An average of 4.3 mm of radial nerve excursion was required at the wrist to accommodate wrist motion from 15 degrees of radial deviation to 30 degrees of ulnar deviation and 8.8 mm was needed for elbow motion from 10 degrees to 90 degrees . The radial nerve at the elbow experienced a 28% strain associated with the same motion of flexion and extension at the elbow. When all the motions of the wrist, fingers, elbow, and shoulder were combined 9.4 mm of radial nerve excursion was required at the wrist and 14.2 mm at the elbow. CONCLUSIONS: Any factor that limits excursion at these sites could result in repetitive traction of the nerve and possibly could play a role in the pathophysiology of a mechanical neuropathy, which in the case of the radial nerve most often manifests as pain.

Body Weights and Measures↗
PubMed1985

Synovial sarcoma: with radial nerve involvement.

An unusual case of radial nerve involvement at the elbow by a synovial sarcoma is reported. The patient was a 16-year-old Caucasian girl presenting with signs of a radial nerve palsy. Treatment was by surgical excision of the tumour and grafting the defect in the radial nerve. The histological diagnosis was a synovial sarcoma. Recovery of function was almost complete eight months later.

Adolescent↗
PubMed2004

The radial nerve should be blocked before the ulnar nerve during a brachial plexus block at the humeral canal.

PURPOSE: The brachial plexus block through the humeral canal as described by Dupré is indicated in hand and forearm surgery. This block requires a multi-stimulation technique that emphasizes the necessity of a rigorous and safe technique. Nerve injury associated with regional anesthesia can entail significant morbidity for patients. Thus, we investigated the brachial block sequence in terms of unintended nerve stimulation as a surrogate of potential nerve injury. METHODS: Sixty patients were randomly allocated in two groups of 30. In Group I the radial nerve was blocked before the ulnar nerve. In Group II the ulnar nerve was blocked before the radial nerve. During the radial nerve approach we recorded, if present, an ulnar nerve response. During the ulnar nerve approach we recorded, if present, a radial nerve response. RESULTS: In Group I while looking for the radial nerve, in 50% of the cases, an ulnar motor response was recorded. In Group II while looking for the ulnar nerve, a radial motor response was recorded in 10% of the cases. CONCLUSION: Our results indicate that the radial nerve should be blocked before the ulnar nerve when performing a brachial plexus block at the humeral canal.

Adolescent↗
PubMed1985

The overlap pattern of the lateral antebrachial cutaneous nerve and the superficial branch of the radial nerve.

The anatomic relationship between the lateral antebrachial cutaneous nerve (LABC) and the superficial branch of the radial nerve (SBR) is outlined in 53 cadaver and 41 clinical dissections. Either partial or complete overlap of the LABC with the SBR occurred in 75% of the cases. The LABC and the SBR innervated separate territories in only 25% of the dissections. We suggest that injury to the LABC may be a concomitant finding in patients with injury to the SBR and that this associated injury to the LABC may be one of the reasons why neuromas of the SBR have been thought to be more resistant to therapy than neuromas elsewhere.

Humans↗
PubMed1981

[Tunnel neuropathy of the radial nerve in the elbow region].

Symptoms of tunnel pathologies of the radial nerve in the ulnar region were analyzed in 39 patients (48 arms). Of importance in the tunnel neuropathy development is an overstrain of the short radial extensor of the wrist and the supinator which are in a close anatomical contact with the radial nerve branches. The affection of the radial nerve manifests in a sharp painfulness on the lateral surface of the ulnar region. The pains irradiate in the distal direction. Sensitivity disturbances within the autonomous zone innervated by the radial nerve were revealed in 17, and a moderate paresis of the wrist and finger extensors in 18 patients. When the epicondylar branch was involved, the secondary syndrome of lateral epicondylitis developed: this was observed in 34 patients. In 17 patients a deceleration of the impulse transmission along the efferent fibres of the radial nerve was observed. The treatment consisted in paraneural injection of hydrocortisone emulsion and radial nerve decompression.

Adolescent↗
PubMed2003

[Anterior radial nerve transposition in humerus midshaft fractures: anatomic and clinical study].

PURPOSE OF THE STUDY: Plate fixation of midshaft humerus fractures raises the risk of radial nerve injury. Anterior transposition of the radial nerve has been proposed as a possible solution but few reports have been published. The purpose of the present study was to validate the effect of transposition on the transposed radial nerve and its branches. MATERIAL AND METHODS: We conducted an anatomic study on 10 cadavers. The length of the radial nerve between 2 anatomic landmarks was determined before and after transposition and plate fixation. A clinical evaluation was performed four years after surgery in 6 patients with midshaft humerus fractures treated with plate fixation after radial nerve transposition. RESULTS: The anatomic study demonstrated a mean gain of 11 mm in the length of the radial nerve with no problem for the transposed nerve or its branches. Clinically, osteosynthesis was facilitated and tension on the nerve was reduced. DISCUSSION: These 2 complementary studies demonstrated the releasing effect of transposition on the radial nerve and the facilitated osteosynthesis reported by others. The benefit of transposition is particularly important when bone fixation is particularly difficult to achieve without risk of injuring the radial nerve. Transposition does however require an extensive dissection, and the patient must be informed. CONCLUSION: The ideal indication for anterior transposition of the radial nerve is an oblique fracture of the mid-third to lower-third of the humeral shaft with radial palsy at onset. A certain degree of comminution facilitates the technique. Indications for this technique could however be widened to include cases of difficult osteosynthesis where the option to transpose the radial nerve is always a peroperative decision.

Adult↗
PubMed1986

Apparent weakness of median and ulnar motors in radial nerve palsy.

Muscle testing of a patient with radial nerve palsy can incorrectly suggest median and ulnar weakness because of a decreased ability to stabilize the thumb and wrist. Ten adult volunteers had radial nerve blocks and their strengths were quantitatively evaluated before and after blocking for grip, key pinch, isolated thumb adduction (adduction pinch), thumb palmar abduction, finger flexion, and flexor pollicis longus (FPL) function. Data were analyzed by paired t test (p less than 0.05). All composite motions that required stabilization of the wrist or thumb showed marked weakness after the radial nerve block (grip decreased 77%, key pinch decreased 33%, and thumb palmar abduction strength decreased 53%). The strength of adduction pinch, finger flexion, and FPL showed no significant decreases after the radial nerve block. Since adduction pinch and isolated FPL function can be easily tested clinically, they should be examined to prevent confusion with median and ulnar problems.

Adolescent↗
PubMed1976

Variables in recording motor conduction of the radial nerve.

Motor conduction examinations of the right radial nerve were performed on 25 healthy students. The purposes of this study were to determine the optimum position for placement of the active recording electrode, to determine the optimum position of the elbow during conduction examinations, and to report normal values for radial motor nerve characteristics. The radial nerve was stimulated at the supraclavicular notch, axilla, lateral surface of the brachium, and over the middle third of the forearm. The evoked responses were recorded from the abductor pollicis longus or the extensor pollicis brevis. The optimum site for placement of the active recording electrode was found over the medial aspect of the abductor pollicis longus or the extensor pollicis brevis and at a point that represents 28 percent of the forearm length. The optimum position for the elbow was full extension. The distal latency of 2.6 msec, the velocity of the brachium-forearm segment of 50 meters per second, and amplitude of muscle action potentials of 4.0 mv may serve as the limits of normal values for motor conduction of the radial nerve.

Action Potentials↗
PubMed1996

Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve.

An anatomical study was performed to define the course of the radial nerve in the posterior aspect of the arm, with particular reference to its relationship to operative exposures of the posterior aspect of the humeral diaphysis. In ten cadaveric specimens, the radial nerve was found to cross the posterior aspect of the humerus from an average of 20.7 +/- 1.2 centimeters proximal to the medial epicondyle to 14.2 +/- 0.6 centimeters proximal to the lateral epicondyle. As it crossed the posterior aspect of the humerus in each specimen, the nerve had several branches to the lateral head of the triceps; however, no branches were found innervating the medial head of the triceps in the posterior aspect of any of the specimens. At the lateral aspect of the humerus, the nerve trifurcated into a branch to the medial head of the triceps, the lower lateral brachial cutaneous nerve, and the continuation of the radial nerve into the distal part of the upper arm and the forearm. Three operative approaches were performed in each specimen. The posterior triceps-splitting approach exposed an average of 15.4 +/- 0.8 centimeters of the humerus from the lateral epicondyle to the point at which the radial nerve crossed the posterior aspect of the humerus. For the second approach, the radial nerve was mobilized proximally to allow an additional six centimeters of the humeral diaphysis to be visualized. The third approach (the modified posterior approach) involved the identification of the radial nerve distally as it crossed the lateral aspect of the humerus, followed by reflection of both the lateral and the medial heads of the triceps medially. This exposure permitted visualization of 26.2 +/- 0.4 centimeters of the humeral diaphysis from the lateral epicondyle proximally. The results after use of the modified posterior approach in seven patients were also reviewed.

Female↗
PubMed1976

Injection injury of the radial nerve.

Four cases of radial nerve palsy following intra-muscular injections into the arm are reported. Recovery occurred in all 4 cases--1 after neurolysis and 3 spontaneously. The mechanism of nerve damage and its treatment are discussed.

Adult↗
PubMed2001

[Repair and reconstruction of radial nerve injury].

OBJECTIVE: To investigate the reparative method and effect of radial nerve injury. METHODS: From 1990 to 2000, 50 cases with radial nerve injuries were adopted in this study. Among them, there were 38 males and 12 females, aged from 5 to 65 years. For the 50 cases, there were 28 cases with complete nerve rupture, 3 cases with incomplete nerve rupture, 10 cases with compressive injury, 5 cases with contusion injury and 4 cases with defect and irreversible injury. All the patients were treated with radial nerve exploration in 1 hour to 6 months after injury. 31 cases were treated with nerve anastomosis, 10 cases with nerve lytic operation, 4 cases with tendon transfer and 5 cases with palliative treatment. RESULTS: All the cases were followed up 3 months to 10 years. The curative effect was assessed according to Highest grade method. There were excellent and good results in 46 cases, moderate results in 4 cases. CONCLUSION: It is necessary to explore and repair the radial nerve injury immediately after the diagnosis being confirmed. If the function of radial nerve could not recover in 6 months, tendon transfer should be carried out to reconstruct the extension of elbow, thumb and fingers.

Adolescent↗
PubMed2004

One-third, two-thirds: relationship of the radial nerve to the lateral intermuscular septum in the arm.

The radial nerve penetrates the lateral intermuscular septum of the arm before dividing into deep and superficial branches. It may be encountered in both anterior and posterior approaches to the humerus. An ability to accurately predict the point at which the nerve pierces the septum would be valuable during surgery in the arm, and would facilitate planning an approach to exploring the radial nerve after fractures of the distal humeral shaft. It would, in particular, make minimally invasive surgical techniques less dangerous. We dissected 20 cadaver upper limbs to establish whether the radial nerve enters the anterior compartment of the arm at a predictable level. We found that in almost every case the radial nerve entered the anterior compartment at a point within 5 mm of the junction of the distal and middle thirds of a line joining the lateral epicondyle of the humerus to the most lateral point of the acromion process of the scapula. This has not previously been described, and we believe is a useful aide-de-memoir to predicting the level at which the radial nerve penetrates the lateral intermuscular septum.

Aged↗
PubMed2006

Tenodesis extension splinting for radial nerve palsy.

Injuries to the radial nerve or posterior interosseous nerve can lead to significant functional limitation. Inability to extend the wrist and/or digits prevents the hand from being positioned properly for functional tasks. Therapy after radial nerve injury is geared toward maintaining passive extension of the wrist and digits. Sensory reeducation can also be performed but often not necessary since the distribution of the nerve distally is on the dorsoradial surface of the hand. Since nerve regeneration is often a lengthy process and the extent of recovery is variable, splinting the involved extremity is used to prevent contractures and maximize function. This article introduces a new splint that allows patients to extend the fingers and thumb via a tenodesis effect at the wrist. In early trials, it has produced excellent results for enhancing functional use of the injured extremity while nerve regeneration occurs or until tendon transfers have been performed.

Equipment Design↗
PubMed1992

Unusual delayed radial nerve palsy caused by a traumatic aneurysm of a collateral radial artery: report of two cases.

Two patients with delayed radial nerve palsy occurring a month after penetrating missile wounds are presented. The history and presence of a pulsatile mass over the posterolateral aspect of the arm were highly suggestive of a traumatic aneurysm of a collateral radial artery, confirmed by angiography in one patient and at surgery in the other. After removal of the aneurysm and radial nerve neurolysis, the patients' symptoms were relieved. In a thorough review of the literature, we found these to be the first examples of traumatic aneurysms of collateral radial arteries causing unusual delayed neural palsies.

Adolescent↗
PubMed1990

Tendon transfer for radial nerve palsy.

Fifty patients (42 males and 8 females) with radial nerve paralysis were treated by tendon transfer. The age range was 20-50 years, and the follow-up period was 2-12 years. The right hand was affected in 39 cases; the left hand in 11. Forty-three of the 50 cases had high radial nerve palsy and 7 had low radial nerve palsy. Irreparable damage to the radial nerve associated with severe humeral shaft fracture was encountered in 38 cases; a penetrating stab wound was the cause in 7 cases; and 5 cases were found as a result of full recovery from brachial plexus palsy. The pronator teres was transferred to the extensor carpi radialis longus and brevis in 43 patients, the flexor carpi ulnaris to the extensor digitorum communis in 40 patients, and the flexor digitorum superficialis of the fourth finger to the extensor digitorum communis in 10 patients. The palmaris longus was transferred to the extensor pollicis longus in all 50 cases. The results of the surgery were excellent in 12 cases, good in 31, and fair in 7. Five cases had mild radial deviation of the hand without disturbance of hand function.

Adult↗
PubMed1992

Quantitation of axon loss and conduction block in acute radial nerve palsies.

Eleven acute radial nerve palsies were examined between 3 days and 14 weeks following the onset of the neuropathy. Our objective was to quantify the relative extent of axon loss and conduction block in radial motor fibers supplying the extensor and abductor pollicis longus (EPL/APL) muscles. In 10 of 11 cases, conduction block exceeded axon loss. Maximum motor and sensory conduction velocities were normal distal to the spiral groove, suggesting that the larger myelinated fibers were not selectively involved in this acute neuropathy. The localization of the conduction block and slowing was, in every case, across the spiral groove. This method provides a relatively simple way of assessing the approximate contributions of axon loss and conduction block, and fits well with the early and usually complete clinical recovery in these cases.

Adult↗