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At least 73 records · Page 4Linked to original sources
PubMed1997

Intramedullary entrapment of the radial nerve associated with humeral shaft fracture.

We present an unusual case of a humeral shaft fracture with intramedullary entrapment of the radial nerve by an undisplaced posterior triangular fragment tightly fixed to the lateral intermuscular septum. Initial examination showed a complete high radial nerve palsy and an angulated mid-shaft humeral fracture associated with an undisplaced posterior triangular fragment. After failure of several closed reductions, we decided to attempt an open reduction and internal fixation with simultaneous exploration of the radial nerve. During surgery, the radial nerve was found emerging from the medullary canal of the proximal fragment. The nerve was freed by briefly displacing the undisplaced posterior triangular fragment. The fracture was then reduced and fixed by plate and screws. Six months after the operation, there was full recovery of the radial nerve and complete union of the fracture. Clearly, closed intramedullary nailing would be contraindicated in this particular type of associated radial nerve injury. We therefore suggest that in cases of mid-shaft fractures of the humerus with associated radial nerve palsy, and an undisplaced posterior triangular fragment, consideration should be given to the possible entrapment of the radial nerve in the medullary canal.

Adult↗
PubMed2005

Nerve supply of the brachioradialis muscle: surgically relevant variations of the extramuscular branches of the radial nerve.

The brachioradialis muscle is utilized in tendon-transfer operations, carried out for a variety of purposes. The extramuscular branches of the radial nerve to the brachioradialis were dissected and studied in 43 embalmed cadaveric specimens. The number of primary and secondary branches and the spatial locations of their origins and muscle-entry points was determined for each specimen. All distances were measured relative to the lateral epicondyle. A wide anatomic variation was observed in both the nerve branching pattern as well as the number and locations of muscle-entry points. A single primary nerve branch was found in 20 specimens, or 46.5% of the cases. On an average, single primary nerve branches arose from the radial nerve 30 mm proximal to the lateral epicondyle. In 16 of these cases, the primary branch splits into two to four secondary branches, and in four cases there was only one branch entering the muscle. Seventeen specimens had two primary branches whose origin points were separated by 5 to 40 mm with an average of 15 mm. In seven of these seventeen cases one or both of the primary branches split into secondary branches. Six specimens had three primary branches; the origin points of the most proximal and the most distal branch were separated by up to 30 mm with an average of 13 mm. Excluding the four cases with extensive fanning into multiple thin branches, the number of muscle-entry points ranged from 1 to 4 (mean 2.7). The locations of the muscle-entry points for all specimens were widespread ranging from 50 mm proximal and 40 mm distal to the lateral epicondyle with an average at 6 mm proximal to the lateral epicondyle. The greatest distance between muscle-entry points was 50 mm in a single specimen. In surgical procedures involving dissection of the brachioradialis muscle more proximal than 50 mm distal to the elbow, the extramuscular branch(es) of the radial nerve branches to the brachioradialis may be at risk.

Cadaver↗
PubMed1989

[Traumatic lesions of the radial nerve of the arm].

The authors analyse their experience with 63 lesions of the radial nerve in the upper arm. 39 cases were associated with fractures of the humeral shaft, 20 cases with open wounds or nerve contusions, and 4 cases with grade 3 complicated humeral fractures with neurovascular lesions. In contusions and open wounds the indication for nerve reconstruction is obvious and results are good or very good after graft-reconstruction or suture. In closed humeral fractures, the results of nerve reconstructions and the improvement of microsurgical techniques, together with precise indications are in favor of treatment of radial nerve lesions by suture or graft-reconstruction. Muscular transfers are only secondary procedures to the nerve reconstruction itself. The indications for treatment in emergency of fractures of the humeral shaft associated with radial nerve palsy, depend on the type of fracture, the associated lesions and the cutaneous status. An osteosynthesis is desirable in specific situations, like in poly-traumatised patients or multiple-level fractures of the upper limb, and an exploration of the radial nerve will be done during exposure. We believe also that an osteosynthesis with exploration of the radial nerve is indicated in severely displaced fractures, in particular in oblique or spiral midshaft fractures, and in fractures of the distal third of the humerus, because in this type of fracture a majority of radial nerve lesions, accessible to direct suture are found. In all the other cases, conservative treatment remains indicated with clinical and electromyographical follow-up and exploration two months after fracture union, in the rare cases of absence of recovery.

Adolescent↗
PubMedDate not supplied

Radial nerve paralysis associated with fractures of the humerus. A review of 62 cases.

Sixty-two patients with radial nerve paralysis associated with fractures of the humerus were reviewed. Seventy-three per cent of the patients had primary radial nerve paralysis and 27% had secondary paralysis. Conservative management has led to excellent nerve recovery in all groups of patients. Overall, 95% of the patients with radial nerve paralysis recovered normal or near normal function. All patients with secondary paralysis had full functional recovery of the radial nerve. Conservative management is recommended in patients with radial nerve paralysis associated with fractures of the humerus, regardless of age of the patient, cause of injury, level of fracture, type of fracture, and whether paralysis is primary or secondary. Use of dynamic splints and exercises, to keep all joints of the hand and wrist supple, should be an integral part of the treatment. Indications for early surgery are unacceptable fracture reduction, open fractures requiring debridement, and associated vascular injuries. In all open procedures, the radial nerve should be explored at the same time and treated appropriately. EMG studies are recommended at four and six months. If there Is no evidence of recovery, the nerve should be explored. Except in unequivocal irreparable radial nerve damage, tendon transfers should be deferred for at least six months, preferably for one year. The possible effect of entrapment of nerve by scar and callus remains to be established.

Adult↗
PubMed1988

Radial nerve palsy.

The anatomy of the radial nerve, functional loss from nerve damage at various levels, timing of tendon transfers, choices of tendon motors for transfer, and operative and postoperative management have been discussed. My preference of transfers for complete radial nerve palsy is: (table: see text).

Hand↗
PubMed1990

[Bilateral radial nerve paralysis. Diagnostic and differential diagnostic aspects].

Bilateral radial nerve palsies are rare, and hence in this situation an underlying generalized peripheral neuropathy must always be considered. Among 103 patients with radial nerve palsies seen at our department during the last five years, there were three cases presenting with bilateral non-traumatic radial nerve palsies. These patients are presented in detail. One had a bilateral nerve entrapment in the supinator channel associated with a neuropathy of unclear origin, the second had bilateral sleep palsy, and the third had mononeuropathy multiplex associated with HIV infection. Following a summary of the cases reported in the literature, diagnostic considerations and additional investigations are discussed.

Adult↗
PubMed1985

[Proximal radial nerve compression syndrome. Treatment and results].

Radial palsy after a single brisk contraction of the triceps muscle was first described by Gowers in 1892. The cause of such paralyses, which also can be found after chronic overexposure, in the course of fracture healing and because of inflammation or tumors, has not been explained until 1969. Two mechanisms are of importance for pressure effects on the radial nerve; either the nerve can be compressed in the hiatus nervi radialis due to swellings or a direct lesion occurs. The latter can happen because of a sudden brisk muscle contraction or on account of chronic trauma caused by the lateral head of the triceps. Since 1969, twenty patients with such radial nerve compressions have received surgical treatment and follow-up in our clinic.

Adolescent↗
PubMed2000

Radial nerve palsy after simple fracture of the humerus.

Radial nerve palsy is a common complication of simple fracture of the humerus. The aim of this retrospective study was to assess the degree of spontaneous recovery and the need for exploration and repair of the nerve. The study included 26 patients with radial nerve palsy after simple fracture of the humerus. The male:female ratio was 3:1 and the median age was 21 years (range 9-79). Three patients had early exploration of the radial nerve in connection with osteosynthesis, and no appreciable damage to the nerve was found. Two other patients were explored later because they failed to recover. This exploration showed damage to the nerve which required further operation. Twenty-one patients were treated conservatively and all recovered well. None needed later operation. Because of the low incidence of nerve lesions we recommend an expectant policy initially.

Adolescent↗
PubMed1999

Relation of the radial nerve with the sulcus nervi radialis: a morphometric study.

The radial nerve's course from the axillary region, branch patterns and the relation of the nerve to fixed anatomical landmarks in the arm region were studied in 27 embalmed intact cadavers. The radial nerve and its relation with the sulcus nervus radialis (SNR) was analyzed. The direct contact of the nerve with humerus in SNR was observed during the dissections. The following measurements were made: the total length of the humerus (the palpable uppermost point of the tuberculum majus and the lateral epicondyle); proximal safe zone (the tuberculum majus and the proximal beginning of the SNR); distal safe zone (the intercondylar axis and the middle of SNR); lateral safe zone (the lateral epicondyle and the distal end of SNR). In conclusion, it was aimed to correlate the osseus palpable landmarks of humerus with the course of the radial nerve for a safe surgery as the sulcus nervi radialis region is one of the main risky areas for the radial nerve palsies.

Anatomy, Artistic↗
PubMed2004

Radial nerve palsy associated with high-energy humeral shaft fractures.

PURPOSE: To determine whether the radial nerve should be explored when there is a complete sensory and motor deficit after a high-energy fracture of the humeral diaphysis. METHODS: Twenty-four patients aged 16 years or older with a high-energy, diaphyseal fracture of the humerus and complete motor and sensory radial nerve palsy were reviewed retrospectively. Eleven fractures were open-6 of these were part of a very complex upper-extremity injury (multiple ipsilateral fractures in 3 patients and near amputation in 3). All 11 patients with open fractures and 3 of 13 patients with closed injuries had radial nerve exploration. RESULTS: All 6 patients with a transected radial nerve had an open humerus fracture and were part of a complex upper-extremity injury. Five of 6 had primary repair of the radial nerve, and none recovered. All 8 intact explored nerves and 9 of 10 unexplored nerves recovered; the only nonrecovery occurred in a patient treated with closed intramedullary rod fixation who may have had iatrogenic nerve injury. The average time to initial signs of recovery was 7 weeks (range, 1-25 weeks). The average time to full recovery was 6 months (range, 1-21 months). CONCLUSIONS: Transection of the radial nerve is usually associated with open fractures of the humerus that are part of a very complex upper-extremity injury. The results of primary nerve repair in this circumstance are poor, likely related to an extensive zone of injury and the need for nerve grafting. Intact nerves and nerve palsies that are part of a closed fracture nearly always recover, even after high-energy injuries. Because the first signs of nerve recovery and complete recovery of the nerve can be quite delayed, patience is merited before considering tendon transfers.

Adolescent↗
PubMed1991

Spinal root origin of the radial nerve and nerves innervating shoulder muscles of the dog.

The ventral spinal root origin of the radial nerve, its muscle branches, and brachial plexus nerves which supply shoulder and thoracic musculature was determined in the dog. Electrophysiological signal averaging techniques measured evoked potential from specific ventral spinal roots to individual muscle nerves. The entire radial nerve received input from the sixth cervical (C6) through the second thoracic (T2) spinal roots. The most significant (p less than .05) input to triceps brachii came from C8 while the deep ramus of the radial nerve received its largest input from C7. The brachiocephalicus, suprascapular, and subscapular nerves all received their most significant (p less than .05) innervation from C6. Approximately 90% of the evoked potential to the axillary nerve originated from C7. The thoracodorsal nerve received most of its innervation from ventral roots C7 and C8. The lateral thoracic nerve which innervates the cutaneous trunci muscle was supplied by ventral roots C8-T2. Examination of innervation patterns suggests that only modest variation of spinal root input to specific nerves occurred between individual dogs.

Animals↗
PubMed2006

Superficial radial nerve injury during standard K-wire fixation of uncomplicated distal radial fractures.

This study determines the incidence of superficial radial nerve injury after Kirchner wire insertion. An experienced orthopedic surgeon inserted the K-wires into the radii of 92 adult cadavers. Subsequent dissection of the area exposed the superficial radial nerve and any observed nerve injury was documented. It is clear from the results that nerve injury may still occur as a result of K-wire insertion; however, the current method of K-wire insertion still proves to be a reliable and safe procedure for fixation of distal radial fractures.

Bone Wires↗
PubMed2001

[Delayed radial nerve palsy following a humeral shaft fracture].

We reported a 24-year-old man with right radial nerve palsy. He had suffered from a right humeral shaft fracture approximately three years before. The fracture was treated with intramedullary nailing. Our radiograph of the right upper limb showed callus around the fracture site. A nerve conduction study revealed conduction block of the radial nerve at the lateral side of the callus. Tinel's sign was present in the median nerve at the medial side of the callus. Surgical exploration revealed that the radial nerve trunk was compressed at the callus site. The median nerve trunk was close to the callus. We decompressed radial nerve trunk, and the patient's neurological symptoms improved gradually after the operation. Delayed radial nerve palsy has been reported only rarely, whereas acute compression of the nerve sometimes occurs after humeral shaft fractures. Morever, the median nerve also was vulnerable to compression at the site of callus. These findings underscore the importance of taking into account the possibility of delayed compression neuropathy after humeral shaft fracture.

Adult↗
PubMedDate not supplied

A comparison of proximal and distal radial nerve motor responses in axillary block using triple stimulation.

BACKGROUND AND OBJECTIVES: Stimulation of the radial nerve at the axilla may cause either a proximal movement (forearm extension) or distal movements (supination, wrist or finger extension). In the most recent studies on axillary block, only a distal twitch was accepted as valid. However, this approach was based only on clinical experience. The aim of this study was to verify if a proximal motor response can be considered a satisfactory endpoint. METHODS: This was a prospective, randomized, double-blinded study. One hundred fifty patients received a triple-injection axillary brachial plexus block in which the radial nerve was located by a proximal (group PROX) or a distal motor response (group DIST). Patients were assessed for sensory and motor block of the branches of the radial nerve by a blinded investigator at 5-minute intervals over 30 minutes. RESULTS: An 81% success rate for anesthetizing the sensory distal branches of the radial nerve was seen in group PROX; a significantly higher success rate was recorded in group DIST (95%). The onset time of sensory block for the distal branches of the radial nerve was significantly shorter in group DIST (9.9 +/- 6 v 15.4 +/- 7 minutes). The time to perform the block was slightly shorter and the localization of the nerve simpler in group PROX. The overall block success rate was not significantly different in the 2 groups. CONCLUSIONS: Local anesthetic injection at the proximal radial twitch significantly reduces the efficacy and prolongs the onset time of the radial nerve block. Searching for distal response is significantly more difficult and time consuming than searching for proximal response. However, it does not significantly increase patient discomfort or adverse effects.

Adult↗
PubMed2000

Radial nerve entrapment by the lateral intermuscular septum after trauma.

Radial nerve palsy is associated with humeral shaft fractures, usually occurring at the time of injury but sometimes occurring later. We report on a case in which a progressive radial nerve palsy occurred three months after a fracture; on exploration, the nerve was found to be trapped by the lateral intermuscular septum. It is important to recognize progressive radial nerve palsies or late presentations, because they often represent chronic compression and a delay in exploration may be detrimental to the return of nerve function.

Humans↗