Anomalies in the pathways of medial and lateral popliteal and radial nerves.
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Adult↗
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Results for “RADIAL NERVE”
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[Microsurgical autotransplantations in injuries of the radial nerve].
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Adolescent↗
Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review.
The management of radial nerve palsy associated with fractures of the shaft of the humerus has been disputed for several decades. This study has systematically reviewed the published evidence and developed an algorithm to guide management. We searched web-based databases for studies published in the past 40 years and identified further pages through manual searches of the bibliography in papers identified electronically. Of 391 papers identified initially, encompassing a total of 1045 patients with radial nerve palsy, 35 papers met all our criteria for eligibility. Meticulous extraction of the data was carried out according to a preset protocol. The overall prevalence of radial nerve palsy after fracture of the shaft of the humerus in 21 papers was 11.8% (532 palsies in 4517 fractures). Fractures of the middle and middle-distal parts of the shaft had a significantly higher association with radial nerve palsy than those in other parts. Transverse and spiral fractures were more likely to be associated with radial nerve palsy than oblique and comminuted patterns of fracture (p < 0.001). The overall rate of recovery was 88.1% (921 of 1045), with spontaneous recovery reaching 70.7% (411 of 581) in patients treated conservatively. There was no significant difference in the final results when comparing groups which were initially managed expectantly with those explored early, suggesting that the initial expectant treatment did not affect the extent of nerve recovery adversely and would avoid many unnecessary operations. A treatment algorithm for the management of radial nerve palsy associated with fracture of the shaft of the humerus is recommended by the authors.
Algorithms↗
Superficial radial nerve compression caused by a parosteal lipoma of proximal radius: a case report.
The superficial radial nerve might be compressed or injured at various anatomical sites along its course in the forearm. Most of the superficial radial nerve neuropathy are caused by pathological lesions such as trauma, a mass or tight band at the distal third of the forearm. Wartenberg's syndrome is the most common cause of sensory radial entrapment at the distal forearm. Compression of superficial radial nerve occurring at the proximal third of forearm is unusual. We present a rare case of superficial radial nerve compression due to a parosteal lipoma of proximal radius. Results of complete physical and radiological examinations are also presented. Surgical intervention of the tumour mass was performed for nerve decompression. The patient reported total relief of the neurological symptom post-operatively. This rare case demonstrates the unique characteristics of parosteal lipoma with unusual superficial radial nerve neuropathy at the proximal radius. This report reminds us that there is the possibility of superficial nerve compression caused by tumour mass over the proximal third of forearm.
Bone Neoplasms↗
Nontraumatic paralysis of the radial nerve with multiple constrictions.
PURPOSE: To present an uncommon lesion of radial nerve paralysis with multiple constrictions. METHOD: Eight patients were treated in our department between January 1994 and August 2000. There were 4 men and 4 women with a mean age of 26 years (10-43 y). The radial nerves of all patients were explored. There were 1 to 5 segmental constrictive lesions at the main trunks of the radial nerves or the posterior interosseous nerves; no obvious extrinsic compression was noted. Epineurolysis was performed in 3 patients, in the other 5 patients the constricted portions of the nerves were resected, and neurorrhaphy was performed in 2 patients, nerve-grafting in 3. Histologic examination of the resected portions showed concentration of inflammatory cells around the vessels in the perineurium. RESULTS: The patients were followed-up for 6 months to 4 years after surgery. Seven patients had at least grade 4 muscle strength in the involved muscles. One patient who was treated by external neurolysis 15 months after onset had no signs of recovery 10 months after surgery. CONCLUSIONS: Nontraumatic paralysis of the radial nerve with multiple constrictions is very uncommon. The etiology may be a focal inflammatory response around the feeding arteries in the perineurium.
Adolescent↗
[Radial nerve compression].
A new compression syndrome of the deep branch of the radial nerve is described, in which a sudden anterior displacement of a part of this nerve under maximal tension is followed by an axonotmesis. This happens in an area in which the deep branch of the radial nerve crossed some narrow structures which are unyielding and have more compression strength (tense cords of connective tissue Fig. 3). The operative finding of a torsion of the injured fascicles justifies the correctness of the immediate operative revision; otherwise the nerve regeneration would be impaired by the torted empty endoneural tubes. This description is a further constribution not observed before to the compression syndromes of the radial nerve, since in 1970 the author was able to give an explanation for the pathogenesis of compression palsies of the radial nerve, unclear up to that time but observed after forceful muscle contractions again and again since the beginning of this century. This observation gives the evidence that the occurrence of a peripheral compression lesion of nerves is not bound absolutely on the existence of a "physiological narrowness" (fibrous or osteofibrous tunnel etc.). This is also true for the median nerve.
Humans↗
Bilateral high radial nerve compressions: a case report.
A 40-year-old woman with bilateral high radial nerve compressions by non-traumatic cause was reported. It occurred first at the right radial nerve which was explored after a period of investigation and conservative treatment. Two constricted sites 2.0 cm apart of the right radial nerve crossed by branches of the radial collateral artery beneath the lateral head of the triceps were found. The constricted sites including tissue in between was resected and replaced with a sural nerve graft. One year later the patient had the same episode on the left side. The operative finding was the same as the previous one. Sural nerve graft was performed after neurolysis had failed. The patient's normal radial nerve function returned in one year. This is the first reported case in the literature of bilateral high radial nerve compressions by branches of the radial collateral artery.
Adult↗
Radial nerve lesions associated with fractures of the humeral shaft.
Radial nerve palsy associated with a fracture of the shaft of the humerus is a relatively common injury. Out of 91 radial nerve injuries, operated upon in the Neurosurgical University Clinic in Belgrade from 1979 to 1988, 37 were associated with fractures of the humeral shaft or their surgical treatment. These fractures were previously treated in other medical units. In all cases a microsurgical reconstruction of the radial nerve was done: an interfascicular neurolysis in 24 cases and interfascicular grafting in 13 cases. A useful functional recovery was obtained in 91.9 per cent of the cases. Timing of nerve exploration and repair, as a main problem, is discussed.
Humans↗
The central representation area of the radial nerve in the goat, studied by the axon reaction.
The central representation area of the radial nerve has been investigated in the goat, using the axon reaction. The retrograde changes after a two or six weeks survival time have been used to study both its position and architecture. Reconstructions have been made using a computer assisted approach. In the goat the central representation area of the radial nerve is situated in the dorsolateral part of the lateral motoneuronal cell group, extending from caudal C6 to caudal T1. It begins very small in C6, enlarges through C7, reaches its maximal diameter in C8, from where it gradually decreases to end in caudal T1. The contribution of the C6 segment to the central representation area of the radial nerve in the goat is in agreement with findings in some other species but it contrasts with the macroscopic origin of the radial nerve in ruminants. It is suggested that this finding, together with the statistically significant reduction in the number of alpha motoneurons at the C6 level in calves affected with Arthrogryposis Multiplex Congenita (AMC) in the forelimbs, may prove an at least partial involvement of the radial nerve in the pathogenesis of this disease, which is also suggested by clinical symptoms.
Animals↗
Anatomy of the radial nerve motor branches in the forearm.
Knowledge of radial nerve motor branch anatomy is important when performing surgery in its vicinity, neurorrhaphy, and nerve blocks and for understanding the rate and order of recovery of muscle function after injury. Twenty normal fresh cadaver arms were dissected to quantitate radial nerve motor branch anatomy in the forearm. Though variable in individual specimens, innervation order from proximal to distal (based on mean shortest branch lengths) was brachioradialis, extensor carpi radialis longus, supinator, extensor carpi radialis brevis, extensor digitorum communis, extensor carpi ulnaris, extensor digiti quinti, abductor policis longus, extensor policis longus, extensor policis brevis, and extensor indicis proprius. In 10 specimens, branches innervated the branchialis. Mean distances from a point 100 mm proximal to the lateral epicondyle to the muscle measured along the shortest nerve branch ranged from 97.2 mm for the brachioradialis to 299.8 mm for the EIP. The mean number of muscular branches ranged from 1.1 in the EIP to 4.6 in the EDC. Mean nerve length from the radial styloid to the last motor branch was 115.8 mm.
Cadaver↗
[Lesions of the radial nerve in fractures of the humeral diaphysis. Apropos of 62 cases].
PURPOSE OF THE STUDY: Evaluate outcome of different techniques used for radial nerve repair after humeral shaft fractures. Identify situations where nerve exploration is required or inversely unneeded. Evaluate the risk of more systematic nerve exploration in case of radial nerve palsy. MATERIAL AND METHODS: Over a 10 year period, we cared for 62 patients with humeral fractures associated with radial nerve palsy who were addressed directly to our unit or referred after prior care. There were 54 men (mean age 30 years, 17 - 66) and 8 women (mean age 40 years, 19 - 80). There were 40 fractures of the mid-third and 22 fractures of the distal third of the humerus. Anatomic severity varied although most fractures were displaced or subsequent to high-energy trauma. Orthopedic treatment was used alone in 14 cases. There were 6 plate fixations and 42 intramedullary nailings. Twenty-four of the 62 cases of radial nerve palsy resulted from nerve tears but a continuous nerve was found in 38 cases. Tears were treated by primary suture (n =4), secondary graft (n =17, 5 with 2 torons and 12 with 3 or 4 torons), or primary muscle transfer (n =3). Neurolysis was used in 6 of the 38 cases with continuous nerve. Motor outcome was assessed using composite criteria taking into account the physiological role of each muscle group. RESULTS: All primary sutures gave excellent results. Excellent or good outcome was achieved in 12 of the 17 secondary grafts although a complementary transfer was required in 2 cases. Conversely, outcome was average in 2 cases and a failure in 3. Outcome depended on the length of the graft and the number of torons used. The importance of a proximal resection in healthy tissue sometimes required a complementary medial access and a graft between the biceps and the brachialis. Recovery was achieved in 37 of the 38 lesions with continuous nerve including 31 cases which did not require a second procedure. DISCUSSION: In case of nerve rupture, the outcome of primary suture appears to be better than that of secondary grafts. The success of the graft depends on the length of the tissue loss after sectioning in healthy tissue and on the number of torons used. This difference in prognosis points out the usefulness of systematic exploration in order to use primary or early direct suture in cases of high-energy displaced fractures. Minimally displaced fractures often are accompanied by a simple contusion with spontaneous recovery. However, in intermediary cases, the decision to make a systematic nerve exploration during the osteosynthesis procedure (aimed at early mobilization) is based on the fact that recovery was achieved in 23 cases in which initial exploration of a continuous nerve has been performed. Indirectly, the favorable outcome of postoperative paralyses reported by several authors, also supports this policy.
Adolescent↗
Influence of electrical stimulation on regeneration of the radial nerve in dogs.
The effects of biphasic electric fields on nerve regeneration that follows injury to the left radial nerve were studied in dogs by electromyography (EMG). Left and right radial nerves were crushed with a serrated haemostat. Stimulating electrodes were positioned proximally and distally to the site of the injury. The left nerves received rectangular, biphasic and current pulses (30 microA, 0.5 Hz) through the injury for two months. The right radial nerves were treated as controls and regenerated without electrical stimulation. EMG activities were recorded intramuscularly from the left and right musculus extensor digitalis communis (MEDC). Results obtained at the end of the two-month stimulation period showed a significant difference in EMG activity between the left (stimulated) and the right (non-stimulated) MEDC, suggesting that electrical treatment enhanced nerve regeneration.
Animals↗
The superficial branch of the radial nerve: an anatomic study with surgical implications.
Twenty fresh cadaver extremities were dissected to delineate and quantify the course of the superficial branch of the radial nerve. This branch bifurcated from the radial nerve at the level of the lateral humeral epicondyle in eight specimens, and in all specimens the bifurcation was no more than 2.1 cm from the lateral epicondyle. It continued distally, deep to the brachioradialis and became subcutaneous a mean of 9.0 cm proximal to the radial styloid, traversing between the tendons of the brachioradialis and extensor carpi radialis longus. The superficial branch of the radial nerve branched a mean of 5.1 cm proximal to the radial styloid. Distally, at the level of the extensor retinaculum, the closest branches to the center of the first dorsal compartment and to Lister's tubercle were mean distances of 0.4 and 1.6 cm, respectively. In the hand, the superficial branch of the radial nerve most commonly supplied branches to the thumb, the index finger, and the dorsoradial aspect of the long finger. Knowledge of the course of the superficial branch of the radial nerve will help prevent injury during operative procedures on the radial side of the hand, wrist, and forearm and will aid in its localization in treatment of traumatic injuries or performance of nerve blocks in its distribution.
Anthropometry↗
Intraoperative interfragmentary radial nerve compression in a medially plated humeral shaft fracture: a case report.
Persistent secondary radial nerve palsy following open reduction and plating of humeral shaft fractures is rare, as the nerve is usually identified and protected throughout surgery. However, it is very difficult to identify and protect the radial nerve during medial and posteromedial approaches and closed intramedullary nailing, thus increasing the risk of damaging it. This case of interfragmentary radial nerve compression at the fracture site occurred during posteromedial plating of a laterally displaced and angulated segmental fracture of the middle and distal thirds of the humeral shaft. Exploration and nerve grafting was later required to regain function. It is important that the radial nerve be identified and protected in fixation of humeral shaft fractures with high-risk fracture configurations.
Adult↗
Regeneration of the radial nerve in a dog influenced by electrical stimulation.
The effect of biphasic electric fields on nerve regeneration that follows injury to the left radial nerve of a dog was examined using electromyography (EMG). The left and right radial nerves were crushed with a serrated hemostat and the stimulating electrodes were positioned proximally and distally relative to the site of the injury. The left nerves received rectangular, biphasic current pulses (30 microA, 0.5 Hz) through the lesion for two months. The right radial nerves were treated as controls and regenerated without electrical stimulation. EMG activity was recorded intramuscularly from left and right musculus extensor digitorum (from Medical dictionary) communis (MEDC). Results obtained at the end of the two-month stimulation period showed a significant difference between the EMG activity of the stimulated and the unstimulated MEDC suggesting that the electrical treatment enhanced the nerve regeneration.
Animals↗
[Subacute proximal entrapment neuropathy of the radial nerve at the hiatus radialis].
Endogenous lesions of the radial nerve at the upper arm level and in the canalis spiralis are exceptional. Entrapment of the radial nerve in the hiatus radialis following forced arm movements, stretching, or as a consequence of pathologies of the surrounding tissue is known. We observed two patients suffering from a painful subacute middle radial nerve palsy with complete axonal degeneration caused by a lesion at the hiatus radialis, demonstrated by EMG, sonography, MRI, and surgical exploration. Successful nerve repair, in one case with a nerve graft, was performed. In both cases the most appropriate explanation was a focal neuritis with swelling of the nerve followed by strangulation at the hiatus radialis. In one case acute neuroborreliosis was the reason for the neuritis.
Adult↗
[Late autoplasty of the ulnar nerve and superficial branch of the radial nerve after gunshot injury of the forearm].
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Adult↗
Intraoperative radial nerve injury during coronary artery surgery--report of two cases.
BACKGROUND: Peripheral nerve injury and brachial plexopathy are known, though rare complications of coronary artery surgery. The ulnar nerve is most frequently affected, whereas radial nerve lesions are much less common accounting for only 3% of such intraoperative injuries. CASE PRESENTATIONS: Two 52- and 50-year-old men underwent coronary artery surgery. On the first postoperative day they both complained of wrist drop on the left. Neurological examination revealed a paresis of the wrist and finger extensor muscles (0/5), and the brachioradialis (4/5) with hypoaesthesia on the radial aspect of the dorsum of the left hand. Both biceps and triceps reflexes were normoactive, whereas the brachioradialis reflex was diminished on the left. Muscles innervated from the median and ulnar nerve, as well as all muscles above the elbow were unaffected. Electrophysiological studies were performed 3 weeks later, when muscle power of the affected muscles had already begun to improve. Nerve conduction studies and needle electromyography revealed a partial conduction block of the radial nerve along the spiral groove, motor axonal loss distal to the site of the lesion and moderate impairment in recruitment with fibrillation potentials in radial innervated muscles below the elbow and normal findings in triceps and deltoid. Electrophysiology data pointed towards a radial nerve injury in the spiral groove. We assume external compression as the causative factor. The only apparatus attached to the patients' left upper arm was the sternal retractor, used for dissection of the internal mammary artery. Both patients were overweight and lying on the operating table for a considerable time might have caused the compression of their left upper arm on the self retractor's supporting column which was fixed to the table rail 5 cm above the left elbow joint, in the site where the radial nerve is directly apposed to the humerus. CONCLUSION: Although very uncommon, external compression due to the use of a self retractor during coronary artery surgery can affect--especially in obese subjects--the radial nerve within the spiral groove leading to paresis and should therefore be included in the list of possible mechanisms of radial nerve injury.
Case Reports↗