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Radial nerve potential was studied at the level of the wrist in 13 normal subjects. Simultaneous recording at the level of the median nerve potentials and of a block of its conduction showed that median activity spreads to the area of recording of radial potentials. However, the radial latency is shorter so that potentials of each nerve can be distinguished. This technique could be applied in current practice.
An aberrant axillary artery that penetrated the radial nerve from deep to superficial during its course, was observed. The brachial plexus in the present case was classified as the Adachi's C-type brachial plexus. Further, an accessory radial root existed, which was a nerve bundle branching from the deep aspect of the inferior trunk and communicating with the radial root from the posterior cord to form the radial nerve. The axillary artery went on along the lower border of the brachial plexus and passed between the radial root and the accessory radial root from deep to superficial at its third section. As the axillary artery penetrated the origin of the radial nerve from deep to superficial, it was judged to reach deep under the posterior cord, hence deeper than the brachial plexus.
A series of 59 patients with immediate complete radial nerve palsy complicating a fracture of the shaft of the humerus was analysed. In 27 patients the radial nerve was explored and the fracture was fixed within 3 weeks of the accident. In 12 other patients exploration was performed after an average of 17 weeks. The remaining 20 patients showed signs of spontaneous recovery within 4 months and were managed conservatively. The mean follow-up time was 3 years. At exploration, laceration, interposition between the fragments or entrapment of the radial nerve in callus was found significantly (P less than 0.01) more often with longitudinal fractures of the distal third (46 per cent) than with transverse fractures of the middle third, in which 85 per cent of the explored cases showed the nerve to be no more than slightly bruised. Useful recovery was seen in 46 patients (78 per cent of the whole series).
Electromyography and conduction studies in motor and sensory fibres were performed in 58 patients with different types of radial nerve injury. The site of nerve injury was predicted by clinical and electromyographic findings and correlated with changes in conduction, thereby permitting a more exact classification of the type of nerve injury. In patients with Saturday-night palsy, there was considerable slowing of conduction in both motor and sensory fibres across the presumed site of the lesion with return to normality within six to eight weeks. These observations suggest that local demyelination is the cause of nerve palsy. There were changes in sensory conduction even when there was no sensory deficit clinically, with no difference in susceptibility of motor and sensory fibres to ischaemia. In patients with radial nerve palsy secondary to fracture of the humerus, out-growth in motor and sensory fibres was equal and estimated to be about 1 mm per day. When the radial nerve palsy was attributed to traction or mild blunt injury the site of lesion was based on clinical and electromyographic findings. The rate of conduction in motor and sensory fibres was normal, suggesting that axonal damage was the cause of paresis, with sparing of some of the fastest conducting fibres.
Humeral shaft fractures traditionally have been managed with closed treatment. In patients with polytrauma, open fractures, and patients at risk for nonunion, open reduction and internal fixation and intramedullary nailing have been advocated. The current study describes a technique used in humeral shaft fractures that reduces the risk of iatrogenic radial nerve injury during plate osteosynthesis in fracture patterns at high risk of nonunion (highly comminuted, transverse fractures). Ten patients who had radial nerve transposition were reviewed retrospectively using the electronic records database at the authors' institution. The average age of the patients was 27 years and average followup was 25 months. All had humeral shaft fractures, AO class A3.2 in four patients, B3.2 in five patients, and C2.2 in one patient. All fractures were deemed to be at high risk for nonunion. There were no iatrogenic nerve palsies as a result of the transposition, and no infections. Two patients had delayed or nonunion, who achieved healing after a second intervention. Transposition of the radial nerve is a useful adjunct to plating of humeral shaft fractures in patients at high risk for nonunion. The technique is safe, does not cause iatrogenic injury, and protects the radial nerve during all subsequent approaches to the fracture site.
Experiences are presented with the surgical treatment of 33 patients with traumatic radial nerve injuries after humerus fracture. Diagnostic and surgical difficulties of primary orthopaedic humerus fragment union by osteosynthesis with simultaneous evaluation of the damaged nerve. In the group of patients who had been given primary orthopaedic treatment the causes were analysed of reinnervation failure. In another group of patients undergoing metal plate removal after full bone union had been achieved the own experiences are presented related to an improved method of operative approach and delayed reconstruction of the damaged nerve. The authors suggest reconstruction of radial nerve injury after humerus fracture by specialized teams of orthopaedic surgeons and neurosurgeons.
The presence and localization of NADPH-diaphorase (NADPH-d) in the radial nerve cords of Patiria pectonifera was shown by electron histochemistry. NADPH-d-positive structures were found in ectoneural and hyponeural regions of the radial nerve cord. Ultrastructural localization of NADPH-d was detected in neurons, sensory cells, supporting cells, and in the nerve plexus. The highest enzymatic activity in ectoneural region of the radial nerve cord is due, presumably, to the involvement of NADPH in sensory signal processing.
Isolated neuropathy of the cutaneous branch of the radial nerve is a rarely recognized pathology. It was described in 1932 by Wartenberg, who suggested the name cheiralgia paraesthetica. The syndrome is described as known the entrapment of the superficial branch of the radial nerve. Many different etiologic factors for chronic nerve entrapment have been described, however our case has an unusual cause. A 52 year old man had pain and paresthesia in the area over the lateral aspect of the wrist, thumb and first web six months after Colles' fracture. The patient underwent bony spike resection after five months with ineffective conservative treatment. He has satisfied after this operation. The case was presented because of disappearing his preoperative complaints after the operation with respect to Wartenberg's syndrome constituted a rare cause of bone spike which has not been mentioned in the literature.
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The authors carried out an anatomical, roentgenological and surgical study of the ramus superficialis of the radial nerve in man. This branch springs down 1,2 cm. below the humeroradial space and crosses the posterior rim of brachioradialis 8 cm. above the tip of the radial processus styloideus. Twice the exceptional arteria antebrachialis dorsalis was found; the vessel and the radial nerve looked like a posterior pedicle at the forearm. Among the 3 ending branches, the middle one is the most vulnerable in lateral approach of radius and naviculare.
A radial nerve injury associated with a humeral shaft fracture is an important injury pattern among trauma patients. It is the most common peripheral nerve injury associated with this fracture. Although treatment for this injury pattern is a controversial subject among upper-extremity surgeons, certain principles of management need to be applied in all cases. As our understanding of the pathoanatomy of the humerus and surrounding neurovascular structures has evolved, surgeons have adapted their strategies to improve outcome and avoid long-term morbidity. The principles of management and the clinical outcomes of various treatment strategies, defined in the literature, are reviewed in this article.
A 43-year-old man underwent revision of a loose total elbow arthroplasty in 1995. The arthroplasty had been implanted 20 years previously for post-traumatic osteoarthritis after a gunshot wound complicated by permanent ulnar nerve palsy. The patient suffered a minimally displaced periprosthetic fracture 4 years after implantation that was treated closed. The patient subsequently developed severe loosening with bony dilation. During revision surgery, while grasping and removing the periprosthetic membrane from within the humeral medullary canal with a Kerrison rongeur, dorsiflexion of the wrist and hand occurred. Close inspection of the membrane revealed that the radial nerve was encased inside the bone. Although not divided, the traction and contusion of the nerve caused a radial nerve palsy that partially resolved by 4 years of follow-up.
This is a case of late-onset (6 weeks) radial nerve paralysis following open reduction and internal fixation of a comminuted distal humerus fracture. A transected radial nerve within the callus was found at reoperation. The mechanism of transection was thought to be repetitive motion of the nerve across an edge of new bone. The nerve was repaired and tendon transfers done subsequently with less than full functional recovery at 16 months. No such case has been previously reported.
The occurrence of changes within the spinal cord over a long period after a peripheral nerve injury was investigated in adult cats. The lateral superficial branch of the radial nerve was exposed and transsected unilaterally. In one group the nerve endings were re-approximated with epineural sutures and in the other group the proximal nerve stump was enclosed to prevent regeneration. After a survival period of 4-17 months the same nerve on both sides was exposed to an intra-axonal nerve tracer, lectin-conjugated horseradish peroxidase, to label the nerve terminals within the spinal gray matter by transganglionic transport. The general distribution of the terminal field was almost the same after suturing as after encapsulation of the transsected nerve, except for a slightly more cranial location of the terminal area after suturing compared with the control side. The terminal area comprised laminae I-IV of the fifth cervical to the first thoracic spinal segment, concentrated towards the sixth to eighth cervical segments. This distribution was the same as on the control side, but the experimental and control sides differed in intensity of terminals. There was a loss of terminals throughout the terminal field in both operated groups, but after nerve suture there was some recovery of terminal intensity between 4 and 17 months after the injury.
The position of the elbow while conducting motor studies of the radial nerve is generally extended (15) or slightly flexed (10), but little is known about the effects of elbow flexion on the radial motor conduction velocity. We attempted to measure the effects of the elbow position on the radial motor conduction velocity, as well as directly measure the change in the length of the nerve at different elbow positions in the cadaver. In addition, we established normal values for the radial F-wave with the recording electrode on the extensor indicis proprius muscle. Radial motor nerve conduction was studied in 25 normal subjects to evaluate the effect of 3 different elbow positions (0 degree, 45 degrees, and 90 degrees) on motor conduction velocity (MCV) across the elbow. Direct (in situ) radial nerve measurements were performed on four cadaver specimens to compare changes in nerve length during elbow flexion. Normal values for radial F-wave latencies recording from the extensor indicis proprius muscle were also determined in 23 subjects. The radial MCV decreased significantly as the elbow flexed from 0 degree to 90 degrees. The normal range of values for radial motor nerve conduction at 0 degree of elbow flexion was 71.7 +/- 4.7 m/s, 68.9 +/- 4.9 at 45 degrees of elbow flexion, and 62.0 +/- 6.4 m/s at 90 degrees elbow flexion. Actual (in situ) radial nerve measurements were also found to decrease in length as the elbow flexed. The minimal radial F-wave latency was 19.8 +/- 3.7 milliseconds. For routine determination of motor nerve conduction velocity across the elbow, we recommend that the elbow be fully extended, as the distance measurement most accurately reflects the maximum anatomic length of the nerve. We also feel that the radial nerve F-wave latency is readily obtainable from the extensor indicis proprius muscle.
Radial neuropathy is frequently associated with fracture of the middle third of the humerus owing to the course of the nerve adjacent to the humeral shaft. The prevalence varies from 2 to 18% of humeral fractures. The therapeutic management is still controversial. Some authors recommend initial surgical exploration, whereas others prefer observation and intervention only if the injured nerve failed to recover after a period of more than 4 months. According to the literature, verification of an entrapped radial nerve in a fracture gap requires surgical exploration, but diagnostic tools to verify the existence of a pathologic condition are limited. We describe the sonographic findings of an entrapped radial nerve and review the literature regarding diagnosis and treatment of entrapped radial nerve in cases of humeral fracture.
Nerve injuries complicating elbow dislocation reported in literature involve ulnar and median nerve. A case of radial nerve paralysis after lateral dislocation of the elbow is reported.
OBJECTIVES: In the present study we set out to obtain normative values for radial nerve F-waves, with surface recording from the extensor indicis muscle. METHODS: Forty-nine patients with unrelated complaints were tested. Surface recording electrodes were placed on the extensor indicis muscle. This was found by asking the patient to extend the second digit against resistance. The active surface recording electrode was placed over the most distal portion of the muscle, near the radial border of the ulnar bone near the wrist. Stimulation was performed near the lateral epicondyle between the radial and ulnar bones. RESULTS: The mean F-wave minimum latency was found to be 20.55 ms, with an upper limit of 24.35 ms. The absolute interside minimum latency difference was found to have a mean of 0.55 ms, with a maximum of 1.7 ms. The mean amplitude of the F-waves was 145.61 microV and the mean mF/M ratio was 0.022. F-waves were unobtainable in 2/62 (3.2%) of limbs. Normative values for the radial nerve motor response were also obtained. Three cases are described to illustrate the usefulness of the above technique. CONCLUSIONS: It is technically feasible to record radial nerve F-waves from the extensor indicis muscle.