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.     

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.     

Neurological recovery across a 2-cm gap of radial nerve repair using end to end suture following supracondylar humerus fracture: Case report

Introduction and ImportanceTraumatic laceration of the radial nerve following supracondylar humerus fracture in the pediatric population is highly uncommon. Transection of the radial nerve is rare, and approximately 12.7% of all nerve injuries are categorized as neurapraxia that will resolve spontaneously.Case presentationWe report a rare case of a 9-year-old boy presented with a right wrist drop after fell on an outstretched hand two weeks before. The radiological finding revealed a posteriorly displaced supracondylar humerus fracture. Intraoperatively, we found the radial nerve had lost its continuity and interposed by fibrotic tissue. We resect and do a direct repair of the nerve along with fixation of the fracture. At 4-months postoperative follow-up, the patient could fully extend his right thumb and wrist but retain a tingling sensation in the radial nerve distribution. At 1-year follow up the motor and sensory functions were normal without any complication.Clinical DiscussionTransection of radial nerve following the supracondylar fracture represents a rare case. The radial nerve was transected and interposed by scar tissue at the fracture site level, preventing spontaneous nerve regeneration. In a case of nerve transection, surgical repair is indicated.ConclusionIn the case of supracondylar humerus fracture with posterior displacement, radial nerve transection could be associated with injuries. Authors favour nerve exploration with fracture stabilization performed as soon as possible when nerve injury is suspected. Appropriately managed, the outcome in the pediatric population is highly favourable.     

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.     

Severance of the radial nerve complicating transverse fracture of the mid-shaft of the humerus

A case of radial nerve injury associated with a transverse fracture of the middle third of the humerus is reported. The radial nerve was found to be completely severed at the fracture site. Early exploration of the nerve and internal fixation of the fracture gave a satisfactory result. Received: 12 November 1997     

Frohse's arcade syndrome revealing sarcoidosic myopathy

We report the first case of an unusual sarcoidosic muscular involvement, complicated with radial nerve palsy. A 58-year-old woman suffering from a mediastinopulmonary sarcoidosis, was admitted for a driving deficit of the hands with a radially deviation during the wrist extension. She had been given a diagnosis of motor branch radial nerve entrapment syndrome. The patient had neurolysis with many muscle biopsies compatible with multiples sarcoidosic nodules, especially at the level of supinator muscle at the origin of the radial nerve compression.     

Late-Onset Radial Nerve Palsy Associated with Conservatively Managed Humeral Fracture. A Case Report and Suggested Classification System

Radial nerve palsy can occur with humerus fracture, either at the time of injury (primary) or during reduction (secondary). Late-onset radial nerve palsy (not immediately related to injury or reduction) has been very seldom reported in the English literature. We describe a case of late-onset radial nerve palsy, which developed 9 weeks after an attempted closed management of a midshaft humerus fracture. Exploration of the nerve was performed. The radial nerve was found to be stretched over the ends of the fracture. Open reduction and external fixation of the fracture with mobilization of the nerve from the fracture site lead to complete return of radial nerve function occurring by 3 months. We recommend exploration of cases of late-onset radial nerve palsy in contrast to primary or secondary radial nerve palsy, which can be treated conservatively. Our experience suggests that the cause of the palsy is a continuous ongoing pathology and not a single time event as in primary or secondary cases. Radial nerve palsies associated with humeral fracture should be classified as either primary (at the time of injury), secondary (at the time of reduction), or late onset (not related to either injury or reduction).     

Median to radial nerve transfer for treatment of radial nerve palsy. Case report

The purpose of this study is to report a surgical technique of nerve transfer to restore radial nerve function after a complete palsy due to a proximal injury to the radial nerve. The authors report the case of a patient who underwent direct nerve transfer of redundant or expendable motor branches of the median nerve in the proximal forearm to the extensor carpi radialis brevis and the posterior interosseous branches of the radial nerve. Assessment included degree of recovery of wrist and finger extension, and median nerve function including pinch and grip strength. Clinical evidence of reinnervation was noted at 6 months postoperatively. The follow-up period was 18 months. Recovery of finger and wrist extension was almost complete with Grade 4/5 strength. Pinch and grip strength were improved postoperatively. No motor or sensory deficits related to the median nerve were noted, and the patient is very satisfied with her degree of functional restoration. Transfer of redundant synergistic motor branches of the median nerve can successfully reinnervate the finger and wrist extensor muscles to restore radial nerve function. This median to radial nerve transfer offers an alternative to nerve repair, graft, or tendon transfer for the treatment of radial nerve palsy.     

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.     

Multiple nerve dysfunction after carpal tunnel release

A case is reported of the delayed onset of multiple nerve dysfunction after simple carpal tunnel release. The patient received a local anesthetic with the use of an arm tourniquet. The multiple dysfunctions included radial sensory and motor dysfunction at 5 days, anterior interosseous nerve syndrome at 33 days, and ulna intrinsic motor loss between 33 and 77 days after operation. There was no recovery in the radial or anterior interosseous nerves after 5 months of conservative management. At operation the radial nerve was compressed by the intermuscular septum, and the anterior interosseous nerve was compressed by the superficialis arcade. Decompression was followed by complete recovery.     

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.     

Beware the painful nerve palsy; neurostenalgia, a diagnosis not to be missed

We present a case of painful radial nerve palsy following application of a humeral lengthening frame. At re-operation, the radial nerve was found to be compressed against a distal pin. This was re-sited providing immediate pain relief and a gradual resolution of the radial nerve palsy. Pain in association with a nerve palsy should alert the clinician to the possibility of nerve compression that may benefit from urgent decompression.     

Comparison of regeneration across a vascularized versus conventional nerve graft: case report

A histological and functional comparison of regeneration across a vascularized and conventional nerve graft was carried out in a clinical case. The two branches of the medial antebrachial cutaneous nerve were used to neurotize the median nerve at the wrist. The superficial branch of the radial nerve (vascularized nerve graft) and a conventional sural nerve graft were used as the interposition grafts between the two branches of the medial antebrachial cutaneous nerve and the median nerve. This nerve grafting procedure was carried out in two stages. The proximal neurorrhaphy was carried out 7 months prior to the distal nerve repair. Biopsies were taken from the distal portions of the vascularized radial sensory nerve and the conventional sural nerve at the time of the second procedure. Histological evaluation demonstrated superior regeneration across the vascularized nerve graft. Subjectively, the patient described better sensory recovery in the territory innervated by the vascularized nerve graft. Sensory testing in the two territories demonstrated better sensibility in the territory innervated by the vascularized nerve graft.     

Radial nerve injury during double plating of a displaced intercondylar fracture

Double-plate fixation is a popular treatment method for intercondylar humeral fractures. Ulnar nerve complications are emphasized, but radial nerve complications are rarely mentioned. We present a case of iatrogenic radial nerve palsy following open reduction and double plating of a supracondylar/intercondylar fracture of the humerus. Before surgery, only a sensory deficit in the radial nerve territory was present, but after surgery, there was a complete motor deficit of the wrist and finger extensors. On exploration, a segment of nerve was found crushed within the reduced lateral condyle fracture site, with a screw from the posteroradial plate going through the nerve. Although rare, radial nerve injury can occur with posteriorly displaced supracondylar/intercondylar humerus fractures. When preoperative signs of radial nerve injury are present, we recommend that the radial nerve be identified and protected during double-plate fixation.     

Superficial radial nerve compression due to fibroma of the brachioradialis tendon sheath: A case report

Fibroma of the tendon sheath (FTS) is a rare benign tumour that usually develops in the upper extremity, particularly in the fingers, hands and wrists. Herein, we present the case of a patient with an unusually localised FTS compressing the superficial branch of the radial nerve. A 62-year-old woman presented with a superficial radial nerve compression due to FTS of the brachioradialis. Histopathological diagnosis was confirmed as a FTS after marginal excision. The patient who had compression-related symptoms in the superficial branch of the radial nerve recovered completely at one month after surgery. One year later, the patient remained free of symptoms and no recurrence was observed.     

Neglected pediatric Monteggia fracture dislocation with persistent posterior interosseous nerve palsy: a case report

This is a rare case report of persistent PIN palsy following a case of neglected Monteggia fracture dislocation in a 7-year-old boy. The patient had presented with prominence around the elbow and inability to abduct the thumb, extend the thumb at interphalangeal joint, and inability to extend the fingers at the metacarpophalangeal joints. The index procedure of ulnar osteotomy and closed reduction of radial head did not yield satisfactory results; subsequently, patient underwent a second surgery for open reduction of radial and exploration of the PIN with simultaneous sural nerve grafting. To the best of our knowledge, this is the first case from India describing the use of sural nerve as a cable graft for neglected Monteggia fracture dislocation with nerve palsy.     

Compression du rameau superficiel du nerf radial par un kyste synovial du coude (À propos d’un cas et revue de littérature)

Compression of the radial nerve at the elbow is quite rare; entrapment of its superficial branch is exceptional. Extrinsic compression is the most frequent etiology. Magnetic resonance imaging plays a major role in the diagnosis, and early surgical excision or echoguided drainage – in case of synovial ganglion – allows a total recovery. The authors report the case of a compression of the superficial branch of radial nerve by an elbow synovial cyst treated by surgical resection.     

Compression neuropathy of the radial palmar thumb nerve

Compression neuropathy of a single digital nerve is a rare entity. We report the case of a patient with numbness in the distribution of the radial digital nerve of the thumb caused by the use of a walking stick. The nerve was compressed between the handle of the stick, the loop and the radial sesamoid bone of the first metacarpophalangeal joint. The site of the lesion was confirmed by electrophysiologic examination. Orthodromic recording of the sensory response from the radial palmar digital nerve of the thumb documented a complete absence of nerve action potential whereas the ulnar digital thumb nerve showed a normal response. Sensory function was restored when a padded ski glove was used to protect the area of the metacarpophalangeal joint whilst using the stick.     

The square pronator: an "aspirin" strip in antalgic surgery for painful neuromas of the wrist

From June 96 to January 2001, 25 patients have been operated on for painful neuromas localised at the wrist. They were between 10 and 52 years of age. These neuromas were located in at the median nerve 17 cases, at the ulnar nerve in seven cases and at the radial nerve in one case. In all cases the pain was not spontaneous but triggered off by external stimulus. All these neuromas were in continuity except 1 case at the median nerve where a total severing was present. After external neurolysis, the quadratus pronatus muscle is wrapped around the neuromas in 24 cases and around epineurial suture in one case. No internal neurolysis was done. This flap was vascularized by the anterior interosseous artery in 23 cases and by the posterior interosseous artery in two cases of distal ulnar nerve neuroma. All patients have been improved by using this method. In 21 cases (84%) (17 median, 4 ulnar nerves) the pain has completely disappeared and in four cases (3 ulnar, 1 radial), the pain has considerably decreased but without total disappearance. In the cases of median nerve neuromas the dysaesthesia has greatly decreased. No complications and no sequelae on the donor site are reported.     

Nerve transfer to the triceps after brachial plexus injury: report of four cases

These case reports review the clinical outcomes of 4 patients who underwent nerve transfer to a triceps motor branch of the radial nerve. Mean follow-up was 26 ± 15 months. Two patients had a transfer using an ulnar nerve fascicle to the flexor carpi ulnaris muscle, yielding a motor recovery of grade M5 elbow extension strength in one case and M4+ in the other. In 1 patient, a thoracodorsal nerve branch was used as the donor; this patient recovered M4 strength. One patient had a transfer using a radial nerve fascicle to the extensor carpi radialis longus muscle and recovered M5 strength. These outcomes indicate that expendable fascicles of the ulnar, thoracodorsal, and radial nerves are viable donors in the surgical reconstruction of elbow extension.