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At least 109 records · Page 6Linked to original sources

PubMedDate not supplied

Extensile approach to the anterolateral surface of the humerus and the radial nerve.

A proposed approach to the anterolateral surface of the humeral shaft that would allow for exploration of the radial nerve was studied in 30 cadaver arms. The incision starts proximally along the posterior border of the deltoid muscle and extends anteriorly and distally over the lateral border of the biceps muscle. A deep dissection is made in the internervous plane between the deltoid and the triceps muscles proximally and between the longitudinally split fibers of the brachialis muscle distally. The approach provides access to the anterolateral surface of the humerus up to the level of the axillary nerve and the posterior circumflex humeral vessels. The insertion of the deltoid muscle into the anterior border of the humerus is preserved and the radial nerve is protected by the triceps muscle proximally and by the retracted lateral portion of the brachialis muscle distally. The entire course of the radial nerve in the arm can be exposed. Proximally, the radial nerve can be exposed by elevating the lateral head of the triceps muscle from the humerus. Distally, the radial nerve can be exposed between the brachioradialis and the brachialis muscles. A plate can be applied on the anterolateral surface of the humerus without having to elevate the firmly attached anterior deltoid insertion.

Arm↗

PubMed2005

[Functional reconstruction of hands with irreversible radial nerve injury].

OBJECTIVE: To evaluate the effect of tendon transfer on reconstructing the extension of wrist, thumb and digit after irreversible radial nerve injury. METHODS: From January 1987 to February 2005, 25 cases of irreversible radial nerve injury were treated with Riordan tendon transfer. Among them there were 19 cases of central radial nerve injury with wrist, thumb and digit extension dysfunction and 6 cases of deep branch of radial nerve injury with digit and thumb extension dysfunction. The muscle strength of wrist and digit extension ranged from grade 0 to grade I . Tendon transfer was done 4 months to 8 years after their injuries. RESULTS: Twenty-three cases were followed up for 3 to 60 months. According to the standard established by Chen Desong, 19 cases (82.6%) showed excellent and good results. Fair result was showed in 2 cases and poor result was showed in 2 cases. CONCLUSION: Riordan tendon transfer should be the first choice of treating irreversible radial nerve injury.

Adolescent↗

PubMed1976

Radial nerve lesions and their treatment.

Out of 332 patients with peripheral nerve injuries operated upon in our Department from the beginning of 1972 to the end of 1974, in only 30 were different types of radial nerve injury observed. In most cases radial nerve palsy was seen to be a secondary occurrence following fracture of the humerus or other types of injuries. Operation revealed 16 cases of fibrosis of the radial nerve and 14 of radial nerve defect. The longest defect was 20 cm long. In the first group of patients funiculolysis was performed, and in the second group funiculorrhaphy was performed using sural nerve grafts. With the exception of one case in the first group, good reinnervation of the previously denervated muscles was achieved, as well as the restoration of sensitivity in the affected skin areas.

Humans↗

PubMed2006

[Is surgery likely to be successful as a treatment for traumatic lesions of the superficial radial nerve?].

In the last 10 years 22 patients with lesions of the superficial branch of the radial nerve have been treated surgically in our neurosurgical department. The patients' main complaints were burning pain and paraesthesia in the region supplied by the superficial branch of the radial nerve. In most cases the lesion was due to tendolysis performed earlier to treat de Quervain tendovaginitis stenosans. In 8 cases external neurolysis was done with conservation of continuity; in 4 cases the nerve was reconstructed after resection of the neuroma (end-to-end-suture or implantation of a vicryl conduit); and in 10 cases the neuroma was resected and transposition of the proximal nerve end was performed. Nineteen patients were available for evaluation of the postoperative results, after an average follow-up of 51 months. Surprisingly, only 5 reported good subjective improvement of pain after surgery. Seven patients reported an unchanged status postoperatively, and in 1 case the pain was even worse after the surgical intervention. Satisfactory results (complete or partial pain relief in 75% of cases) was found to have been achieved in the subgroup of patients treated by resection of the neuroma of the superficial branch of the radial nerve and transposition of the nerve stump. In conclusion, we recommend caution when surgical interventions are considered for traumatic lesions of the superficial radial nerve, because the prospects of success are limited. In addition, we do not consider nerve reconstruction desirable in these circumstances.

Humans↗

PubMedDate not supplied

Contribution of cutaneous and muscle afferent fibres to cortical SEPs following median and radial nerve stimulation in man.

Somatosensory evoked potentials were recorded after stimulation of motor and cutaneous nerves in the upper limb. Stimulation of the thenar motor branch of the median nerve and the deep motor branch of the radial nerve produced only broad, ill-defined and small-amplitude scalp-recorded responses. In contrast, stimulation of purely cutaneous nerves (digital and the superficial radial) gave responses of large amplitude. The cortical responses following combined deep and superficial radial nerve stimulation were of smaller amplitude than the two individual responses combined. These findings suggest that, contrary to an earlier report (Gandevia et al. 1984), muscle afferents do not make a major positive contribution to the scalp-recorded cortical responses produced by electrical stimulation of mixed nerves in the upper limb.

Adult↗

PubMed2005

Peripheral projections of sensory fascicles in the human superficial radial nerve.

The sensory territories of different cutaneous fascicles of the superficial radial nerve were delineated by microneurography at the level of the distal forearm in humans. Three fascicular patterns were found at this level: one supplying the dorsum of the radial aspect of the dorsum of the hand over the first dorsal interosseous space; another supplying the lateral aspect of the first metacarpal extending to the lateral aspect of the thumb; and a third innervating the second interosseous space and the proximal phalanx of the index and middle fingers. The compound fascicular territory is comparable to the classical territory described for the superficial radial nerve. Intraneural microstimulation of individual fascicles did not evoke paraesthesiae or pain beyond their fascicular territory, regardless of the stimulus intensity. We conclude that the superficial radial nerve at the forearm in man is composed of only three fascicles, as shown by the present study and from previous anatomical work. Referred pain seems related to nerve activity in afferent fibres from fascicles supplying deep tissues and muscles, not from cutaneous afferents.

Electric Stimulation↗

PubMed1986

Radial nerve cross-finger flap differential nerve contribution in thumb reconstruction.

Six patients with extensive palmar thumb pulp and soft tissue loss were treated with a staged transfer of radial nerve innervated flap tissues from the dorsum of the index finger. They were followed for a mean period of 3 years. This transfer of radial nerve innervated dorsal index finger tissues to the palmar surface of the thumb has been a successful method of innervation restoration. The ultimate sensibility of the reconstructed thumb seems to be a mixture of median and radial nerve sensibility. Sensory testing shows that after transfer, the ulnar side of the flap is more innervated from the radial nerve than the radial side. Our findings suggest that the presence of active sensory axons in the radial nerve innervated flap may play an inhibitory role in direct and/or functional neurotization of the transferred flap.

Adult↗

PubMed2002

Anomalous superficial radial nerve: a patient with probable autosomal dominant inheritance of the anomaly.

The sensory symptoms due to lesions of the superficial branch of the radial nerve are usually limited to the dorsolateral area of the hand. We describe a 40-year-old woman who presented with numbness of the dorsomedial aspect of the right hand following arthroplasty of the wrist. Clinically, the sensory loss suggested a lesion of the dorsal branch of the ulnar nerve. However, nerve conduction studies showed that the sensory loss was due to a lesion of a branch of the superficial branch of the radial nerve. The patient had bilateral, anomalous innervation of the dorsum of the hand-the dorsal branch of the ulnar nerve could not be demonstrated with nerve conduction techniques and the superficial branch of the radial nerve innervated most of the dorsum of the hand. Antidromic stimulation of the dorsal branch of the ulnar nerve and superficial branch of the radial nerve with paired surface recording of sensory nerve action potentials from the dorsolateral (radial side) and dorsomedial (ulnar side) hand is useful for evaluating this anomaly. Our patient had two children, one of them with a similar anomaly. This suggests an autosomal dominant inheritance of the anomaly.

Action Potentials↗

PubMed1980

[Radial nerve compression syndrome at the elbow with reference to radiohumeral epicondylosis--clinico-anatomic studies].

Compression of the radial nerve in the angle of the elbow can manifest itself clinically as "epicondylosis" ("tennis elbow"). Operative findings and systematic necropsy studies point to four specific areas in which a compression of the radial nerve occurs: 1. Occasionally, firm connective tissue fibers running between the brachialis and brachioradialis extend over the radial nerve in the proximal part of the radial tunnel. 2. Blood vessels may cross the nerve in the angle of the elbow and cause compression. 3. The profundus branch of the nerve may be compressed by the tendon of the extensor carpi radialis brevis when the origin of the muscle is located far medially, and 4. by the tendon of the superficial part of the supinator (arcade of Frohse). These structures can lead to an entrapment neuropathy of the radial nerve, and thereby to an epicondylosis humeri radialis. In patients with clinical symptoms of "epicondylitis" feeling pain along the radial nerve upon application of pressure, the nerve should be exposed to that compressing structures may possibly be released operatively.

Elbow Joint↗

PubMed2002

Radial nerve injuries from gunshot wounds and other trauma: comparison of electrodiagnostic findings.

OBJECTIVE: To identify the difference and similarity of radial nerve injury in gunshot wounds compared to blunt trauma with regard to level of injury, completeness of injury, and other associated nerve injury. DESIGN: This study was a retrospective review of electrophysiologic data performed in an electromyographic laboratory of a county hospital. A total of 67 consecutive patients had gunshot wounds or other trauma to the radial nerve during a 7-yr period (1992-1998). Forty patients met the criteria for this study. The radial nerve injury was categorized according to the level of involvement and completeness of injury. The relationship between the etiology, level of injury, completeness of injury, and other associated nerve injury was analyzed via Fisher's exact test. RESULT: There was no difference in the level of radial nerve injury, completeness of nerve injury, and associated nerve involvement between gunshot wound cases and blunt trauma cases. CONCLUSION: In contrast to the upper and lower extremity traumatic plexopathy in which differences were seen, our study showed that gunshot wound-induced radial nerve injury is similar to injury induced by other trauma in the factors measured.

Adolescent↗

PubMed2002

Locked nailing of spiral humeral fractures with or without radial nerve entrapment.

The experience of locked nailing of spiral humeral fractures and the perioperative conditions of the radial nerve are reported. The nerve is at risk of entrapment after such a fracture, and severe injury may occur during closed nailing. Among 162 humeral fractures treated by locked nailing, there were 21 spiral fractures: 18 acute fractures, and three delayed unions. The distribution of the fractures was two at the middle and 19 at the distal (1/3). Twelve patients had preoperative radial nerve palsy. All fractures excluding one middle fracture were retrograde nailed, and all patients had radial nerve exploration. Thirteen fractures were locked statically, seven were locked distally and had cerclage wiring, and one was locked distally only. Fisher's exact tests showed that the risk of radial nerve entrapment significantly increased in fractures with varus angulation or resulting from high-energy trauma. All the patients achieved fracture union and regained satisfactory joint functions. The author suggests that in external rotational spiral humeral fractures, radial nerve exploration should be done if nerve entrapment is highly suspected, irrespective of the fracture location or nerve palsy. Locked nailing with transfixing screws or cerclage wire could be a reliable treatment method for these fractures.

Adult↗

PubMed1999

Newborn radial nerve palsy: report of four cases and review of published reports.

Four newborns presented with isolated radial nerve palsy during the first 2 days of life. In three, there was a history of failure of progression of labor, which may have resulted in prolonged radial nerve compression. Furthermore, three infants had fat necrosis of the upper arm above the elbow, suggestive of compression of the radial nerve in the region of the spiral groove. Significant recovery of function was evident within 1 month in all four infants. The authors review published reports about the rare condition of isolated radial nerve palsy in the newborn.

Arm↗

PubMed2001

Anatomic relations between the cephalic vein and the sensory branches of the radial nerve: How can nerve lesions during vein puncture be prevented?

UNLABELLED: The cephalic vein of the forearm is often used for IV catheters because of its ease of access for peripheral venous cannulation. But its close relation to the sensory branch of the radial nerve sometimes causes it to be damaged when the vein is cannulated. Our anatomic study conducted on 33 specimens confirmed the risk of nerve lesion. However, it is impossible to define a safe zone, because of the randomly located nerve and vein crossing zones, where the iatrogenic risk of damaging the radial nerve is maximum. We suggest that to avoid incidents, the cephalic vein should be punctured above the emergence of the sensory branch of the radial nerve, e.g., at least 12 cm above the level of the styloid process of the radius. IMPLICATIONS: We attempted to determine the relationship between the cephalic vein and the sensory branch of the radial nerve at the wrist to help prevent lesions of the radial nerve when the cephalic vein is cannulated. We examined the anatomy of 33 postmortem specimens and suggest that puncture of the cephalic vein 12 cm or more proximal to the styloid process can prevent radial nerve lesions.

Catheterization↗

PubMed1999

Cross-chest radial nerve transfer in brachial plexus injuries. Experimental and anatomical basis.

Brachial plexus avulsion injuries are devastating injuries to the upper limb, and nerve transfer remains the only option in reconstruction. Despite the encouraging results concerning recovery of shoulder and elbow function, no option is available for treatment of the paralytic hand. In rats, we sectioned the radial nerve in the elbow region and transferred it across the chest to reinnervate the lesioned contralateral medial cord of the brachial plexus. Rats were then evaluated for motor and sensory recovery, electrophysiologically, behaviorally and morphologically. Forepaw functional recovery was estimated to be 90%. In cadavers, the radial nerve and profunda brachii artery were dissected. It was observed that the radial nerve vascularized by the profunda brachii artery was able to reach the contralateral brachial plexus distal to the shoulder region without nerve grafts. After sectioning the radial nerve, sensory loss is minimal and motor palsy can be easily restored by tendon transfers. The results of tendon transfer for radial nerve palsy are better than for any other nerve. Cross-chest radial nerve transfer might be of clinical interest in the reconstruction of hand function in entire injury to the brachial plexus.

Analysis of Variance↗

PubMed2004

Radial nerve palsy owing to localized hypertrophic neuropathy (intraneural perineurioma) in early childhood.

Localized hypertrophic neuropathy, also termed intraneural perineurioma, is a rare disorder of unknown etiology that produces a slowly progressive painless focal lesion of a peripheral nerve. It is characterized histologically by concentric whorls ("onion bulbs") of epithelial membrane antigen-reactive, S-100 protein-negative perineurial cells surrounding nerve fibers. We report a radial nerve palsy in a child aged 2 years in whom the diagnosis of localized hypertrophic neuropathy was made by biopsy. Resection of the affected nerve segment and sural nerve grafting produced no useful recovery after 3 years, probably because of the long duration of denervation. When this mononeuropathy presents in early childhood, uncertainty over the time of onset can lead to difficulty in distinguishing this potentially treatable lesion from congenital and other causes of nerve palsy.

Child, Preschool↗

PubMed2004

Missile severances of the radial nerve. Results of 131 repairs.

BACKGROUND: Reports on missile-caused radial nerve injuries are relatively rare in current literature. We present the outcome after repair of such injuries as well as the factors influencing the result of treatment. METHODS: Prospective study included 131 complete missile-caused radial nerve severances repaired with nerve graft or direct suture. Final outcome was defined 4 years postoperatively at least, on the basis of motor recovery (M), EMNG recovery (E) and patient's judgement on the quality of outcome (P). Recovery was estimated with 0-5 points and final outcome was defined according to the total sum (0-15 points) as: poor, insufficient, good or excellent. Both the good and the excellent outcomes were considered as successful, and both the poor and the insufficient outcome as unsuccessful. RESULTS: Excellent outcome was noted in 38.2% and good outcome in 47.3% of all patients. Average point score was 9.9 +/- 3.3 points for the whole series (domain of good outcome) and 6.6 +/- 3.0, 10.1 +/- 3.2 and 10.9 +/- 2.2 points for high, intermediate and low repairs, respectively (p<0.01). Useful motor recovery (>or =M3), good EMNG recovery (> or =E3) and affirmative patient's judgement on the outcome (> or =P3) had similar frequencies for intermediate (83.2-89.7%) and low repairs (85.7-92.8%), but for high repairs, good EMNG recovery was more frequent (70%) than were useful motor recovery and affirmative patient's judgement (40%). Successful outcome was noted in 89.3% of direct sutures and in 82.7% of nerve grafts (p>0.05). Patients with a successful outcome had a significantly shorter nerve defect (p<0.001), shorter preoperative interval (p<0.001) and younger age (p<0.05) than patients with an unsuccessful outcome. Significant deterioration of results began with defects longer than 8 cm, preoperative interval longer than 6 months and age above 40 years. CONCLUSIONS: The outcome is significantly worse after high radial nerve repairs than after intermediate and low repairs. The length of nerve defect, duration of preoperative interval and age of the patient also influence the repair outcome. Correlation of motor recovery with EMNG recovery and with patient's judgement on the outcome is relatively good, but depends on the level of the repair.

Adolescent↗

PubMed2006

[Electroneuromyographic study of the radial nerve at the brachium level: standard values and conduction block].

A study aims to design an electroneuromyographic technique of radial nerve investigation and conduction block (CB) definition at the spiral groove level using surface electrodes. Eight healthy volunteers, 17 patients with focal radial nerve neuropathy in the spiral groove, 4 patients with a complete injury of the radial nerve aged from 22 to 54 years have been studied. The M-response was recorded from the extensor digitorum communis. Stimulation was performed at (1) the lateral brachium; (2) the Erb's point; (3) the medical brachium (stimulation of the median and ulnar nerves). Normal values have been determined. CB was calculated as follows: 100-A2/(A1+A3)*100%, where A1--a value of the M-response area amplitude at first point stimulation, A2--the second one, A3--the third one. The proximal M-response is the sum of motor unit action potentials of posterior and anterior groups of forearm muscles. Proximal M-response in patients with a complete injury of the radial nerve did not differ from the third one. The correlation between CB and the paresis degree as well as surface EMG were revealed in patients with radial neuropathy. Besides, there was correlation between CB and the percentage contribution of the third M-response in proximal one in this group.

Adult↗

PubMed1988

Transfer of sensory branches of radial nerve in hand surgery.

Transfer of sensory branches of the radial nerve to sensory branches of the ulnar or median nerves has been carried out to restore sensitivity to the digits in patients suffering from severe, longstanding and irreparable damage to the median or ulnar nerves, due to war injuries. The author describes the two surgical techniques in detail and reports the results obtained.

Adolescent↗