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Long-term results of transplantations to repair median, ulnar, and radial nerve lesions by a microsurgical interfascicular autogenous cable graft technique.

A comprehensive analysis of 187 patients (78 median, 86 ulnar, and 23 radial nerve lesions) treated by an interfascicular autogenous nerve grafting technique is presented. After a follow-up of at least 18 months good motor recovery was achieved in 72% of median nerve lesions, 77% of ulnar nerve lesions, and 57% of radial nerve lesions. Good functional sensory recovery was found in 36% of median, 45% of ulnar, and 48% of radial nerve lesions. It appears by multivariate analysis that the results obtained generally were better in younger patients, in patients with a shorter preoperative delay, and in cases with a shorter transplant.

Adolescent↗

Isolated radial nerve lesion in the newborn.

Two newborn infants had isolated radial nerve lesion documented on electromygraphy. Fibrillation potentials present in one child at age 6 days suggest the possibility of an in utero onset. Skin necrosis present above the triceps muscle and radial nerve favors an entrapment mechanism, possibly from the umbilical cord. Because both patients had complete resolution in 4 months, it is important to differentiate this lesion form the more common but more serious medial brachial plexus lesion.

Electromyography↗

[Polyclonal antibodies, labeling radial nerve cells of the starfish Asterias amurensis].

The results of preliminary studies suggest that the cytoskeletal fraction of the radial nerve of the starfish Asterias amurensis contained a 32 kDa protein, which is tissue specific. This protein was isolated from the radial nerve by preparative electrophoresis and used as an antigen for raising polyclonal antibodies. When testing these antibodies on sections of the starfish tissues, it was shown that they interact only with the proteins present in the radial nerve cells. A conclusion was drawn that the raised antibodies may be used as a cell marker when studying regeneration of the nervous system in starfish.

Animals↗

Radial nerve entrapment at the elbow: surgical anatomy.

The surgical anatomy of interest in the posterior interosseous nerve syndrome was studied to shed light on the ramifying pattern of the radial nerve, the number of its muscular branches and their branching levels, and to pinpoint the location of the fibrous bands that may cause radial nerve entrapment. The fibrous arch of the supinator muscle (arcade of Frohse) was found to lie 3 cm to 5 cm below Hueter's line, that of the extensor carpi radialis brevis muscle lay 0.5 cm to 1 cm proximal to the arcade of Frohse. Symptom patterns in terms of muscle weakness caused by radial nerve entrapment at different levels were also evaluated.

Elbow↗

Bilateral transient radial nerve palsies in an infant after cardiac surgery.

PURPOSE: To describe the case of an infant who suffered bilateral transient radial nerve palsies after cardiac surgery. CLINICAL FEATURES: A one-month-old baby was found to have bilateral wrist and finger drop after the removal of splints that has been applied to the right hand for 14 days and to the right hand for six days during perioperative management of Blalock-Taussig shunt surgery. The hand splints had been applied to the forearms with adhesive silky tape to keep peripheral vascular lines in place. The patient also suffered from several episodes of cardiogenic shock, hypoxemia and generalized edema relating to cardiac dysfunction during this fine period. Given the findings of no impairment of median or ulnar nerves and brachioradial muscle, it was suspected that bandaging with adhesive tapes caused peripheral radial nerve damage at the level of posterior interosseus nerve on forearm. Diminished oxygen delivery and edema may additionally have contributed to peripheral nerve ischemia. The aforementioned neurologic symptoms resolved spontaneously after several days. CONCLUSION: Prolonged compression by bandaging of splints on forearm may have resulted in ischemic damage to the posterior interosseus nerve branch combined with extensor carpi radialis longus nerve branch of the radial nerve. We should attempt to reduce the frequency and duration of splinting of the extremities, especially in sedated, paralyzed babies, given the potential risk of compression neuropathy.

Arteriovenous Shunt, Surgical↗

The results of secondary microsurgical repair of radial nerve in 33 patients.

33 patients with injuries to the radial nerve were reviewed, on average, 12.1 (5-20) years after secondary repair. 24 were male and nine female, with a mean age of 29.8 (7-54) years. Most of the nerve lesions were blunt (17) or sharp (14) injuries. Division was total in 24 cases and they were mostly injured at the upper arm level (21 cases). The average interval between injury and repair was 6.0 (1-19) months. The procedures used were fascicular grafting in 21 and direct suture in 12 cases. Motor and sensory recovery were evaluated quantitatively. Useful results were obtained in 65.0% and useless in 25.0%. Fascicular grafting restored a useful level of motor function in only 8/21 cases (38.1%). Pre-operative delay had a significant influence. Associated lesions proved to be the critical factor for restoration of radial nerve function.

Adolescent↗

Does the motor branch of the long head of the triceps brachii arise from the radial nerve? An anatomic and electromyographic study.

Anatomy textbooks say that the motor branch of the long head of the triceps brachii (LHT) arises from the radial nerve. Some clinical observations of traumatic injuries of the axillary nerve with associated paralysis of the LHT have suggested that the motor branch of the LHT may arise from the axillary nerve. This anatomic study was performed, using both cadaver anatomical dissections and a surgical study, to determine the exact origin of the motor branch of the LHT. From the adult cadaver specimens (group I), 20 posterior cords were dissected from 10 subjects (eight embalmed, two fresh) using 3.5x magnification. The axillary nerve was followed from its onset to the posteromedial part of the surgical neck of the humerus and the radial nerve. We looked for the origin of the proximal branch of the LHT by a meticulous double anterior and posterior dissection. From the surgical group (group II), 15 posterior cords were dissected from 15 patients suffering from a C5-C6 injured paralysis, without paralysis of the LHT. During the surgical procedure, we looked for the origins of the motor branch of the LHT with a nerve stimulator. In group I, the motor branch of the LHT arose in 13 cases from the axillary nerve near its origin, in five cases from the terminal division of the posterior cord itself, and in two cases from the posterior cord 10 mm before its terminal division into the radial and axillary nerves. In no case did we find the motor branch of the LHT arising from the radial nerve. In eight cases, we found some accessory branches that arose near the principal branch. In group II, the motor branch of the LHT arose in 11 cases from the axillary nerve near its origin and in four cases from the terminal division of the posterior cord itself. The motor branch of the LHT never originated from the radial nerve. In four cases, we found some accessory branches that arose near the principal branch of the LHT. These results reveal that the motor branch of the LHT seems to originate most often from the axillary nerve. This contribution could be relevant for surgical treatment of traumatic nerve injuries.

Adult↗

Motor unit estimation in a muscle supplied by the radial nerve.

The number of motor units in a muscle, the abductor pollicis longus (APL), supplied by the radial nerve was estimated. In 40 APL muscles of control subjects, the mean number of motor units was found to be 421 +/- 99 (SD). Ten patients underwent conventional EMG examination to confirm the clinical suspicion of denervation in radial nerve territory. All presented a significant reduction in the number of motor units in the APL muscle. These results show that this method is useful in the evaluation of muscles supplied by the radial nerve.

Adolescent↗

The surgical anatomy of the radial nerve around the humerus.

Twenty-four cadaveric arms were dissected to determine the position of the radial nerve on the posterior aspect of the humerus relative to the posterior tip of the acromion, the medial and lateral epicondyles, the division between the lateral and long heads of the triceps, and the triceps aponeurosis. The radial nerve passed anterior to the long head of triceps and cross onto the posterior shaft of the humerus an average of 124 mm below the posterior tip of the acromion. It was never closer than 97 mm. The nerve usually lies on the medial head of the triceps as it courses posteriorly around the humerus and then leaves the posterior shaft of the humerus an average of 126 mm above the lateral epicondyle and 131 mm above the medial epicondyle. It was never within 100 mm of either epicondyle. The surgeon can use these landmarks as guidelines to avoid the radial nerve during operative intervention on the humerus.

Aged↗

Flexor carpi ulnaris transfer for radial nerve palsy: functional testing of long-term results.

Controversy persists over the use of the flexor carpi ulnaris for transfer to the extensor digitorum communis in the treatment of radial nerve palsy. Six patients with complete, irreparable radial nerve palsies were treated in part with the flexor carpi ulnaris to extensor digitorum communis tendon transfer (standard transfers: pronator teres to extensor carpi radialis brevis, flexor carpi ulnaris to extensor digitorum communis, and palmaris longus to the rerouted extensor pollicis longus) and were functionally tested for long-term results. The average follow-up time was 8 years (range, 3-15). A control group was comprised of 10 volunteers of similar demographics. This study evaluates the long-term functional recovery in three categories: range of motion, dynamic power of wrist motion, and functional ability as determined by work simulation techniques. The activities simulated were swinging a hammer, sawing wood, tightening screws, and using pliers. A functional range of motion was maintained in all patients, and the power of wrist motion was sufficient to perform all activities of daily living. The work simulation testing revealed no significant difference between the tendon transfer patients and control group with respect to hand dominance and normal variance. All patients were able to perform the simulated work with the same variance in power as the control group. Despite the obvious anatomic loss, wrist function is not significantly impaired after flexor carpi ulnaris tendon transfer for radial nerve palsy.

Activities of Daily Living↗

The giant neurone system in Ophiuroids. I. The general morphology of the radial nerve cords and circumoral nerve ring.

The nervous system of Ophiura texturata contains nerve fibres and cell bodies that are an order of magnitude larger than anything previously described in the Asteroidea and Echinoidea. These large nerve cells are designated giant fibres. Giant nerve cells are present in both the ectoneural and hyponeural nervous system. The layout of these nerve cells is described and it is shown that the organization is repeated in each segmental ganglion that makes up the radial nerve cord. The circumoral nerve ring is composed, in the main, of tracts of nerve fibres joining the radial nerves, and it contains only limited areas of neuropil associated with the alimentary canal and muscle of the disc and jaws. Degeneration studies have shown that each segmental ganglion of the radial nerve cords contains a discrete population of neurones separate from adjacent ganglion and that there are not anatomically continuous giant fibres along the whole length of the nerve cord.

Animals↗

Radial nerve entrapment by the lateral head of the triceps.

A case of slowly progressive radial nerve entrapment of spontaneous onset is presented. Surgical exploration revealed compression of the radial nerve by a musculotendinous arch of the lateral head of the triceps. Relief of signs and symptoms did not ensue.

Adult↗

[Humeral fractures complicated by radial nerve lesions].

In the period of 1966-1975 the authors treated 228 patients with a fractures of diaphysis of humerus, 103 of whom underwent surgery; in 36 of them a paralysis of the radial nerve occurred. These 36 patients were divided into two groups: primary lesions (22 cases) which were discovered during hospitalization, and secondary lesions which occurred in postoperative course. The aim of clinical research with the primary lesion (respectively 22 patients) was to ascertain which method would have the best effect. In 77,2% of these patients, a radial nerve was not interrupted, while in 13.6% its continuity was partially preserved, and only in 9.09% a complete interruption occurred. Complete recovery of the nerve was in 50% of patients, 22.7% had a small conduction deficit, while its paralysis was further present in 18.8% of cases. Accordingly to this, the authors attained an excellent and very good results in 59% of patients, while in the remaining 41% of cases the results was satisfactory. It has been established that primary lesions of radial nerve has been occurring in 7.64% of cases (similar date do exist in reviewed reports), and in the majority of patients a spontaneously recovery will occur in the course of 2-3 months. Therefore the authors are not for a primary exploration of n.radialis if it is a question of closed fractures. In rare cases with interruption of the radial nerve with extensive contusions of both simultaneously interrupted nervous stumps a primary suture is not indicated. Therefore an eventual surgical exploration to establish whether an interruption of the nerve exists, does not contribute to attain recovery.

Adolescent↗

High radial nerve palsy following strenuous muscular activity. A case report.

A case of high radial nerve palsy occurred following muscular overexertion in a 20-year-old man. Late surgical exploration showed a nerve constricture from the lateral head of the triceps. A literature review showed that entrapment of the radial nerve following muscular overexertion can occur from a fibrous arch coming from the lateral head of the triceps or by the lateral head of the triceps muscle. The neuropathy can be irreversible, and early recognition of this syndrome is mandatory so that surgical decompression can be considered before permanent nerve damage occurs.

Adult↗

Investigation of two possible compression sites of the deep branch of the radial nerve and nerve supply of the extensor carpi radialis brevis muscle.

The posterior interosseous nerve arises from the deep branch of the radial nerve, and compression by adjacent structures results in posterior interosseous nerve syndrome. Sixty upper limbs from 30 Turkish subjects (18 males and 12 females) were dissected to reveal the course of the posterior interosseous nerve and to examine possible compression sites at the proximal and distal edges of the supinator muscle, and the exit of the nerve from the extensor carpi radialis brevis muscle. Posterior interosseous nerve syndrome is most probably caused by the tendinous part of the supinator muscle at the proximal edge.

Adult↗

Emergence of radial nerve dominance in median nerve cortex after median nerve transection in an adult squirrel monkey.

Throughout the glabrous representation in Area 3b, electrical stimulation of the dominant (median or ulnar) input produces robust, short-latency excitation, evident as a net extracellular "sink" in the Lamina 4 current source density (CSD) accompanied by action potentials. Stimulation of the collocated nondominant (radial nerve) input produces a subtle short-latency response in the Lamina 4 CSD unaccompanied by action potentials and followed by a clear excitatory response 12-15 ms later. Laminar response profiles for both inputs have a "feedforward" pattern, with initial activation in Lamina 4, followed by extragranular laminae. Such corepresentation of nondominant radial nerve inputs with the dominant (median or ulnar nerve) inputs in the glabrous hand surface representation provides a likely mechanism for reorganization after median nerve section in adult primates. To investigate this, we conducted repeated recordings using an implanted linear multi-electrode array straddling the cortical laminae at a site in "median nerve cortex" (i.e., at a site with a cutaneous receptive field on the volar surface of D2 and thus with its dominant afferent input conveyed by the median nerve) in an adult squirrel monkey. We characterized the baseline responses to median, radial, and ulnar nerve stimulation. We then cut the median nerve and semichronically monitored radial nerve, ulnar nerve and median nerve (proximal stump) evoked responses. The radial nerve response in median nerve cortex changed progressively during the weeks after median nerve transection, ultimately assuming the characteristics of the dominant nerve profile. During this time, median, and ulnar nerve profiles displayed little or no change.

Action Potentials↗

Electrophysiological correlates among the radial nerve, the caudate and the entopeduncular nuclei in cats.

The entopeduncular nucleus (EPN), as the medial part of the globus pallidum, has been considered the efferent structure of the striatum. Based on this, we decided to study its possible somatosensory projections and the electrophysiological relationship with the caudate nucleus (CN). Radial nerve stimulation produced evoked responses (ER) in CN and EPN. The ERs recorded in EPN are of shorter latencies (11 msec) than those in CN (23 msec). Electrical stimulation of CN elicited ERs in EPN. These ERs are bigger when the stimulation sites coincide with the regions of CN where somatic stimulation also elicited ERs. The same regions of CN yielding ERs by somatic stimulation respond to EPN stimulation. The ERs recorded in EPN by radial nerve stimulation diminished when the CN was stimulated 7 msec after the radial nerve, while other intervals were less effective. The results show that the radial nerve probably has direct ipsi and contralateral projections to the EPN and a bidirectional connection between EPN and CN. We suggest a feedback response of EPN to CN stimulation, an arrangement which would be the functional basis for the central motor regulation.

Afferent Pathways↗

[Traumatic lesions of the deep branch of the radial nerve].

PURPOSE OF THE STUDY: We report a retrospective study of 21 patients treated for an injury of the deep branch of the radial nerve. The aim of this study was to precise the indication and to evaluate the results of nerve surgery and tendon transfer. MATERIAL: 21 patients, mean age 32, with complete divided lesion of the nerve due to open injury were included. 5 cases with fresh discision of the deep branch of the radial nerve were treated in emergency by suture repair. 16 cases were old lesions. 6 of them had initially severe associated lesions involving skin, forearm muscles or radius. In this case, the treatment of the nerve lesion was delayed after the treatment of the associated lesions. 10 were simple lesions of the nerve who were initially misknowned (6 cases) or caused by a surgical procedure at the proximal forearm (4 cases). METHODS: 4 patients had tendon transfers, due to a very old lesion for one of them and a severe muscle involvement for the 3 others. Twelve nerve graft repairs were performed. Their were 8 troncular grafts and 4 fascicular grafts because the lesion was in the posterior forearm at the level of the terminating branches of the nerve. They required a mean length of 5.8 cm and an average of 3 to 4 cables for nerve graft. RESULTS: The mean follow up was 25 months. Results were appreciated on the recovery of 5 functions (supination, fingers extension, thumb abduction, thumb retropulsion, wrist postero-ulnar extension). Primitive nerve repairs had full recovery in all cases. Tendon transfers had good results. The 12 nerve grafts had 2 excellent results, 8 good results, 1 fair and 1 poor result. These 2 last cases required secondary tendon transfers. DISCUSSION: Traumatic lesions of the deep branch of the radial nerve are often misknowned and often iatrogenic. Nerve surgery provides better functional results than tendon transfers. Nerve grafts in delayed nerve repairs are possible even if the lesion is distal. They give excellent or good functional recovery in most cases after a delay of 7 months. Tendon transfers are indicated if nerve surgery fails or in case of large forearm muscle defect, old patient, and when the delay after the injury is superior to 12 months.

Adult↗