[Notes on neurological semeiology. XII. The peripheral nerves. b) Spinal nerves. Radial nerve].
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Databases, Genetic↗
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Results for “RADIAL NERVE”
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Radial tunnel syndrome. A retrospective review of 30 decompressions of the radial nerve.
Radial tunnel syndrome results from compression of the radial nerve by the free edge of the supinator muscle or closely related structures in the vicinity of the elbow joint. Despite numerous reports on the surgical management of this disorder, it remains largely unrecognized and often neglected. The symptoms of radial tunnel syndrome can resemble those of tennis elbow, chronic wrist pain or tenosynovitis. Reliable objective criteria are not available to differentiate between these pathologies. These difficulties are discussed in relation to 29 patients who underwent 30 primary explorations and proximal decompressions of the radial nerve. Excellent or good results were obtained in 70%, fair results in 13% and poor results in 17% of patients. The results can be satisfactory despite the prolonged duration of symptoms. We believe that a diagnosis of radial tunnel syndrome should always be born in mind when dealing with patients with forearm and wrist pain that has not responded to more conventional treatment. Patients with occupations requiring repetitive manual tasks seem to be particularly at risk of developing radial tunnel syndrome and it is also interesting to note that 66% of patients with on-going medico-legal claims had successful outcomes following surgery.
Adolescent↗
Radial nerve in the radial tunnel: anatomic sites of entrapment neuropathy.
Common anatomical structures that can lead to radial nerve entrapment in the radial tunnel (radial tunnel syndrome) were studied in 46 embalmed cadaveric upper limbs. After dissecting the radial tunnel, we investigated: the radial nerve and its division into superficial and deep (DBRN) branches; the course of the DBRN in relation to the extensor carpi radialis brevis (ECRB) muscle; the presence of fat; fibrous adhesions between the anterior radiohumeral joint capsule and the DBRN; the nature of the superomedial margin of the ECRB; vascular arcades of the radial recurrent vessels; and the superior and inferior borders of the superficial layer of the supinator muscle. The locations of some of these structures were measured in reference to two fixed points: the radiohumeral joint line and a line joining the tips of medial and lateral epicondyles of humerus. Near the radiohumeral joint, fibrous adhesions were observed between the DBRN and underlying capsule in 23/46 (50%) cases; vascular arcades of the radial recurrent vessels were found in 33/46 (72%) cases; the superomedial margin of the ECRB was tendinous in 36/46 (78%) instances; the superior border of the superficial layer of the supinator muscle was noted to be tendinous (arcade of Frohse) in 40/46 (87%) specimens, and the inferior border of the superficial layer of the supinator muscle was tendinous in 30/46 (65%) cases. These anatomical features in the radial tunnel are significant enough to lead to entrapment neuropathy of the radial nerve.
Adult↗
Results of interfascicular nerve grafting for radial nerve lesions.
During the 10 year interval 1979-1989, 20 patients underwent nerve grafting of a radial nerve lesion, 13 high radial and 7 posterior interosseous. Average follow-up was 38 months (range 12 months-10 years). Overall 72% of patients achieved a Highet Scale rating of M3 or better function and 44% M4 or better recovery. Age of the patient and length of the nerve graft did not seem to influence outcome. Time from initial injury to nerve grafting did affect outcome, with 85% of patients grafted within 6 months obtaining M3 or better recovery. No patient grafted 12 months after injury recovered any useful function. Lesions of the posterior interosseous nerve had a consistently superior recovery. Power grip strength in the affected hand of patients averaged 60% of the unaffected hand while key pinch averaged 74%. There was good correlation between the Highet Scale rating of recovery and the ultimate power grip or key pinch strength obtained. Hand dexterity, as assessed by the turning and displacing tests of the Minnesota Rate of Manipulation Test, displayed a wide range of scores in both affected and unaffected hands. Nevertheless, a relative score derived from the results obtained in the displacing test did show correlation with the Highet Scale rating. All patients with M4 or better recovery obtained relative scores for the affected hand that were in the middle of the range of scores considered an average performance for a normal population. Patients who achieved M4 or better nerve recovery following radial nerve grafting also obtained a functional hand as evidenced by the results of grip, key pinch strength, and hand dexterity testing. Lesser degrees of recovery were accompanied by poorer strength and dexterity ratings reflecting inferior function.
Adult↗
Anatomical observations on the arcade of Frohse and other structures related to the deep radial nerve. Anatomical interpretation of deep radial nerve entrapment neuropathy.
In a series of 120 elbow regions (66 male, 54 female) from embalmed human cadavers, the authors observed the course of the deep radial nerve and then related it to structures such as a) the deep surface of the initial part of the extensor carpi radialis brevis, which was found to be tendinous in 90% of the cases, b) the superior hiatus of the supinator muscle, which formed a fibrous arcade of Frohse in 61% of the cases, and the distance of its peak from the lateral condyle, which ranged from 4 to 6 cm, and c) the angle between the superficial oblique muscle fibres of the supinator and the long axis of the radius, which varies from 18 degrees to 38 degrees and crossed the nerve almost transversely. The above anatomical factors--and particularly the thickened fibrous arcade of Frohse--are all important for the deep radial entrapment neuropathy in predisposed individuals.
Adult↗
Anatomic bases for the compression and neurolysis of the deep branch of the radial nerve in the radial tunnel.
The anatomy of the radial tunnel was studied on twenty-five elbow preparations. We noted five different elements that could affect the deep branch of the radial nerve in the radial tunnel and cause an entrapment syndrome: a capsule-tendon-aponeurotic complex on the anterior aspect of both the humeroradial joint and the radial head, the vascular arcade formed by the radial recurrent a, and its branches, the arcade formed by the medial edge of extensor carpi radialis brevis muscle, and the superior and inferior arcades of the superficial layer of the supinator muscle. These results are compared with recent anatomical and clinical data, and the relevance of a surgical approach between the extensor carpi radialis brevis and longus muscles is discussed.
Cadaver↗
Unobtainable radial nerve F-waves in a case of radial nerve conduction block.
We present here the first known case of an unobtainable radial nerve F-wave in a case of radial nerve conduction block. This case further demonstrates that F-waves are used not only to rule out neuropathy or radiculopathy, but also to detect conduction block.
Adult↗
Analysis of Tsuge's procedure for the treatment of radial nerve paralysis.
Radial deviation and limited flexion of the wrist joint and a lack of abduction of the thumb have been noticed after the Riordan's procedure. Therefore, Tsuge et al. modified the Riordan's procedure, and their procedure includes transfer of the pronator teres to the extensor carpi radialis brevis, the flexor carpi radialis (FCR) to the extensor digitorum communis (EDC), and the palmaris longus to the extensor pollicis longus, along with tenodesis of the abductor pollicis longus. We reviewed the charts of 21 patients with isolated radial nerve paralysis who were treated with the Tsuge's procedure. Mean follow-up period was 11.3 years. Postoperatively, patients showed good extension of the metacarpophalangeal joint measured at the middle finger, useful flexion of the wrist joint, and decreased radial deviation of the wrist. The FCR transfer to the EDC is an excellent procedure for extension of the fingers. However, reconstruction of active abduction of the thumb remains controversial.
Adolescent↗
The first reported case of radial nerve palsy.
Radial nerve injury produced by anterior dislocation of the shoulder is uncommon. Here I present a probable case from 3,000 years ago, described in the Bible. My report is based on the "medical history" only. Differential diagnosis, laboratory findings, and treatment are discussed.
Bible↗
Posterior interosseous nerve paralysis related to focal radial nerve constriction secondary to vasculitis.
A case of posterior interosseous nerve paralysis is reported with discussion of some characteristics that appear to distinguish it from entrapment neuropathy and neuralgic amyotrophy. The surgical implications are also discussed. More than ten similar cases have been reported, but the pathogenesis of this condition is still controversial. The patient presented with posterior interosseous nerve paralysis related to focal radial nerve constriction secondary to vasculitis in the perineurium. The constriction site was resected and the radial nerve was sutured. The patient recovered completely after 8 months.
Adult↗
[Lesion of the ramus profundus of the radial nerve (supinator syndrome). Dissociated radial paralysis of the proximal under arm type].
Anatomy and clinical patterns of dissociated distal paralysis of the radial nerve ("supinator syndrome" or paralysis of posterior interosseous nerve) due to trauma, tumors, rheumatic diseases and with spontaneous onset are discussed in the light of the literature and 6 personally observed cases, 5 of them with traumatic lesions. Surgical exploration and intraneural neurolysis resulted in total or partial remission in 5 instances. In our experience surgical exploration should be performed at the earliest moment after spontaneous recovery is no longer to be expected.
Bone Plates↗
RADIAL NERVE TRANSPLANT AND INTERNAL FIXATION IN CASES OF HUMERUS FRACTURE WITH RADIAL NERVE INJURY.
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Fracture Fixation↗
Radial nerve compression.
Symptomatic radial nerve compression is relatively uncommon. A relatively high incidence of compressive neuropathy involves other major nerves in the same extremity. Because sensory complaints are minor, radial nerve compression may successfully masquerade as tendonitis or tendon rupture. The most common site of radial nerve compression is in the forearm, at the arcade of Frohse. Spontaneous onset of dense paralysis is often due to space-occupying lesions in the forearm. Trauma-related compression in the forearm is most often due to radial head dislocation and either humeral fracture or local external pressure in the upper arm. Compression resulting in weakness that does not improve with several months of splinting, anti-inflammatory medication, and activity changes should be treated surgically to reduce the extent of permanent deficit. After decompression, early active motion is instituted to encourage nerve gliding. Results after decompression are not as favorable as those for carpal or cubital tunnel release. The worst results of decompression are seen in patients who have work-related injuries, chronic pain, and poor localization of symptoms on physical examination.
Diagnosis, Differential↗
[Radial nerve lesions].
INTRODUCTION: The radial nerve is a prolongation of the posterior secondary trunk of the brachial plexous. It goes round the posterior aspect of the humerus, and is found anteriorly at the level of the forearm where it divides into two branches: 1. A deep motor branch, the posterior interosseus nerve; and 2. A superficial sensory branch, the superficial radial nerve. MATERIAL AND METHODS: Lesions of the radial nerve are studied by conduction tests (sensory and motor) and electromyography. Sensory manifestations of lesions of the radial nerve are usually limited to the dorso-lateral area of the hand. Motor disorders are usually seen as defects of extension, in which the triceps muscle may be involved depending on the level at which the lesion occurs. When topographical criteria are considered, the clinical syndromes of the radial nerve may be classified as: 1. Neuropathies of the main trunk; 2. Neuropathies of the posterior interosseus nerve; and 3. Neuropathies of the superficial radial nerve. Trauma, external compression and trapping are the main causes of lesions in these syndromes. CONCLUSIONS: The radial nerve may be involved in multi-neuropathic processes forming part of a systemic illness (vasculitis, diabetes, etc.) or of a purely neuro-muscular disorder (acute neuropathy of the brachial plexus, neuropathy due to the effect of pressure and motor multifocal neuropathy.
Arm↗
Radial nerve entrapment.
The radial nerve is frequently more involved in entrapment syndromes than the ulnar and median nerves. Common sites of compression are the juncture of the middle and distal third of the arm (especially with fractures of the humerus), just distal to the elbow (radial tunnel), and proximal to the wrist between the brachioradialis and extensor carpi radialis longus. Often in entrapment syndromes involving the radial nerve, the true diagnosis is not evident and is arrived at only by exclusion, which sometimes delays initiation of effective treatment. Radial tunnel syndrome is rare, but decompression when indicated, can provide relief. Radial sensory nerve entrapment in the forearm (distal third) does occur, but patients often respond to temporary thumb spica splinting.
Adult↗
Lack of effect of pulsed low-intensity infrared (820 nm) laser irradiation on nerve conduction in the human superficial radial nerve.
BACKGROUND AND OBJECTIVE: To investigate the effect of pulsed low-intensity laser irradiation on nerve conduction in the human superficial radial nerve and on temperature in the skin overlying the nerve. STUDY DESIGN/MATERIALS AND METHODS: Thirty-two healthy human volunteers were recruited and randomly assigned to either placebo, laser 1 (9.12 Hz), laser 2 (73 Hz), or control groups (n = 8 all groups). A GaAlAs laser diode (820 nm, 50 mW peak) was used to irradiate the skin overlying the right superficial radial nerve at three points (1.2 J per point; energy density, 9.55 J/cm(2)). Antidromic action potentials were recorded from the superficial radial nerve preirradiation and at 5, 10, and 15 minutes after irradiation. Skin temperature was monitored concomitantly by using two surface thermistor probes attached to the skin overlying the nerve. RESULTS: Repeated measures analysis of variance showed no significant differences between groups for negative peak latency nor skin temperature data after laser irradiation. CONCLUSION: This study has demonstrated that laser irradiation at the radiant exposure and pulsing parameters indicated did not produce any specific neurophysiologic effects in this model of nerve function.
Action Potentials↗
Nerve transfer to the median nerve using parts of the ulnar and radial nerves in the rabbit--effects on motor recovery of the median nerve and donor nerve morbidity.
In this study, motor re-innervation of the median nerve by transfer of one-third, one-half, and two-thirds of either the agonistic ulnar nerve or the antagonistic radial nerve was investigated in both extremities of 20 rabbits. Recipient median nerve: Muscle contraction force of the flexor digitorum sublimus muscle after a one-third and a one-half of the ulnar nerve transfer achieved an average of 75 and 97% muscle power respectively as compared to conventional end-to-end neurorrhaphy. Muscle contraction force after one-third or one-half of the radial nerve transfer was significantly lower (36%). Donor nerves: Extensor carpi radialis muscle or flexor carpi ulnaris muscle contraction force 6 months postoperatively demonstrated a significant decrease after a one-half ulnar nerve and a two-thirds ulnar or radial nerve transfer, but not after a one-third transfer of either radial or ulnar nerves. Histologically, the number of axons in the re-innervated median nerve and both donor nerves distal to the coaptation site seemed to follow variable patterns. It was concluded that in the rabbit use of one-third of the agonistic ulnar nerve for re-innervation of the median nerve results in useful motor recovery with negligible donor site morbidity. Clinically, this technique may offer an alternative option for proximal nerve injuries or for free functioning muscle transplantations.
Animals↗
A new method of nerve repair: repair of a lesion of the radial nerve with a branch to the triceps muscle.
Regeneration of the radial nerve following a new technique of nerve anastomosis in the humeral spiral groove is reported. Neurorrhaphy was performed by anastomosing a branch supplying the medial head of the triceps to the distal cut end of the radial nerve at the level of the lateral intermuscular septum. The progress of the nerve is detailed and has been confirmed by electromyographic studies showing regeneration of the radial nerve 3 years after operation and 4 years after injury. This technique for repair of the radial nerve has not been previously described.
Adult↗