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Cureus Nov 2020Radial nerve palsies in closed humeral shaft fractures are common, with an incidence of 7%-17%. The management of radial nerve palsies in closed fractures is often... (Review)
Review
Radial nerve palsies in closed humeral shaft fractures are common, with an incidence of 7%-17%. The management of radial nerve palsies in closed fractures is often expectant, with 70.7% spontaneously recovering within six months. A literature search was conducted for studies on radial nerve palsies in humeral shaft fractures from 2000-2018. A total of 4972 humeral shaft fractures were identified, with an incidence of 12.2% of primary radial nerve palsies. During the exploration, no neurological intervention was performed in nearly 41% of cases, and the most common finding was no evidence of any nerve lesion (35%). Those who underwent neurolysis were more likely to resolve when compared to primary repair or nerve grafting. Overall, there was a high rate of spontaneous radial nerve palsy recovery (85%) with radial nerve exploration increasing rates of resolution. While exploration demonstrates increased resolution, it is yet to be determined which fractures are indicated for nerve exploration.
PubMed: 33335819
DOI: 10.7759/cureus.11490 -
The Journal of Hand Surgery, European... Apr 2022The anconeus nerve is the longest branch of the radial nerve and suitable as a donor for the neurotization of the axillary nerve. The aim of this study was to map its...
The anconeus nerve is the longest branch of the radial nerve and suitable as a donor for the neurotization of the axillary nerve. The aim of this study was to map its topographical course with reference to palpable, anatomical landmarks. The anconeus nerve was followed in 15 cadaveric specimens from its origin to its entry to the anconeus. It runs between the lateral and the medial head of the triceps before entering the medial head and running intramuscularly further distal. Exiting the muscle, it lies on the periosteum and the articular capsule of the elbow, before entering the anconeus muscle. Two types of anconeus nerve in relation to branches innervating triceps were found: nine nerves also innervated the lateral triceps head, while the other six only contributed two branches to its innervation. The course of the anconeus nerve is important for harvesting as a donor nerve and to protect the nerve in surgical elbow approaches.
Topics: Brachial Plexus; Cadaver; Elbow; Elbow Joint; Humans; Muscle, Skeletal; Nerve Transfer; Radial Nerve
PubMed: 34878946
DOI: 10.1177/17531934211061437 -
JSES International May 2023The consequences of radial nerve palsy associated with a humeral shaft fracture are unclear. The aim of this study was to examine the functional recovery of radial nerve...
BACKGROUND
The consequences of radial nerve palsy associated with a humeral shaft fracture are unclear. The aim of this study was to examine the functional recovery of radial nerve palsy, at presentation or postoperatively, in patients with a humeral shaft fracture.
METHODS
Data from patients who participated in the HUMeral shaft fractures: measuring recovery after operative versus non-operative treatment (HUMMER) study, a multicenter prospective cohort study including adults with a closed humeral shaft fracture Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 12A or 12B, and had radial nerve palsy at presentation or postoperatively, were extracted from the HUMMER database. The primary outcome measure was clinically assessed recovery of motor function of the radial nerve. Secondary outcomes consisted of treatment, functional outcome (Disabilities of the Arm, Shoulder, and Hand and Constant-Murley Score), pain level, quality of life (Short Form-36 and EuroQoL-5D-3L), activity resumption, and range of motion of the shoulder and elbow joint at 12 months after trauma.
RESULTS
Three of the 145 nonoperatively treated patients had radial nerve palsy at presentation. One recovered spontaneously and 1 after osteosynthesis. Despite multiple surgical interventions, the third patient had no recovery after entrapment between fracture fragments. Thirteen of the 245 operatively treated patients had radial nerve palsy at presentation; all recovered. Nine other patients had postoperative radial nerve palsy; 8 recovered. One had ongoing recovery at the last follow-up, after nerve release and suture repair due to entrapment under the plate. At 12 months, the functional outcome scores of all patients suggested full recovery regarding functional outcome, pain, quality of life, activity resumption, and range of motion.
CONCLUSION
Radial nerve palsy in patients with a humeral shaft fracture at presentation or postoperatively functionally recovers in 94% and 89%, respectively.
PubMed: 37266182
DOI: 10.1016/j.jseint.2023.02.003 -
Hand (New York, N.Y.) Nov 2022Radial nerve injuries cause profound disability, and a variety of reconstruction options exist. This study aimed to compare outcomes of tendon transfers versus nerve...
BACKGROUND
Radial nerve injuries cause profound disability, and a variety of reconstruction options exist. This study aimed to compare outcomes of tendon transfers versus nerve transfers for the management of isolated radial nerve injuries.
METHODS
A retrospective chart review of 30 patients with isolated radial nerve injuries treated with tendon transfers and 16 patients managed with nerve transfers was performed. Fifteen of the 16 patients treated with nerve transfer had concomitant pronator teres to extensor carpi radialis brevis tendon transfer for wrist extension. Preoperative and postoperative strength data, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and quality-of-life (QOL) scores were compared before and after surgery and compared between groups.
RESULTS
For the nerve transfer group, patients were significantly younger, time from injury to surgery was significantly shorter, and follow-up time was significantly longer. Both groups demonstrated significant improvements in grip and pinch strength after surgery. Postoperative grip strength was significantly higher in the nerve transfer group. Postoperative pinch strength did not differ between groups. Similarly, both groups showed an improvement in DASH and QOL scores after surgery with no significant differences between the 2 groups.
CONCLUSIONS
The nerve transfer group demonstrated greater grip strength, but both groups had improved pain, function, and satisfaction postoperatively. Patients who present early and can tolerate longer time to functional recovery would be optimal candidates for nerve transfers. Both tendon transfers and nerve transfers are good options for patients with radial nerve palsy.
Topics: Humans; Radial Neuropathy; Tendon Transfer; Nerve Transfer; Retrospective Studies; Quality of Life
PubMed: 33530787
DOI: 10.1177/1558944720988126 -
European Journal of Trauma and... Aug 2022The aim of this study was to present our experience of treating humerus fracture sustained during arm wrestling.
PURPOSE
The aim of this study was to present our experience of treating humerus fracture sustained during arm wrestling.
METHODS
Data of patients treated in our clinic with the diagnosis of humeral shaft fracture due to arm wrestling between 2000 and 2020 was retrospectively reviewed. Data collected included age, sex, dominant arm, history of professional or experienced participation, type and laterality of fracture, presence of radial nerve palsy, other surgical complications, management (surgical or conservative), duration of union defined as the time from injury until callus was evident on the radiograph, and the range of motion of the elbow joint at the last follow-up.
RESULTS
Nineteen patients with humeral shaft fracture as a result of the arm wrestling were included. All had right arm fracture and all had right as the dominant side. All of the fractures were spiral at the distal third of the humerus and medial butterfly fragment was present in eleven (57.9%). Seven (36.8%) were treated surgically. Five (26.3%) had radial nerve palsy on admission. At last follow-up, no patient had neural deficit and none had significant loss of range of movement.
CONCLUSION
Arm wrestling is an important cause of humerus shaft fracture. The dominant side is invariably affected. In this series all fractures were spiral type and occurred in the distal third of the humerus. One quarter of patients experienced radial nerve palsy, which can resolve spontaneously. Satisfactory results can be obtained with both conservative and surgical treatment.
LEVEL OF EVIDENCE
IV.
Topics: Arm; Fracture Fixation, Internal; Humans; Humeral Fractures; Radial Neuropathy; Retrospective Studies; Wrestling
PubMed: 34981137
DOI: 10.1007/s00068-021-01852-4 -
Journal of Ultrasound in Medicine :... Dec 2021This pictorial review focuses on the ultrasound (US) appearance of the normal and pathological radial nerve (RN) and its branches and provides tips with which to locate... (Review)
Review
This pictorial review focuses on the ultrasound (US) appearance of the normal and pathological radial nerve (RN) and its branches and provides tips with which to locate them and avoid misinterpretation of normal findings. A wide range of our pathological cases are reviewed and presented to help in familiarizing the reader with common and uncommon clinical scenarios that affect the RN and its main branches.
Topics: Humans; Radial Nerve; Ultrasonography
PubMed: 33629784
DOI: 10.1002/jum.15664 -
Hand Surgery & Rehabilitation Feb 2022Palliative tendon transfer is an integral part of radial nerve palsy treatment. It can be considered in the first weeks when the possibility of nerve repair by direct...
Palliative tendon transfer is an integral part of radial nerve palsy treatment. It can be considered in the first weeks when the possibility of nerve repair by direct suture or nerve grafting is not feasible or reasonable. Mostly, it is discussed secondarily when it is too late for nerve surgery and motor recovery cannot be expected, or after failure or incomplete recovery after nerve repair. The goal of tendon transfers is to restore wrist, finger and thumb extension. For wrist extension, the use of pronator teres is well accepted. The best tendon transfer for finger extension is debated. This can be restored doing a flexor carpi ulnaris (FCU), flexor carpi radialis or flexor digitorum superficialis (FDS) to extensor digitorum communis transfer. Regarding thumb extension and abduction, a palmaris longus (PL) or one FDS tendon to the rerouted extensor pollicis longus (EPL) transfer can be performed. If a transfer is done on the EPL without rerouting it, abduction can be restored by doing a tendon transfer to the abductor pollicis longus (APL) or an APL tenodesis. The different tendon transfer options are selected based on the surgeon's preference, and most importantly, discussed with the patients to define the objectives together. The transfer is chosen based on the clinical examination (high or low radial nerve palsy, tendon available for transfer like PL, wrist mobility) and based on the patient's needs and expectations (activities requiring the FCU, finger independence, independence of thumb extension or abduction). If the surgical rules and the postoperative instructions for rehabilitation are followed, tendon transfers for radial nerve palsy regularly produce very satisfactory results.
Topics: Hand; Humans; Radial Neuropathy; Tendon Transfer; Tendons; Wrist Joint
PubMed: 34343724
DOI: 10.1016/j.hansur.2018.09.009 -
Frontiers in Surgery 2022Radial nerve lesions present a clinical entity that may lead to disability, psychological distress, and job loss, and thus requires great attention. Knowledge of the...
INTRODUCTION
Radial nerve lesions present a clinical entity that may lead to disability, psychological distress, and job loss, and thus requires great attention. Knowledge of the etiology and exact mechanism of the nerve impairment is of great importance for appropriate management of these patients, and there are only a few papers that focused on these features in patients with surgically treated radial nerve lesions. The lack of studies presenting the etiology and injury mechanisms of surgically treated radial nerve lesions may be due to a relatively small number of specialized referral centers, dispersion to low-flow centers, and a greater focus on the surgical treatment outcomes.
AIM
The aim of this study was to describe the etiological and epidemiological characteristics of patients with surgically treated radial nerve lesions of various origins.
METHODS
This retrospective study evaluated 147 consecutive patients with radial nerve lesion, treated in the department during the last 20 years, from January 1, 2001, until December 31, 2020.
RESULTS
The majority of patients belonged to the working population, and 70.1% of them were male. Most commonly, the etiology of nerve lesion was trauma (63.3%) or iatrogenic injury (28.6%), while the less common origin was idiopathic (4.1%) or neoplastic (4.1%). The most frequent location of the lesion was in the upper arm, followed by the elbow and forearm. Fracture-related contusion was the most common mechanism (29.9%), followed by postoperative fibrosis (17.7%), lacerations (17.7%), and compression (15.6%).
CONCLUSION
Based on the fact that traumatic or iatrogenic injuries constitute the majority of cases, with their relevant mechanisms and upper arm predomination, it is crucial to raise awareness and understanding of the radial nerve injuries among orthopedic surgeons to decrease the numbers of these patients and properly preserve or treat them within the initial surgery.
PubMed: 36204344
DOI: 10.3389/fsurg.2022.942755 -
BioMed Research International 2021The posterior interosseous nerve (PIN) innervates the posterior compartment muscle of the forearm and is a continuation of the deep branch of the radial nerve. The...
The posterior interosseous nerve (PIN) innervates the posterior compartment muscle of the forearm and is a continuation of the deep branch of the radial nerve. The anatomic descriptions of PIN vary among different authors. This study investigated the distribution patterns of PIN and its relationships to the supinator muscle. This study investigated which nerves innervate the posterior compartment muscles of the forearm, the radial nerve, and the PIN, using 28 nonembalmed limbs. Also, the points where the muscle attaches to the bone were investigated. The measured variables in this study were measured from the most prominent point of the lateral epicondyle of the humerus (LEH) to the most distal point of the radius styloid process. For each specimen, the distance between the above two points was assumed to be 100%. The measurement variables were the attachment area of the supinator and branching points from the radial nerve. The attachment points of the supinator to the radius and ulna were 47.9% ± 3.6% and 31.5% ± 5.2%, respectively, from the LEH. In 67.9% of the specimens, the brachioradialis and extensor carpi radialis longus (ECRL) were innervated by the radial nerve before superficial nerve branching, and the extensor carpi radialis brevis (ECRB) innervated the deep branch of the radial nerve. In 21.4% of the limbs, the nerve innervating the ECRB branched at the same point as the superficial branch of the radial nerve, whereas it branched from the radial nerve in 7.1% of the limbs. In 3.6% of the limbs, the deep branch of the radial nerve branched to innervate the ECRL. PIN was identified as a large branch without divisions in 10.7% and as a deep branch innervating the extensor digitorum in 14.3% of the limbs. The anatomic findings of this study would aid in the diagnosis of PIN syndromes.
Topics: Aged; Aged, 80 and over; Cadaver; Elbow; Female; Forearm; Humans; Male; Middle Aged; Muscle, Skeletal; Radial Nerve; Radius; Supination
PubMed: 34692843
DOI: 10.1155/2021/8691114 -
Hand Surgery & Rehabilitation Feb 2022Imaging has become an essential tool in the study of the posttraumatic paralytic upper limb, in addition to the clinical examination and electroneuromyography. Upper... (Review)
Review
Imaging has become an essential tool in the study of the posttraumatic paralytic upper limb, in addition to the clinical examination and electroneuromyography. Upper extremity surgeons must be aware of how these different techniques contribute to the initial and preoperative assessment of nervous injuries. We review the appearance of traumatic nerve damage and muscle denervation during the initial injury assessment, focusing on the main aspects of brachial plexus injuries, paralysis after shoulder dislocation and traumatic damage to the radial nerve. Finally, we discuss the role of imaging for preoperative assessment of musculotendinous and osteoarticular palliative surgeries.
Topics: Brachial Plexus; Brachial Plexus Neuropathies; Humans; Nerve Transfer; Radial Nerve; Upper Extremity
PubMed: 34481127
DOI: 10.1016/j.hansur.2020.10.023