-
Clinics in Sports Medicine Jul 2020Sports-related peripheral neuropathies account for 6% of all peripheral neuropathies and most commonly involve the upper extremity. The routes of the median, radial, and... (Review)
Review
Sports-related peripheral neuropathies account for 6% of all peripheral neuropathies and most commonly involve the upper extremity. The routes of the median, radial, and ulnar nerves are positioned in arrangements of pulleys and sheaths to glide smoothly around the elbow. However, this anatomic relationship exposes each nerve to risk of compression. The underlying mechanisms of the athletic nerve injury are compression, ischemia, traction, and friction. Chronic athletic nerve compression may cause damage with moderate or low pressure for long or intermittent periods of time.
Topics: Athletic Injuries; Elbow; Humans; Median Nerve; Peripheral Nervous System Diseases; Radial Nerve; Ulnar Nerve; Elbow Injuries
PubMed: 32446578
DOI: 10.1016/j.csm.2020.02.006 -
The Journal of Hand Surgery Feb 2022Dorsoradial forearm and hand pain was historically considered difficult to treat surgically due to a particular susceptibility of the radial sensory nerve (RSN) to... (Review)
Review
Dorsoradial forearm and hand pain was historically considered difficult to treat surgically due to a particular susceptibility of the radial sensory nerve (RSN) to injury and/or compression. A nerve block, if it were done at all, was directed at the region of the anatomic snuff box to block the RSN in an effort to provide diagnostic information as to the pain etiology. Even for patients with pain relief following a diagnostic block, resecting the RSN often proved unsuccessful in fully relieving pain. The solution to successful treatment of this refractory pain problem was the realization that the RSN is not the sole source of sensory innervation to the dorsoradial wrist. In fact, in 75% of people the lateral antebrachial cutaneous nerve (LABCN) dermatome overlaps the RSN with other nerves, such as the dorsal ulnar cutaneous nerve and even the posterior antebrachial cutaneous nerves, occasionally providing sensory innervation to the same area. With this more refined understanding of the cutaneous neuroanatomy of the wrist, the diagnostic nerve block algorithm was expanded to include selective blockage of more than just the RSN. In contemporary practice, identification of the exact nerves responsible for pain signal generation informs surgical decision-making for palliative neurolysis or neurectomy. This approach offers a systematic and repeatable method to inform the diagnosis and treatment of dorsoradial forearm and wrist pain.
Topics: Forearm; Hand; Humans; Pain; Radial Nerve; Ulnar Artery
PubMed: 34887137
DOI: 10.1016/j.jhsa.2021.10.009 -
The Journal of Hand Surgery Apr 2020To describe the branching pattern of the posterior antebrachial cutaneous nerve (PABCN) and to corroborate measurements and observations reported by previous authors. (Review)
Review
PURPOSE
To describe the branching pattern of the posterior antebrachial cutaneous nerve (PABCN) and to corroborate measurements and observations reported by previous authors.
METHODS
Using 28 fresh-frozen cadaver specimens, we dissected the PABCN from its origin from the radial nerve to its terminal arborization in the distal forearm. Measurements relative to the lateral humeral epicondyle were recorded. The course of the nerve over the muscles of the mobile wad and its branching pattern in the proximal forearm were noted.
RESULTS
The PABCN originated from the radial nerve at a mean of 14.2 cm proximal to the lateral epicondyle. The fascial hiatus through which the PABCN emerged to become superficial was a mean of 8.2 cm proximal to the lateral epicondyle. All specimens had at least 1 longitudinal branch that passed a mean of 2.8 cm anterior to the lateral epicondyle. Thirty-two percent of specimens had a lesser proximal branch in the distal third of the lateral arm; 86% had an epicondylar branch to the lateral epicondyle; and 21% had a second longitudinal branch. Ninety-three percent had a longitudinal branch coursing over the interval between the brachioradialis and the extensor carpi radialis longus in the proximal forearm.
CONCLUSIONS
After becoming superficial in the distal brachium, the PABCN typically gives off a discrete epicondylar branch and then continues distally in the forearm as 1 or 2 longitudinal branches. In addition, in the proximal third of the forearm, a consistent longitudinal branch of the PABCN courses over the interval between the brachioradialis and the extensor carpi radialis longus. This review confirms previous observations of the PABCN.
CLINICAL RELEVANCE
Knowledge of the course of the PABCN will assist surgeons in identifying and avoiding injury in clinical situations such as plating the proximal radius or releasing the radial tunnel.
Topics: Arm; Cadaver; Elbow; Forearm; Humans; Radial Nerve; Ulna
PubMed: 31653469
DOI: 10.1016/j.jhsa.2019.08.011 -
Tremor and Other Hyperkinetic Movements... 2022There is growing recognition of peripheral stimulation techniques for controlling arm symptoms in essential tremor (ET). Recently, the FDA gave clearance to the Cala... (Review)
Review
BACKGROUND
There is growing recognition of peripheral stimulation techniques for controlling arm symptoms in essential tremor (ET). Recently, the FDA gave clearance to the Cala system, a device worn around the wrist to treat arm tremors. The Cala system stimulates the sensory afferents of the peripheral nerves with high-frequency pulses. These pulses are delivered to the median and radial nerves alternately at the tremor frequency of the individual patient.
METHODS
The PubMed database was searched using the terms ("Essential Tremor"[Mesh] OR "essential tremor" [Title/Abstract] OR "tremor" [Title/Abstract]) AND ("peripheral arm stimulation" [Title/Abstract] OR "Cala device" [Title/Abstract] OR "sensory afferent stimulation" [Title/Abstract] OR "afferent stimulation" [Title/Abstract] OR "arm stimulation" [Title/Abstract] OR "peripheral nerve stimulation" [Title/Abstract]).
RESULTS
The search yielded 54 articles. Many studies discussed the rationale and various strategies for peripheral modulation of tremor. While the Cala system was found to be safe and well-tolerated in ET, data on efficacy revealed mixed findings. In a large randomized, blinded trial (n = 77), the primary outcome evaluated with spiral drawing task did not improve but the secondary outcomes reflected by the arm tremor severity and the activities of the daily living score revealed 20-25% improvements. A subsequent trial (n = 323) found that the in-home use of the Cala device led to improvements of similar magnitude lasting for at least three months but the clinical assessments were open-labeled.
DISCUSSION
Peripheral stimulation techniques are promising therapeutic modalities for treating ET symptoms. Stimulation of sensory afferent nerve fibers at the wrist can potentially modulate the peripheral and central components of the tremor network. Although the Cala system is user-friendly, safe, and well-tolerated, the current clinical evidence on the efficacy is inconsistent and insufficient. Thus, more data is warranted for implementing peripheral nerve stimulation as a standard of care for ET.
HIGHLIGHTS
The current review discusses the rationale, background, and potential mechanisms for using peripheral arm stimulation devices for treating ET. The Cala system is a wrist-worn peripheral nerve stimulation device that received FDA clearance to treat arm tremors. The current review evaluates the evidence for the safety and efficacy of using the Cala system and similar devices in clinical practice.
Topics: Essential Tremor; Humans; Peripheral Nerves; Radial Nerve; Transcutaneous Electric Nerve Stimulation; Tremor
PubMed: 35949227
DOI: 10.5334/tohm.685 -
The Journal of Hand Surgery May 2020With radial nerve lesions, the results of nerve transfers and how they objectively compare with the outcomes of tendon transfers remain unstudied. We compared the...
PURPOSE
With radial nerve lesions, the results of nerve transfers and how they objectively compare with the outcomes of tendon transfers remain unstudied. We compared the results after nerve transfer in patients with less than 12 months since radial nerve injury with the results after tendon transfer in patients not eligible for nerve surgery because of longstanding paralysis (minimum of 15 months).
METHODS
In 14 patients with radial nerve lesions incurred less than 12 months previously, we transferred the anterior interosseous nerve to the nerve of the extensor carpi radialis brevis (ECRB), while the nerve to the flexor carpi radialis was transferred to the posterior interosseous nerve. In 13 patients with lesions of longer duration, we transferred the pronator teres tendon to the ECRB, the flexor carpi ulnaris tendon to the extensor digitorum communis, and the palmaris longus to the rerouted extensor pollicis longus (EPL) tendon. At a final evaluation, we measured passive and active range of motion (ROM) of the wrist, finger, and thumb and grasp strength.
RESULTS
In a comparison of wrist flexion-extension ROM and grasp strength, we observed better recovery in the nerve transfer than in the tendon transfer group. In the tendon transfer group, we observed limitations in wrist flexion in 9 of the 13 patients and permanent radial deviation in 5. Half of the patients in the tendon transfer group needed to flex their wrist to fully extend their fingers, whereas finger extension was possible with the wrist either extended or at neutral in all patients following nerve transfer. After nerve transfer, extension at the first carpometacarpal joint was restored in 11 of the 14 patients, whereas this occurred in just 4 of the 13 patients following tendon transfer. In both groups, we observed a 30° lag in thumb metacarpophalangeal extension, which reflects poor recovery of EPL function.
CONCLUSIONS
Overall, we observed better outcomes in those who underwent nerve transfer versus tendon transfer procedures. However, room still remains for improved thumb motion with both procedures.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
Topics: Humans; Nerve Transfer; Paralysis; Radial Nerve; Radial Neuropathy; Tendon Transfer; Wrist Joint
PubMed: 32093993
DOI: 10.1016/j.jhsa.2019.12.009 -
Anaesthesia, Critical Care & Pain... Apr 2021Radial artery is a common site of cannulation in acute care setting. There are conflicting reports as to which nerve, radial or median or both supplies the radial...
BACKGROUND AND AIMS
Radial artery is a common site of cannulation in acute care setting. There are conflicting reports as to which nerve, radial or median or both supplies the radial artery. We did this prospective study in patients undergoing minor procedures under peripheral nerve blocks to ascertain which nerve block, radial or median increases the cross sectional area and blood flow in the radial artery.
METHODS
Ninety ASA I/II patients undergoing upper limb minor surgeries under various blocks (radial or median or radial + median nerve) were enrolled in this study. Patients in group R were those who received Ultrasound-guided (USG) radial nerve block, group M median nerve block while group MR received both the nerve blocks. The primary objective was to assess the increase in cross sectional area (CSA) of radial artery in the groups after the block. Secondary objectives included assessment of time average maximum velocity (TAMAX) and blood volume (BV) after the block.
RESULTS
The CSA, TAMAX and BV of radial artery increased in all the three groups. Within each group the difference between the preblock and postblock parameters were highly significant. However, the differences are greater in groups M and M + R than in group R; (P < 0.001).
CONCLUSION
Ultrasound-guided median nerve block causes arterial vasodilation, and an increase in radial artery blood flow velocity. There was no added benefit of radial block along with median block in increasing the blood flow further.
Topics: Humans; Median Nerve; Nerve Block; Peripheral Nerves; Prospective Studies; Radial Artery; Ultrasonography, Interventional
PubMed: 33744492
DOI: 10.1016/j.accpm.2021.100831 -
The Journal of Hand Surgery Nov 2022To evaluate the anatomy of nerve transfers used to reconstruct wrist extension, hand opening, and hand closing in tetraplegic patients.
PURPOSE
To evaluate the anatomy of nerve transfers used to reconstruct wrist extension, hand opening, and hand closing in tetraplegic patients.
METHODS
Nerve transfers were completed on 18 paired cadaveric upper limbs. The overlap of donor and recipient nerves was measured, as well as the distance to the target muscle. Axons were counted in each nerve and branch, with the axon percentage calculated by dividing the donor nerve count by that of the recipient.
RESULTS
Transfers with overlap of the donor and recipient nerve were from the radial nerve branch to extensor carpi radialis brevis to anterior interosseous nerve (AIN) and from the branch(es) to supinator to posterior interosseous nerve. The extensor carpi radialis brevis to AIN had the shortest distance to the target, with the branch to brachialis to AIN being the longest. The nerve transfers for wrist extension had the highest axon percentage. Of the transfers for hand closing, the brachialis to AIN had the highest axon percentage, and the branch to brachioradialis to AIN had the lowest.
CONCLUSIONS
The anatomical features of nerve transfers used in tetraplegic hand reconstruction are variable. Differences may help explain clinical outcomes.
CLINICAL RELEVANCE
This study demonstrates which nerve transfers may be anatomically favorable for restoring hand function in tetraplegic patients.
Topics: Humans; Nerve Transfer; Forearm; Wrist; Elbow; Peripheral Nerves; Radial Nerve
PubMed: 34702629
DOI: 10.1016/j.jhsa.2021.09.003 -
BMJ Military Health Apr 2021Humeral shaft fractures can lead to radial nerve injury and may require surgery and rehabilitation. We determined the causative events of humeral fracture, including arm...
INTRODUCTION
Humeral shaft fractures can lead to radial nerve injury and may require surgery and rehabilitation. We determined the causative events of humeral fracture, including arm wrestling, in young Korean soldiers and examined whether humeral fracture is related to demographic characteristics and the presence of radial nerve palsy.
METHODS
We reviewed 7.5 years (July 2012 to June 2019) of medical records covering patients who had experienced a humeral shaft fracture after entering military service and had received surgery for open reduction and internal fixation. Data were obtained on basic demographics, initial event provoking the fracture, presence of radial nerve palsy, initial and follow-up severity of the weakness, and any discharge from military service because of prolonged radial nerve palsy.
RESULTS
Of 123 cases, arm wrestling was the leading cause (52.8%). A high energy injury, such as falling from a height (11.4%), and sports related slips (10.6%) were other causes. All humeral shaft fractures caused by forceful contraction were spiral, while 40% of the fractures caused by external force related events were of a transverse type. The percentage of left-sided fractures was significantly higher for fractures arising from an external force than in those caused by forceful contraction related events. Radial nerve palsy was found in 34 patients (27.6%), and 16 were discharged from the military because of prolonged radial nerve palsy 6 months after the fracture. The causative events and other factors did not affect the presence of radial nerve palsy.
CONCLUSION
Arm wrestling was the leading cause of humeral fracture in young Korean soldiers but the chance of developing comorbid radial nerve palsy did not differ from that of other causes. These epidemiologic findings in this young active group may help in understanding the causes of humeral shaft fracture in soldiers and in the wider young population.
Topics: Accidental Falls; Humans; Humeral Fractures; Humerus; Male; Military Personnel; Radial Neuropathy; Recovery of Function; Republic of Korea; Wrestling; Young Adult
PubMed: 32276967
DOI: 10.1136/bmjmilitary-2019-001373 -
Evaluation of the supinator muscle and deep branch of the radial nerve: impact on nerve compression.Surgical and Radiologic Anatomy : SRA Aug 2020The aim of this study was to investigate the superficial head of supinator muscle (SM) and deep branch of the radial nerve (DBRN) course in SM to see whether the texture... (Review)
Review
PURPOSE
The aim of this study was to investigate the superficial head of supinator muscle (SM) and deep branch of the radial nerve (DBRN) course in SM to see whether the texture characteristics of the superficial head of SM might have a potential compressive effect on the nerve.
MATERIALS AND METHODS
Elbow and proximal forearm region of 20 preserved cadavers (n 40, 12 M, 8 F) were dissected in order to measure total and part of DBRN lengths between some reference points. The texture characteristics of both the proximal (where DBRN enters SM) and distal arcade (where DBRN exits SM) of the superficial head of SM were evaluated based on its structure's being muscular, musculotendinous, tendinous, or membranous.
RESULTS
The total length of DBRN between sexes without taking side (L/R) into consideration (P = 0.030) and left radiocapitellar joint (RCJ)-arcade of Frohse (AF) length between sexes (P = 0.050) were statistically significant. There was a gradual increase in caliber getting more flattened in every consecutive level which was statistically significant when every two consecutive levels were compared. When compared according to the texture type, there were also significant differences.
CONCLUSIONS
Flattening of DBRN in the supinator canal suggests a chronic compression on the nerve. Differences in the texture of the superficial head of the supinator might facilitate this compression. An understanding of the anatomy and nerve topography is of utmost importance in the accurate diagnosis and effective management of peripheral nerve compression.
Topics: Cadaver; Dissection; Elbow Joint; Female; Forearm; Humans; Male; Muscle, Skeletal; Nerve Compression Syndromes; Radial Nerve; Supination
PubMed: 32367465
DOI: 10.1007/s00276-020-02480-0 -
Plastic and Aesthetic NursingOne of the most common complications associated with a diaphyseal humeral fracture is the development of a radial nerve injury. We conducted a study to analyze the...
One of the most common complications associated with a diaphyseal humeral fracture is the development of a radial nerve injury. We conducted a study to analyze the degree of recovery and prognostic factors associated with radial nerve palsy in patients with diaphyseal humerus fractures. We retrospectively analyzed 28 patients who presented to the Hospital La Fe, Valencia, Spain, with a diaphyseal humerus fracture associated with radial nerve injury between 2010 and 2020. A total of 14.3% (n = 4) of the patients in our cohort had open fractures and 85.7% (n = 24) had closed fractures. There were no statistically significant differences between the type of treatment and the type of fracture (p = .13). There were also no significant differences between the type of treatment and recovery time (p = .42). There was a statistically significant difference (p = .04) in the mean recovery time for patients with preoperative radial nerve injuries (11.9 months) compared with patients who sustained a radial nerve injury secondary to surgical repair of the fracture (8.6 months). The difference in recovery time between patients with open and closed fractures was not statistically significant (p = .3). Results of the study showed that the type of fracture (i.e., open or closed) did not affect radial nerve palsy recovery time. Patients who sustain radial nerve injuries secondary to a surgical repair have a shorter recovery time than patients who sustain primary radial nerve injuries.
Topics: Humans; Radial Neuropathy; Radial Nerve; Retrospective Studies; Humerus; Humeral Fractures; Fractures, Closed; Paralysis
PubMed: 36450058
DOI: 10.1097/PSN.0000000000000442