Radial Tunnel Syndrome (Entrapment of the Radial Nerve)

Total Page：16

File Type：pdf, Size：1020Kb

Radial Tunnel Syndrome (Entrapment of the Radial Nerve)

15 Newark Ave, Belleville, NJ 07109 87 Summit Ave, Hackensack, NJ 07601 45 West River Road, Rumson, NJ 07760 3146 E. Tremont Ave, Bronx, NY 10461 Radial Tunnel Syndrome (Entrapment of the Radial Nerve) Overview This condition involves the radial nerve in your elbow. The radial nerve passes down your arm to your hand. Its branches travel into your thumb, forefinger and middle finger. With this condition, your radial nerve is compressed, stretched or irritated. Causes This problem is linked to a tight space in your elbow called the "radial tunnel." Your nerve passes through this tunnel. Inside, it can be squeezed by surrounding tissues. Radial tunnel syndrome can develop if you do a lot of forceful pushing and pulling with your arms. It can be caused by repetitive wrist bends, or by gripping, pinching or twisting motions. It can develop because of a problem with the anatomy of your elbow. And, it can happen because of a sharp blow to your elbow, or because of a tumor. Symptoms Symptoms include pain, tenderness and weakness along the top of your forearm just below the elbow. You may feel it in the back of your hand. The pain may feel sharp or achy. It hurts more when you use your arm, especially when you try to straighten your wrist and fingers. Treatment Treatment options may include medications, a brace or splint, and therapy. If these aren't helpful, you may need surgery. Your healthcare provider can create a plan that's right for you. Radial tunnel www.viewmedica.com © 2017 Swarm Interactive. Unauthorized duplication is strictly forbidden..

Copy Link

Recommended publications

The Branching and Innervation Pattern of the Radial Nerve in the Forearm: Clarifying the Literature and Understanding Variations and Their Clinical Implications
diagnostics Article The Branching and Innervation Pattern of the Radial Nerve in the Forearm: Clarifying the Literature and Understanding Variations and Their Clinical Implications F. Kip Sawyer 1,2,* , Joshua J. Stefanik 3 and Rebecca S. Lufler 1 1 Department of Medical Education, Tufts University School of Medicine, Boston, MA 02111, USA; rebecca.lufl[email protected] 2 Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA 94305, USA 3 Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA 02115, USA; [email protected] * Correspondence: [email protected] Received: 20 May 2020; Accepted: 29 May 2020; Published: 2 June 2020 Abstract: Background: This study attempted to clarify the innervation pattern of the muscles of the distal arm and posterior forearm through cadaveric dissection. Methods: Thirty-five cadavers were dissected to expose the radial nerve in the forearm. Each muscular branch of the nerve was identified and their length and distance along the nerve were recorded. These values were used to determine the typical branching and motor entry orders. Results: The typical branching order was brachialis, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, supinator, extensor digitorum, extensor carpi ulnaris, abductor pollicis longus, extensor digiti minimi, extensor pollicis brevis, extensor pollicis longus and extensor indicis. Notably, the radial nerve often innervated brachialis (60%), and its superficial branch often innervated extensor carpi radialis brevis (25.7%). Conclusions: The radial nerve exhibits significant variability in the posterior forearm. However, there is enough consistency to identify an archetypal pattern and order of innervation. These findings may also need to be considered when planning surgical approaches to the distal arm, elbow and proximal forearm to prevent an undue loss of motor function.
[Show full text]
Anatomical, Clinical, and Electrodiagnostic Features of Radial Neuropathies
Anatomical, Clinical, and Electrodiagnostic Features of Radial Neuropathies a, b Leo H. Wang, MD, PhD *, Michael D. Weiss, MD KEYWORDS Radial Posterior interosseous Neuropathy Electrodiagnostic study KEY POINTS The radial nerve subserves the extensor compartment of the arm. Radial nerve lesions are common because of the length and winding course of the nerve. The radial nerve is in direct contact with bone at the midpoint and distal third of the humerus, and therefore most vulnerable to compression or contusion from fractures. Electrodiagnostic studies are useful to localize and characterize the injury as axonal or demyelinating. Radial neuropathies at the midhumeral shaft tend to have good prognosis. INTRODUCTION The radial nerve is the principal nerve in the upper extremity that subserves the extensor compartments of the arm. It has a long and winding course rendering it vulnerable to injury. Radial neuropathies are commonly a consequence of acute trau- matic injury and only rarely caused by entrapment in the absence of such an injury. This article reviews the anatomy of the radial nerve, common sites of injury and their presentation, and the electrodiagnostic approach to localizing the lesion. ANATOMY OF THE RADIAL NERVE Course of the Radial Nerve The radial nerve subserves the extensors of the arms and fingers and the sensory nerves of the extensor surface of the arm.1–3 Because it serves the sensory and motor Disclosures: Dr Wang has no relevant disclosures. Dr Weiss is a consultant for CSL-Behring and a speaker for Grifols Inc. and Walgreens. He has research support from the Northeast ALS Consortium and ALS Therapy Alliance.
[Show full text]
Variations in the Branching Pattern of the Radial Nerve Branches to Triceps Brachii
Review Article Clinician’s corner Images in Medicine Experimental Research Case Report Miscellaneous Letter to Editor DOI: 10.7860/JCDR/2019/39912.12533 Original Article Postgraduate Education Variations in the Branching Pattern Case Series of the Radial Nerve Branches to Anatomy Section Triceps Brachii Muscle Short Communication MYTHRAEYEE PRASAD1, BINA ISAAC2 ABSTRACT Results: The branching patterns seen were types A 1 (3.6%), Introduction: The axillary nerve arises from the posterior cord B1 (1st pattern) 1 (3.6%), B2 (2nd pattern) 1 (3.6%), and C3 of the brachial plexus and supplies the deltoid and teres minor 22 (78.6%). Two new patterns observed were: type B2 muscles. Axillary nerve injuries lead to abduction and external (6th pattern) 1 (3.6%) and type D (2nd pattern) 2 (7.1%). The long rotation weakness. In such cases, branches to the heads of head had single innervation in 89.3% cases and the lateral and triceps brachii muscle have been transferred to the axillary nerve medial heads had dual innervation in 10.7% and 7.1% cases to establish reinnervation of the deltoid muscle. In addition, the respectively. triceps nerve branches can be nerve recipients to reinstitute Conclusion: The knowledge of the different branching patterns elbow extension. that are present will help surgeons to identify the most suitable Aim: To study the different branching patterns of the radial radial nerve branch to triceps brachii that can be used for nerve nerve branches to triceps brachii muscle. transfer to restore the motor function of the deltoid muscle or to reanimate the triceps brachii muscle.
[Show full text]
Posterior Interosseous Neuropathy Supinator Syndrome Vs Fascicular Radial Neuropathy
Posterior interosseous neuropathy Supinator syndrome vs fascicular radial neuropathy Philipp Bäumer, MD ABSTRACT Henrich Kele, MD Objective: To investigate the spatial pattern of lesion dispersion in posterior interosseous neurop- Annie Xia, BSc athy syndrome (PINS) by high-resolution magnetic resonance neurography. Markus Weiler, MD Methods: This prospective study was approved by the local ethics committee and written Daniel Schwarz, MD informed consent was obtained from all patients. In 19 patients with PINS and 20 healthy con- Martin Bendszus, MD trols, a standardized magnetic resonance neurography protocol at 3-tesla was performed with Mirko Pham, MD coverage of the upper arm and elbow (T2-weighted fat-saturated: echo time/repetition time 52/7,020 milliseconds, in-plane resolution 0.27 3 0.27 mm2). Lesion classification of the radial nerve trunk and its deep branch (which becomes the posterior interosseous nerve) was performed Correspondence to Dr. Bäumer: by visual rating and additional quantitative analysis of normalized T2 signal of radial nerve voxels. [email protected] Results: Of 19 patients with PINS, only 3 (16%) had a focal neuropathy at the entry of the radial nerve deep branch into the supinator muscle at elbow/forearm level. The other 16 (84%) had proximal radial nerve lesions at the upper arm level with a predominant lesion focus 8.3 6 4.6 cm proximal to the humeroradial joint. Most of these lesions (75%) followed a specific somato- topic pattern, involving only those fascicles that would form the posterior interosseous nerve more distally. Conclusions: PINS is not necessarily caused by focal compression at the supinator muscle but is instead frequently a consequence of partial fascicular lesions of the radial nerve trunk at the upper arm level.
[Show full text]
Electrodiagnosis of Brachial Plexopathies and Proximal Upper Extremity Neuropathies
Electrodiagnosis of Brachial Plexopathies and Proximal Upper Extremity Neuropathies Zachary Simmons, MD* KEYWORDS Brachial plexus Brachial plexopathy Axillary nerve Musculocutaneous nerve Suprascapular nerve Nerve conduction studies Electromyography KEY POINTS The brachial plexus provides all motor and sensory innervation of the upper extremity. The plexus is usually derived from the C5 through T1 anterior primary rami, which divide in various ways to form the upper, middle, and lower trunks; the lateral, posterior, and medial cords; and multiple terminal branches. Traction is the most common cause of brachial plexopathy, although compression, lacer- ations, ischemia, neoplasms, radiation, thoracic outlet syndrome, and neuralgic amyotro- phy may all produce brachial plexus lesions. Upper extremity mononeuropathies affecting the musculocutaneous, axillary, and supra- scapular motor nerves and the medial and lateral antebrachial cutaneous sensory nerves often occur in the context of more widespread brachial plexus damage, often from trauma or neuralgic amyotrophy but may occur in isolation. Extensive electrodiagnostic testing often is needed to properly localize lesions of the brachial plexus, frequently requiring testing of sensory nerves, which are not commonly used in the assessment of other types of lesions. INTRODUCTION Few anatomic structures are as daunting to medical students, residents, and prac- ticing physicians as the brachial plexus. Yet, detailed understanding of brachial plexus anatomy is central to electrodiagnosis because of the plexus’ role in supplying all motor and sensory innervation of the upper extremity and shoulder girdle. There also are several proximal upper extremity nerves, derived from the brachial plexus, Conflicts of Interest: None. Neuromuscular Program and ALS Center, Penn State Hershey Medical Center, Penn State College of Medicine, PA, USA * Department of Neurology, Penn State Hershey Medical Center, EC 037 30 Hope Drive, PO Box 859, Hershey, PA 17033.
[Show full text]
The Course of the Radial Nerve in Relation to the Humerus: a Cadaveric Study in a Kenyan Adult Population
Research article East African Orthopaedic Journal THE COURSE OF THE RADIAL NERVE IN RELATION TO THE HUMERUS: A CADAVERIC STUDY IN A KENYAN ADULT POPULATION V. Lusweti, MBChB, MMed (Ortho Surg), R. Oluoch, MBChB, MMed (Ortho Surg Registrar), B. R. Ayumba, MMed (Gen Surg), MMed (Ortho), Department of Orthopaedics and Rehabilitation, Moi University, A.Njoroge, MBChB, MMed (Ortho Surg), AO Trauma Fellow and M.G.Y. Elbadawi, MBChB, PhD (Clin Anatomy), Department of Human Anatomy, Moi University, P. O. Box 4606 – 30100, Eldoret, Kenya Correspondence to: Dr. Victor Lusweti, Department of Orthopaedic Surgery and Rehabilitation, College of Health Sciences, School of Medicine, Moi University, P.O. Box 4606–30100, Eldoret, Kenya. Email: luswetibaraza@ gmail.com ABSTRACT Background: The radial nerve arises from the posterior cord of the brachial plexus. It descends distally to the spiral groove of the humerus. The upper and lower margins of this groove form important landmarks relative to the acromion process, medial and lateral epicondyles of the humerus. Objective: To describe the course of the radial nerve in relation to the humerus in a Kenyan adult population. Methods: Dissections were done on fifty-nine left sided formalin fixed adult upper extremities obtained from the Human Anatomy Laboratory of Moi University. Data was recorded and analysed using SPSS version 21. Results: The average humeral length was 314.4 ± 21.4mm. The radial nerve was located 140.8 ± 17.2 mm from the tip of the acromion. It exited the spiral groove 185.1 ± 21.7mm from the tip of the acromion and 132.1 ± 19.4 mm from the lateral epicondyle.
[Show full text]
Upper and Lower Extremity Nerve Conduction Studies Kelly G
2019 Upper and Lower Extremity Nerve Conduction Studies Kelly G. Gwathmey October 18, 2019 Virginia Commonwealth University 2019 Financial Disclosure I have received speaking and consulting honoraria from Alexion Pharmaceuticals. 2019 Warning Videotaping or taking pictures of the slides associated with this presentation is prohibited. The information on the slides is copyrighted and cannot be used without permission and author attribution. 2019 Outline for Today’s talk • Upper extremity nerve conduction studies o Median nerve o Ulnar nerve o Radial nerve o Median comparison studies o Medial antebrachial cutaneous nerve o Lateral antebrachial cutaneous nerve • Lower extremity nerve conduction studies o Fibular nerve o Tibial nerve o Sural nerve o Femoral nerve • Saphenous • Lateral femoral cutaneous • Phrenic nerve • Facial nerve • Anomalous Innervations 2019 Median nerve anatomy • Median nerve is formed by a combination of: o Lateral cord (C6-7) supplies the sensory fibers to the thumb, index, middle finger, proximal median forearm, and thenar eminence. o Medial cord (C8-T1) provides motor fibers to the distal forearm and hand. • The median nerve innervates the pronator teres, then gives branches to the flexor carpi radialis, flexor digitorum superficialis, and palmaris longus. • Anterior Interosseus Nerve (AIN)- innervates the flexor pollicis longus, flexor digitorum profundus (FDP) (digits 2 and 3), and pronator quadratus. Preston, David C., MD; Shapiro, Barbara E., MD, PhD. Published January 1, 2013. Pages 267-288. © 2013. 2019 Median nerve anatomy • Proximal to the wrist- the palmar cutaneous sensory branch (sensation over the thenar eminence) • Through the carpal tunnel- Motor division goes to first and second lumbricals o Recurrent thenar motor branch the thenar eminence (opponens, abductor pollicis brevis, and superficial head of flexor pollicis brevis) • Sensory branch that goes through the carpal tunnel supplies the medial thumb, index finger, middle finger and lateral half of the ring finger.
[Show full text]
Clinical Anatomy of the Radial Nerve
Anatomy Primer Section Clinical anatomy of the radial nerve n the immortal words of Homer Simpson , one of the the humerus (figure 2). In some cases this injury is iatro- Igreat commentators on modern society, “Alcohol is the genic when the orthopedic surgeons repair the humerus cause of, and solution to, all of life’s problems!”. It cer- with meccano. Clinically these patients present with tainly causes its fair share of disease and injury in the wrist drop, weakness of finger extension, sensory distur- peripheral nervous system and this includes the radial bance and sensory loss in the distribution of the superfi- nerve. This nerve is the most frequent target of that pecu- cial radial nerve. There is some weakness of supination liar alcohol related neuropathy,“Saturday night palsy”.So but elbow extension is spared as the branches to the tri- this issue I thought I might briefly review the clinical ceps originate before the spiral groove. anatomy of the radial nerve. Brian McNamara is Consultant Other Radial Neuropathies Neurophyisologist at Anatomy The radial nerve may also be vulnerable to external Cork University The radial nerve is the main continuation of the posteri- compression from inappropriate use of crutches. In these Hospital. He was SHO or chord of the brachial plexus. Consequently it receives patients, in addition to wrist drop and weakness of and Registrar at Cork University Hospital, and branches from each nerve root from C5/T1. After leaving supination there is also weakness of elbow extension and SpR at Addenbrooke's the axilla the nerve gives three sensory branches (Table 1) sensory loss in the distribution of the more proximal Hospital in Cambridge.
[Show full text]
Management of Radial Nerve Lesions After Trauma Or Iatrogenic Nerve Injury: Autologous Grafts and Neurolysis
Journal of Clinical Medicine Article Management of Radial Nerve Lesions after Trauma or Iatrogenic Nerve Injury: Autologous Grafts and Neurolysis Karl Schwaiger 1,* , Selim Abed 1, Elisabeth Russe 1, Fabian Koeninger 1, Julia Wimbauer 1, Hassan Kholosy 1,2 , Wolfgang Hitzl 3 and Gottfried Wechselberger 1 1 Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital of St. John of God (Barmherzige Brüder) Salzburg, Paracelsus Medical University, Kajetanerplatz 1, 5020 Salzburg, Austria; [email protected] (S.A.); [email protected] (E.R.); [email protected] (F.K.); [email protected] (J.W.); [email protected] (H.K.); [email protected] (G.W.) 2 Department of Plastic Surgery and Reconstructive Surgery, Faculty of Medicine, Alexandria University, Alexandria 21563, Egypt 3 Research Oﬃce-Biostatistics, Paracelsus Medical University, 5020 Salzburg, Austria; [email protected] * Correspondence: [email protected]; Tel.: +43-662-8088-8452 Received: 1 November 2020; Accepted: 24 November 2020; Published: 26 November 2020 Abstract: Background: Proximal radial nerve lesions located between the brachial plexus and its division into the superﬁcial and deep branches are rare but severe injuries. The majority of these lesions occur in association with humerus fractures, directly during trauma or later during osteosynthesis for fracture treatment. Diagnostics and surgical interventions are often delayed. The best type of surgical treatment and the outcome to be expected often is uncertain. Methods: Twelve patients with proximal radial nerve lesions due to trauma or prior surgery were included in this study and underwent neurolysis (n = 6) and sural nerve graft interposition (n = 6). Retrospective analysis of the collected patient data was performed and the postoperative course was systematically evaluated.
[Show full text]
Shoulder and Scapular Rehabilitation for Adult Brachial Plexus Injuries
Shoulder and Scapular Rehabilitation for Adult Brachial Plexus Injuries Lynnette Rasmussen, OTRL Brachial Plexus and Peripheral Nerve Program I have no financial relationships relevant to this presentation. Objectives • Participants will be provided with a brief overview of the anatomy of the brachial plexus. • Participants will understand the difference between nerve graft and nerve transfers and how it relates to rehabilitation techniques. • Participants will learn activation techniques for 3 common brachial plexus reconstructions. • Participants will understand the progression of exercises. Outline Surgical Interventions Formulating a Treatment Plan • Brief anatomy Review • What you need to know • Surgical Procedures from the Surgeon • Healing Process • Restrictions • Timing for Interventions • Activation Techniques • Therapy Progressions • Managing Patient Expectations The Brachial Plexus The Muscles Robert Taylor Drinks Cold Beer Two Main Surgical Procedures Nerve Grafts Nerve Transfer Science of Healing • Nerve repair= 3-6 weeks to regain enough strength to tolerate mobilization • Tendon Transfers= 6 weeks to heal • Axonal regeneration= “1 mm per day” or 1” per month”. Prior to Surgery • Full assessment • Focus on joint protection • Range of Motion • No e-stim • Gravity eliminated exercises • Strengthen uninvolved muscles Formulating Your Treatment Plan Following Surgery • How long to immobilize • Protective orthosis? • Starting PROM • Movement Restrictions • Expectations • Donor used will dictate activation process Get the Scoop
[Show full text]
Radial Tunnel Syndrome
46 Radial Tunnel Syndrome ICD-10 CODE G56.90 extrinsic masses, or a sharp tendinous margin of the extensor carpi radialis brevis. These entrapments may exist alone or in combination. THE CLINICAL SYNDROME SIGNS AND SYMPTOMS Radial tunnel syndrome is an uncommon cause of lateral elbow pain that has the unique distinction among entrapment neurop- Regardless of the mechanism of entrapment of the radial nerve, athies of almost always being initially misdiagnosed. The inci- the common clinical feature of radial tunnel syndrome is pain dence of misdiagnosis of radial tunnel syndrome is so common just below the lateral epicondyle of the humerus. The pain of that it is often incorrectly referred to as resistant tennis elbow radial tunnel syndrome may develop after an acute twisting (Table 46.1). As seen from the following discussion, the only injury or direct trauma to the soft tissues overlying the poste- major similarity that radial tunnel syndrome and tennis elbow rior interosseous branch of the radial nerve, or the onset may share is the fact that both clinical syndromes produce lateral be more insidious, without an obvious inciting factor. The pain elbow pain. is constant and worsens with active supination of the wrist. The lateral elbow pain of radial tunnel syndrome is aching Patients often note the inability to hold a coffee cup or hammer. and localized to the deep extensor muscle mass. The pain may Sleep disturbance is common. On physical examination, elbow radiate proximally and distally into the upper arm and forearm range of motion is normal. Grip strength on the affected side (Fig.
[Show full text]
STUDY of VARIATIONS in MUSCULAR BRANCHES of RADIAL NERVE in AXILLA and POSTERIOR COMPARTMENT of ARM Raghavendra D R*1 , Nirmala D 2 , Maveshettar G F 3
International Journal of Anatomy and Research, Int J Anat Res 2019, Vol 7(1.2):6220-24. ISSN 2321-4287 Original Research Article DOI: https://dx.doi.org/10.16965/ijar.2018.445 STUDY OF VARIATIONS IN MUSCULAR BRANCHES OF RADIAL NERVE IN AXILLA AND POSTERIOR COMPARTMENT OF ARM Raghavendra D R*1 , Nirmala D 2 , Maveshettar G F 3. *1 Assistant Professor, Department of Anatomy, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India. 2,3. Professor, Department of Anatomy, J J M Medical College, Davangere, Karnataka. India. ABSTRACT Background: Radial nerve originates from posterior cord of brachial plexus at axilla. It supplies extensor muscles of upper limb. Objectives: To know the variations in muscular branches of radial nerve in axilla and posterior compartment of arm. Methods: Dissection was done on 44 upper limbs from embalmed cadavers and 6 upper limbs from embalmed dead fetuses in the Department of Anatomy, J J M Medical College, Davangere. Dissection of Radial nerve and its branches in the axilla and posterior compartment of the arm was carried out according to Cunningham’s manual of practical anatomy. Results: The site of origin of nerve to long head of tricep (N-LHT) was axilla in 48 specimens (96%) and lower triangular space( LTS) in 2 specimens (4%). The site of origin of nerve to lateral head of tricep( N-LTHT) was radial groove(RG) in 49 specimens (98%) and lower triangular space(LTS) in 1 specimens (2%). The site of origin of nerve to medial head of tricep -ulnar collateral nerve(UCN) was axilla in 38 specimens (76%) and lower triangular space(LTS) in 12 specimens (24%).
[Show full text]