Posterior interosseous nerve dysfunction in the radial tunnel

Investigating the effects of neuromobilization in lateral epicondylitis

STUDY DESIGN

Randomized controlled study.

INTRODUCTION

Lateral epicondylitis (LE) causes pain and loss of function in the affected limb. Different exercises have been used for the treatment of LE. In recent years, the technique of neuromobilization has been frequently used to treat tendinopathy. However, there is no study that demonstrates the effects of neuromobilization techniques on patients with LE.

PURPOSE OF THE STUDY

The aim of the present study was to determine the effects of neuromobilization techniques on pain, grip strength, and functional status in LE patients and to compare them with conservative rehabilitation treatment.

METHODS

A total of 40 patients (26 females and 14 males; age: 42.80 ± 8.91 years) with a history of LE participated in the study. The patients were randomly assigned to two groups: the neuromobilization group and the control group. The neuromobilization group completed a 6-week conservative rehabilitation and radial nerve mobilization program, whereas the control group received conservative rehabilitation therapy only. Both groups underwent a 7-day weekly conservative home rehabilitation program. Pain severity, grip strength, pinch strength, joint motions, and upper extremity functional level were assessed before treatment, at the third week after treatment, and at the sixth week after treatment.

RESULTS

There was a significant decrease in all pain scores in favor of the neuromobilization group at week 6 after treatment (at rest: P = .001, effect size (ES) = 0.84; at night: P = .001, ES = 0.91 and during activity: P = .004, ES = 1.06). No significant differences were found for grip strength, pinch strength, joint motions, and functional level in the neuromobilization group, although trends toward better improvement were observed.

CONCLUSIONS

Radial nerve mobilization techniques are more effective on pain than conservative rehabilitation therapy in LE patients, and this effect continues after treatment.

Anatomic study of the extensor carpi radialis brevis in its relation with the motor branch of the radial nerve

INTRODUCTION

The cause of the tunnel syndrome is the entrapment of the posterior interosseous nerve, and can occur due to different anatomic structures, the arcade of Frohse being the main one of them.

PURPOSE

To describe the anatomic relation between the extensor carpi radialis brevis (ECRB) muscle and the motor branch of the radial nerve at its entrance under the arcade of Frohse.

MATERIALS AND METHODS

An anatomic dissection of 21 elbows of fresh human cadavers was conducted, describing the deep aponeurosis and the superomedial tendinous arch of ECRB and its relation with the motor branch of the radial nerve.

RESULTS

In 100% of the specimens, there was evidence of an aponeurosis in the undersurface of ECRB. A tendinous arch at the superomedial margin of ECRB was found in 20 cases (95.2%). In 71.5%, this arch surpassed proximally the arcade of Frohse on an average of 4.5mm (2-10mm); it passes in direct contact with the motor branch of the radial nerve.

CONCLUSIONS

The extensor carpi radialis brevis muscle courses in a close relation to the motor branch of the radial nerve at its entrance under the arcade of Frohse, and it demonstrates an aponeurosis at its undersurface and a tendinous arch at its medial edge that could play an important role in the development of the radial tunnel syndrome.

LEVEL OF EVIDENCE

Level IV. Anatomic research study.

Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation

The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner's disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis.