Radial Nerve Compression in the Upper Extremity

Acute Radial Compressive Neuropathy: The Most Common Injury Induced by Japanese Rope Bondage

Japanese rope bondage (RB), or Shibari, is an art form involving the voluntary and aesthetic binding of a person with a rope, which may result in compression injuries to peripheral nerves. To investigate the nature and extent of nerve injuries associated with this practice, we conducted a survey of four experienced RB practitioners (riggers) and participants who were willing to share their experiences of injury. Injuries presented acutely and immediately following full-body suspensions, with a total of 10 individuals (16 injuries) identified with damage to the radial, axillary, or femoral nerves. Notably, the radial nerve was the most commonly affected structure in our patient cohort, with 90.0% of individuals experiencing an injury at this level. We present a rare case of acute repeated compression of the radial nerve during full-body suspension RB. A 29-year-old female was suspended for 25 minutes using a 6-mm jute rope, resulting in wrist and finger drop, as well as reduced sensation in the left hand. Analysis revealed a 77.3% conduction block in the upper arm segment. Improvement was observed after three months, fully achieved after five months. Seventeen months later, re-compression of both radial nerves occurred during a similar suspension lasting 8-10 minutes. Improvement occurred after one week, fully achieved after four weeks. The third compression episode occurred three years later, lasting five minutes, with full recovery within two minutes. This study focuses on the injury of peripheral nerves, including the radial, axillary, and femoral nerves, namely, acute compression neuropathy induced by Japanese RB. Because the radial nerve is the most frequently injured structure, the findings underscore the significance of recognizing the anatomical course of the radial nerve, particularly its position posteriorly at the distal deltoid tuberosity level, as a means of preventing nerve injury in this region. This knowledge is particularly crucial for individuals engaged in the practice of RB, emphasizing the importance of taking precautions to avoid potential nerve damage.

Electrophysiological study of posterior antebrachial cutaneous nerve in a sample of normal subjects

Backgrounds

Posterior antebrachial cutaneous nerve sensory conduction study is clinically essential for the assessment of its integrity and for the localization of radial nerve lesions. The aim of the study was to assess posterior antebrachial cutaneous nerve sensory antidromic conduction technique and to obtain normal reference values for different sensory nerve action potential parameters of this nerve among a sample of Egyptian population.

Results

The current study included 120 upper limbs of 60 apparently healthy subjects [35 (58.3%) women]. Their mean age was 39.20 ± 11.95 years. The posterior antebrachial cutaneous nerve was recorded in all upper limbs (100%). The values (mean ± standard deviation) for the posterior antebrachial cutaneous nerve sensory nerve action potential onset latency were 2.05 ± 0.25 ms, peak latency was 2.63 ± 0.28 ms, conduction velocity was 60.50 ± 5.38 m/s, amplitude was 11.04 ± 4.26 μV, and inter-side sensory nerve action potential amplitude ratio was 0.69 ± 0.17. There were no statistically significant differences between men and women, as well as between right and left upper limbs regarding different posterior antebrachial cutaneous sensory nerve action potential parameters. There were no statistically significant correlations between participants’ age and anthropometric measures (i.e., height, weight, and body mass index) with different posterior antebrachial cutaneous nerve sensory nerve action potential parameters. There were no statistically significant adjusted effects of age, gender, and anthropometric measures on different posterior antebrachial cutaneous nerve sensory nerve action potential parameters in multiple linear regression analysis by controlling all other physiologic factors.

Conclusions

This research provides an applicable electrophysiological technique and normal reference values for the posterior antebrachial cutaneous nerve sensory conduction study.

Ultrasound Imaging of Disorders of Small Nerves of the Extremities: Less Recognized Locations

Ultrasound is a well-proven imaging modality for showing peripheral nerve disorders and guiding perineural injections. The aim of this review is to focus on small peripheral nerve abnormalities, which are usually not recognized by sonologists. In fact, most of these small nerves have a tiny diameter (<2 mm), and their anatomy is less familiar. We describe the most common causes of small peripheral nerve disorders, providing an accurate description of their anatomic locations and relationships with adjacent structures; we also focus on technical hints that may help in their evaluation.

Electrophysiologic Features of Radial Neuropathy in Childhood and Adolescence

BACKGROUND

We analyzed the clinical and electrophysiologic patterns of nerve injury in pediatric patients with radial neuropathy.

METHODS

This is a retrospective analysis of 19 children and adolescents with radial neuropathy.

RESULTS

The mean subject age was 12 years (range one month to 19 years), 56% were female, and 53% had traumatic etiologies. Weakness in the finger and wrist extensors was the prevailing complaint (82%). Predominant localization was at the posterior interosseous nerve (37%), followed by the radial nerve below the spiral groove (32%), the radial nerve at the spiral groove (26%), and the radial nerve above the spiral groove (5%). Extensor indicis proprius compound muscle action potential amplitude was reduced in 86% of cases when tested, with a median axon loss estimate of 78%. The radial sensory nerve action potential amplitude was reduced in 53% of all cases, and in 83% of cases affecting the main radial trunk with a median axon loss estimate of 100%. For neuropathy affecting the main radial trunk, there was a high correlation of extensor indicis proprius median axon loss estimate and radial sensory nerve action potential median axon loss estimate (r = 0.72, P = 0.02). Neurogenic changes were seen in the extensor indicis proprius, extensor digitorum communis, extensor carpi radialis, and brachioradialis in 88%, 94%, 60%, and 44% of cases, respectively. Pathophysiology was demyelinating in 10%, axonal in 58%, and mixed in 32%.

CONCLUSIONS

In contrast to adults, where localization at the spiral groove predominates, radial neuropathy in children and adolescents is commonly localized at the posterior interosseous nerve or at the distal main radial trunk. Pediatric radial neuropathy is frequently of traumatic etiology and axonal pathophysiology.

Anatomical Study of the Surgical Approaches to the Radial Tunnel

PURPOSE

To provide a cadaveric analysis of 3 surgical approaches (anterior, anterolateral, posterior) used for decompression of the posterior interosseous nerve within the radial tunnel. The aim of the study was to determine whether the number of compression sites visualized and safely released differed between approaches. We hypothesized that no single approach is adequate for visualization of all key compression sites.

METHODS

Thirty fresh-frozen cadaveric specimens were used to perform 10 anterior, 10 anterolateral, and 10 posterior approaches to the radial tunnel. For each approach, key anatomical structures and the 5 documented anatomical sites of nerve compression that were clearly visualized within the surgical exposure were recorded. The portion of the supinator that was directly visualized in each approach was released. A second window was then created to expose the remaining uncut portion of the supinator. Measurements were taken from each specimen.

RESULTS

Statistical analysis demonstrated that the anterior and anterolateral approaches were best for visualizing the fibrous bands of the radial head, the leash of Henry, the origin of the extensor carpi radialis brevis, and the arcade of Frohse. The posterior approach was best for visualizing the distal border of the supinator. The relative uncut supinator distance varied with approach. The anterior approach left a larger relative uncut portion than the posterior approach.

CONCLUSIONS

No single approach was adequate for complete visualization and release of all compression points of the radial tunnel. In cases of radial tunnel release, complete visualization of the posterior interosseous nerve compression sites is best achieved through multiple windows.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Radial nerve compression between the brachialis and brachioradialis muscles in a manual worker: a case report

We report a case of high right radial nerve palsy in which the nerve was compressed between the brachialis and brachioradialis muscles.