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Węgiel A, Karauda P, Zielinska N, Tubbs RS, Olewnik Ł. Radial nerve compression: anatomical perspective and clinical consequences. Neurosurg Rev 2023; 46:53. [PMID: 36781706 PMCID: PMC9925568 DOI: 10.1007/s10143-023-01944-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/01/2023] [Accepted: 01/16/2023] [Indexed: 02/15/2023]
Abstract
The radial nerve is the biggest branch of the posterior cord of the brachial plexus and one of its five terminal branches. Entrapment of the radial nerve at the elbow is the third most common compressive neuropathy of the upper limb after carpal tunnel and cubital tunnel syndromes. Because the incidence is relatively low and many agents can compress it along its whole course, entrapment of the radial nerve or its branches can pose a considerable clinical challenge. Several of these agents are related to normal or variant anatomy. The most common of the compressive neuropathies related to the radial nerve is the posterior interosseus nerve syndrome. Appropriate treatment requires familiarity with the anatomical traits influencing the presenting symptoms and the related prognoses. The aim of this study is to describe the compressive neuropathies of the radial nerve, emphasizing the anatomical perspective and highlighting the traps awaiting physicians evaluating these entrapments.
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Affiliation(s)
- Andrzej Węgiel
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, Grenada, USA
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurosurgery, Ochsner Medical Center, New Orleans, LA, USA
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
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Gunio D, Babaa A, Bencardino JT. Imaging of Nerve Disorders in the Elbow. Semin Musculoskelet Radiol 2022; 26:123-139. [PMID: 35609574 DOI: 10.1055/s-0042-1743407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Neuropathies of the elbow represent a spectrum of disorders that involve more frequently the ulnar, radial, and median nerves. Reported multiple pathogenic factors include mechanical compression, trauma, inflammatory conditions, infections, as well as tumor-like and neoplastic processes. A thorough understanding of the anatomy of these peripheral nerves is crucial because clinical symptoms and imaging findings depend on which components of the affected nerve are involved. Correlating clinical history with the imaging manifestations of these disorders requires familiarity across all diagnostic modalities. This understanding allows for a targeted imaging work-up that can lead to a prompt and accurate diagnosis.
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Affiliation(s)
- Drew Gunio
- Division of Clinical Radiology, Department of Radiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Ahmad Babaa
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Kesserwani H. The "Dangles" - Wrist, Finger and Thumb Drop: A Case Report of Saturday Night Palsy and a Historical and Molecular Detour. Cureus 2021; 13:e13195. [PMID: 33717737 PMCID: PMC7942519 DOI: 10.7759/cureus.13195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 11/11/2022] Open
Abstract
Saturday night palsy refers to neuropraxia of the radial nerve following prolonged compression against the spiral groove of the humerus. The pattern of weakness is unique with wrist, thumb, and finger drop, and recovery is universal by six months. What makes this clinical entity fascinating are the toxic and metabolic diseases that can manifest similarly, namely, plumbism (Saturnism) and acute porphyrias. The acute porphyrias (heme biosynthetic inborn errors of metabolism) are well known to cause motor neuropathy, with upper more than lower limb weakness, with wrist, thumb and finger drop a frequent manifestation. Intriguingly, lead neurotoxicity (plumbism), which has historically been tightly associated with wrist, thumb, and finger drop, is associated with the inhibition of at least three enzymes of heme biosynthesis. Mechanistically, interference with heme ring synthesis interferes with electron transport chain protein synthesis, which leads to oxidative phosphorylation defects, energy failure, axonal transport impairment, and, subsequently, an axonopathy. The lead atom has a valence of two (giving up two electrons) similar to that of the calcium atom, allowing lead to bind to spongy and cortical bone and interfering with the presynaptic voltage-gated calcium channel (VGCC) neurons. We list the salient features and similarities of these two very rare entities, hence, the term plumboporphyric neuropathy for one of the genetic variants of heme biosynthesis. Lastly, we briefly outline the spectacular history of plumbism and adumbrate on the similarity of the bacchanalian ecstasy of Roman festivals (Saturnism), over-indulgence in lead-sweetened and lead-laden barrels of wine, and the syncretism between the Saturnine palsy and Saturday night palsy. We present a case of wrist, thumb, and finger drop due to compressive neuropraxia as a platform to segue into the historical simulacra.
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Khodulev VI, Nechipurenko NI, Shcharbina NY. Radial motor nerve conduction studies in the upper arm. Muscle Nerve 2020; 62:363-368. [PMID: 32557710 DOI: 10.1002/mus.27006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The main goal of this study was to determine the contribution of the anterior forearm muscles to the compound muscle action potential (CMAP) recorded from the extensor digitorum (ED) after proximal stimulation. METHODS Twenty-one healthy volunteers and 114 patients with compressive and traumatic radial neuropathies were examined. Stimulation was carried out at six different points: distal third of the upper arm; Erb's point; axilla; medial upper arm; antecubital fossa; and ulnar groove. RESULTS In the control group, Erb's CMAP area was significantly greater than the distal CMAP area. In compressive neuropathy, there was conduction block, but no change in conduction velocity. There were no differences in Erb's CMAP latencies between the control group and the neuropathies group. DISCUSSION CMAPs recorded over the ED with stimulation at the brachial plexus represent the sum of the motor unit action potentials of the posterior and anterior forearm muscles.
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Affiliation(s)
- Vasily I Khodulev
- Department of Functional Diagnostics, Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
| | - Natalia I Nechipurenko
- Laboratory of Clinical Pathophysiology of Nerve System, Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
| | - Natallia Y Shcharbina
- Clinical Unit "Eleous" at Religious Community "All Saints Parish in Minsk Eparchy of Belarusian Orthodox Church,", Minsk, Belarus
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Mülkoğlu C, Nacır B, Genç H. Acute compressive radial neuropathy and wrist drop due to the repetitive overuse of the arm. Neurol Sci 2019; 41:989-991. [PMID: 31820323 DOI: 10.1007/s10072-019-04100-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTION Entrapment neuropathies are common in clinical practice. Early diagnosis and management of nerve compression is necessary to maintain limb function and to improve the patient's quality of life. CASE REPORT In this article, we reported a woman presenting with wrist drop as a result of acute radial nerve compression following strenuous activity involving the arms. The diagnosis was based on clinical and ultrasonographic findings. Once the diagnosis was made, activity modifications and systemic steroid were prescribed, and the patient made a near-complete recovery. CONCLUSION Patients with acute wrist drop and sensorial loss should be examined in terms of arm overuse, and radial nerve compression should be confirmed by peripheral nerve ultrasound.
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Affiliation(s)
- Cevriye Mülkoğlu
- Department of Physical Therapy and Rehabilitation, Health Sciences University Ankara Training and Research Hospital, Ulucanlar Street Altındağ, 06230, Ankara, Turkey.
| | - Barış Nacır
- Department of Physical Therapy and Rehabilitation, Health Sciences University Ankara Training and Research Hospital, Ulucanlar Street Altındağ, 06230, Ankara, Turkey
| | - Hakan Genç
- Department of Physical Therapy and Rehabilitation, Health Sciences University Ankara Training and Research Hospital, Ulucanlar Street Altındağ, 06230, Ankara, Turkey.
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Recreational nitrous oxide abuse related subacute combined degeneration of the spinal cord in adolescents - A case series and literature review. Brain Dev 2019; 41:428-435. [PMID: 30611595 DOI: 10.1016/j.braindev.2018.12.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/03/2018] [Accepted: 12/17/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Nitrous oxide (N2O) is a commonly used inhaled anesthetic in outpatient dental procedures. However, the increasing recreational use of N2O may result in vitamin B12 deficiency-related neurologic and psychiatric symptoms. The aim of this study was to demonstrate the clinical features of chronic N2O abuse in pediatric patients. METHODS Patients under 20 years of age who were diagnosed with N2O-induced subacute combined degeneration of the spinal cord from 2012 to 2018 were enrolled in this study. Clinical presentations, laboratory, imaging, ancillary studies, treatments and outcomes were analyzed. RESULTS Nine patients were included, all of whom presented with symptoms of myeloneuropathy including limb numbness, limb weakness or unsteady gait. Six patients had low or low-normal vitamin B12 (cyanocobalamin) levels. Eight patients had evidence of subacute combined degeneration of the spinal cord via neuroimaging studies. All of the patients received vitamin B12 supplementation as treatment. All had full recovery of muscle power within 2 months. Five patients had persistent sensory deficits. CONCLUSION Chronic N2O abuse can cause permanent neurological damage if not treated promptly. Clinical staff should be aware of the various presentations of neurotoxicity related to N2O abuse.
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Agarwal A, Chandra A, Jaipal U, Saini N. Imaging in the diagnosis of ulnar nerve pathologies-a neoteric approach. Insights Imaging 2019; 10:37. [PMID: 30895491 PMCID: PMC6426899 DOI: 10.1186/s13244-019-0714-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023] Open
Abstract
The ulnar nerve is a branch of the C8 and T1 nerve roots and arises from the medial cord of the brachial plexus. It supplies the intrinsic muscles of the hand and assists the median nerve in functioning of the flexors. Also known as the musician’s nerve, it is the second most common nerve involved in compressive neuropathy following the median nerve. Common sites of entrapment include cubital tunnel at the elbow, the ulnar groove in the humerus and the Guyon’s canal at the wrist. Patients present with altered sensation in the ulnar fourth and the fifth digit and the medial side of arm with loss of function of intrinsic muscles of the hand, the flexor carpi ulnaris and ulnar fibres of flexor digitorum superficialis in more severe cases. Diagnosis relies on clinical examination, electrodiagnostic studies and imaging findings. Plain radiographs are used to identify fracture sites, callus, or tumours as cause of compression. Technological advances in ultrasonography have allowed direct visualisation of the involved nerve with assessment of exact site, extent and type of injury. It yields unmatched information about anatomical details of the nerve. MR imaging adds to soft tissue details and helps in characterising the lesion. This pictorial review aims to illustrate a wide spectrum of causes of ulnar neuropathies as seen on ultrasound and MRI and emphasises upon the importance of imaging modalities in the diagnosis of neuropathies.
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Affiliation(s)
- Aakanksha Agarwal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, Rajasthan, India. .,, A 235, Shivanand Marg, Malviya Nagar, Jaipur, India.
| | - Abhishek Chandra
- Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India
| | - Usha Jaipal
- Department of Radiodiagnosis, SMS Medical College, Jaipur, Rajasthan, India
| | - Narender Saini
- Department of Orthopaedics, SMS Medical College, Jaipur, Rajasthan, India
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Abstract
Upper extremity entrapment neuropathies are common and can cause pain, sensory loss, and muscle weakness that lead to functional disability. In this article, the authors review common entrapment neuropathies of the upper extremities, including median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, and radial neuropathy. The authors discuss the pathophysiology of nerve compression and typical etiologies, as well as strategies for differentiating between common mimics such as cervical radiculopathy and for selecting between various treatment modalities.
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Affiliation(s)
- Christopher T Doughty
- Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Michael P Bowley
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, WACC 739B, Boston, MA 02114, USA.
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Agarwal A, Chandra A, Jaipal U, Saini N. A panorama of radial nerve pathologies- an imaging diagnosis: a step ahead. Insights Imaging 2018; 9:1021-1034. [PMID: 30397879 PMCID: PMC6269333 DOI: 10.1007/s13244-018-0662-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/31/2018] [Accepted: 09/19/2018] [Indexed: 12/23/2022] Open
Abstract
Abstract The radial nerve has a long and tortuous course in the upper limb. Injury to the nerve can occur due to a multitude of causes at many potential sites along its course. The most common site of involvement is in the proximal forearm affecting the posterior interosseous branch while the main branch of the radial nerve is injured in fractures of the humeral shaft. Signs and symptoms of radial neuropathy depend upon the site of injury. Injury to the nerve distal to innervation of triceps brachii results in loss of extensor function with sparing of function of the triceps resulting in the characteristic ‘wrist drop’. Injury in the mid-arm is associated with loss of sensation in the dorsolateral aspect of the hand, the dorsal aspect of the radial three-and-a-half digits and in the first web space. Involvement of only the posterior interosseous nerve (PIN) results in weakness of the wrist and digit extensors. Diagnosis relies on clinical examination, electrodiagnostic studies and imaging findings. Plain radiographs are used to identify fracture sites, callus or tumours as cause of compression. Technological advances in ultrasonography have allowed direct visualisation of the involved nerve with assessment of the exact site, extent and type of injury. It yields unmatched information about anatomical details of the nerve. MR imaging adds to soft-tissue details and helps in characterising the lesion. This pictorial review aims to illustrate a wide spectrum of causes of radial neuropathy and emphasises the importance of imaging modalities in diagnosis of neuropathies. Teaching Points • Radial nerve injuries are assessed by clinical examination and diagnosed using electrodiagnostic and imaging studies. • Knowledge of anatomical relations and course of the nerve is necessary to identify the nerve at pre-determined anatomical locations. • Altered echogenicity and signal intensity, discontinuity of the nerve, focal thickening and cause of compression can be assessed by imaging modalities. • MR imaging helps in confirmation of the ultrasound findings, differentiating similar appearing lesions and provides additional soft-tissue details.
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Affiliation(s)
- Aakanksha Agarwal
- Department of Radiodiagnosis and Modern Imaging, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India.
| | - Abhishek Chandra
- Department of Orthopaedics, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Usha Jaipal
- Department of Radiodiagnosis and Modern Imaging, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
| | - Narender Saini
- Department of Orthopaedics, SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India
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Song S, Yoo Y, Won SJ, Park HJ, Rhee WI. Investigation of the Diagnostic Value of Ultrasonography for Radial Neuropathy Located at the Spiral Groove. Ann Rehabil Med 2018; 42:601-608. [PMID: 30180530 PMCID: PMC6129709 DOI: 10.5535/arm.2018.42.4.601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/20/2017] [Indexed: 01/19/2023] Open
Abstract
Objective To determine a diagnostic cut-off value for the cross-sectional area (CSA) of the radial nerve using ultrasonography for radial neuropathy located at the spiral groove (SG). Methods Seventeen patients with electrodiagnostic evidence of radial neuropathy at the SG and 30 healthy controls underwent ultrasonography of the radial nerve at the SG . The CSAs at the SG were compared in the patient and control groups. The CSA at the SG between the symptomatic and asymptomatic sides (ΔSx–Asx and Sx/Asx, respectively) were analyzed to obtain the optimal cut-off value. The relationship between the electrophysiological severity of radial neuropathy and CSA was also evaluated. Results Among the variables examined, there were statistically significant differences in the CSA between the patient and control groups, ΔSx–Asx, and Sx/Asx at the SG. In a receiver operating characteristics analysis, the cut-off CSA was 5.75 mm2 at the SG (sensitivity 52.9%, specificity 90%), 1.75 mm2 for ΔSx–Asx (sensitivity 58.8%, specificity 100%), and 1.22 mm2 for Sx/Asx (sensitivity 70.6%, specificity 93.3%) in diagnosing radial neuropathy at the SG. There was no significant correlation between CSA and electrophysiological severity score for either patient group. Conclusion The reference value obtained for CSA of the radial nerve at the SG may facilitate investigation of radial nerve pathologies at the SG.
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Affiliation(s)
- Seojin Song
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeonji Yoo
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Jae Won
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Jung Park
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Ihl Rhee
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
PURPOSE OF REVIEW This article addresses relevant peripheral neuroanatomy, clinical presentations, and diagnostic findings in common entrapment neuropathies involving the median, ulnar, radial, and fibular (peroneal) nerves. RECENT FINDINGS Entrapment neuropathies are a common issue in general neurology practice. Early diagnosis and effective management of entrapment mononeuropathies are essential in preserving limb function and maintaining patient quality of life. Median neuropathy at the wrist (carpal tunnel syndrome), ulnar neuropathy at the elbow, radial neuropathy at the spiral groove, and fibular neuropathy at the fibular head are among the most frequently encountered entrapment mononeuropathies. Electrodiagnostic studies and peripheral nerve ultrasound are employed to help confirm the clinical diagnosis of nerve compression or entrapment and to provide precise localization for nerve injury. Peripheral nerve ultrasound demonstrates nerve enlargement at or near sites of compression. SUMMARY Entrapment neuropathies are commonly encountered in clinical practice. Accurate diagnosis and effective management require knowledge of peripheral neuroanatomy and recognition of key clinical symptoms and findings. Clinical diagnoses may be confirmed by diagnostic testing with electrodiagnostic studies and peripheral nerve ultrasound.
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Effect of Fascia Penetration on Sensory Nerve Conduction in the Superficial Radial Nerve. J Clin Neurophysiol 2018; 35:263-266. [DOI: 10.1097/wnp.0000000000000461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Karakis I, Georghiou S, Jones HR, Darras BT, Kang PB. Electrophysiologic Features of Radial Neuropathy in Childhood and Adolescence. Pediatr Neurol 2018; 81:14-18. [PMID: 29506771 DOI: 10.1016/j.pediatrneurol.2018.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 01/12/2018] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Ioannis Karakis
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Neurology, Lahey Clinic, Burlington, Massachusetts; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Sofia Georghiou
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - H Royden Jones
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Neurology, Lahey Clinic, Burlington, Massachusetts
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter B Kang
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida; Department of Neurology, University of Florida College of Medicine, Gainesville, Florida.
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Yeo J, Kim Y, Kim S, Oh K, Kang H. Optimal Radial Motor Nerve Conduction Study Using Ultrasound in Healthy Adults. Ann Rehabil Med 2017; 41:290-298. [PMID: 28503463 PMCID: PMC5426271 DOI: 10.5535/arm.2017.41.2.290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/06/2016] [Indexed: 11/15/2022] Open
Abstract
Objective To obtain reference values, to suggest optimal recording and stimulation site for radial motor nerve conduction study (RmNCS), and to analyze the correlation among RmNCS parameters, demographics and ultrasonography (US) findings. Methods A total of 55 volunteers participated in this study. We hypothesized that ‘lateral edge of spiral groove (A)’ was the optimal stimulation site, and the ‘largest cross-sectional area (CSA) of extensor indicis proprius (EIP) muscle (B)’ was the optimal recording site. The surface distance between ‘A’ and the lateral epicondyle of the humerus divided by upper arm length, was named the spiral groove ratio. The surface distance between ‘B’ and the ulnar styloid process divided by forearm length, was named the EIP ratio. Using US, we identified these sites, and further conducted RmNCS. Results Data was collected from 100 arms of the 55 volunteers. Mean amplitude and latency were 5.7±1.1 mV and 5.7±0.5 ms, respectively, at the spiral groove, and velocity between elbow and spiral groove was 73.7±7.0 m/s. RmNCS parameters correlated significantly with height, weight, arm length, and CSA of the EIP muscle. Spiral groove ratio and EIP ratio were 0.338±0.03 and 0.201±0.03, respectively; both values were almost the same, regardless of age, sex and handedness. Conclusion We established a reference value and standardized method of RmNCS using US. Optimal RmNCS can be conducted by placing the recording electrode 20% (about one-fifth) of forearm length from the ulnar styloid process, and stimulating at 34% (about one-third) of the humeral length from the lateral epicondyle.
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Affiliation(s)
- Jungho Yeo
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Yuntae Kim
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Sooa Kim
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Kiyoung Oh
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hyungdong Kang
- Department of Rehabilitation Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Kim Y, Ha DH, Lee SM. Ultrasonographic findings of posterior interosseous nerve syndrome. Ultrasonography 2017; 36:363-369. [PMID: 28494524 PMCID: PMC5621806 DOI: 10.14366/usg.17007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the ultrasonographic findings associated with posterior interosseous nerve (PIN) syndrome. Methods Approval from the Institutional Review Board was obtained. A retrospective review of 908 patients' sonographic images of the upper extremity from January 2001 to October 2010 revealed 10 patients suspicious for a PIN abnormality (7 male and 3 female patients; mean age of 51.8±13.1 years; age range, 32 to 79 years). The ultrasonographic findings of PIN syndrome, including changes in the PIN and adjacent secondary changes, were evaluated. The anteroposterior diameter of the pathologic PIN was measured in eight patients and the anteroposterior diameter of the contralateral asymptomatic PIN was measured in six patients, all at the level immediately proximal to the proximal supinator border. The size of the pathologic nerves and contralateral asymptomatic nerves was compared using the Mann-Whitney U test. Results Swelling of the PIN proximal to the supinator canal by compression at the arcade of Fröhse was observed in four cases. Swelling of the PIN distal to the supinator canal was observed in one case. Loss of the perineural fat plane in the supinator canal was observed in one case. Four soft tissue masses were noted. Secondary denervation atrophy of the supinator and extensor muscles was observed in two cases. The mean anteroposterior diameter of the pathologic nerves (n=8, 1.79±0.43 mm) was significantly larger than that of the contralateral asymptomatic nerves (n=6, 1.02±0.22 mm) (P=0.003). Conclusion Ultrasonography provides high-resolution images of the PIN and helps to diagnose PIN syndrome through visualization of its various causes and adjacent secondary changes.
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Affiliation(s)
- Youdong Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Doo Hoe Ha
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Min Lee
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Brown JM, Yablon CM, Morag Y, Brandon CJ, Jacobson JA. US of the Peripheral Nerves of the Upper Extremity: A Landmark Approach. Radiographics 2017; 36:452-63. [PMID: 26963456 DOI: 10.1148/rg.2016150088] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ultrasonography (US) has become a first-line modality for the evaluation of the peripheral nerves of the upper extremity. The benefits of US over magnetic resonance (MR) imaging include higher soft-tissue resolution, cost effectiveness, portability, real-time and dynamic imaging, and the ability to scan an entire extremity quickly and efficiently. US can be performed on patients who are not eligible for MR imaging. Metallic implant artifacts are usually not problematic. US has been shown to have equal specificity and greater sensitivity than MR imaging in the evaluation of peripheral nerves. Any abnormal findings can be easily compared with the contralateral side. The published literature has shown that US has demonstrated clinical utility in patients with suspected peripheral nerve disease by guiding diagnostic and therapeutic decisions as well as by confirming electrodiagnostic findings. Common indications for upper extremity peripheral nerve US are the evaluation for injury due to penetrating trauma, entrapment by scar tissue, and tumor. US of the upper extremity is most commonly performed to evaluate carpal and cubital tunnel syndrome. It is important for the radiologist or sonographer to have a detailed knowledge of anatomy and specific anatomic landmarks for each nerve to efficiently and accurately perform an examination. The goal of this article is to introduce readers to the basics of US of the peripheral nerves of the upper extremity with a focus on the median, ulnar, and radial nerves. Common sites of disease and the location of important anatomic landmarks will be reviewed.
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Affiliation(s)
- Jordan M Brown
- From the Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Corrie M Yablon
- From the Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Yoav Morag
- From the Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Catherine J Brandon
- From the Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Jon A Jacobson
- From the Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109
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MORAES MARCOAURÉLIODE, GONÇALVES RUBENSGUILHERME, SANTOS JOÃOBAPTISTAGOMESDOS, BELLOTI JOÃOCARLOS, FALOPPA FLÁVIO, MORAES VINÍCIUSYNOEDE. DIAGNOSIS AND TREATMENT OF POSTERIOR INTEROSSEOUS NERVE ENTRAPMENT: SYSTEMATIC REVIEW. ACTA ORTOPEDICA BRASILEIRA 2017. [PMID: 28642652 PMCID: PMC5474404 DOI: 10.1590/1413-785220172501164801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Compressive syndromes of the radial nerve have different presentations. There is no consensus on diagnostic and therapeutic methods. The aim of this review is to summarize such methods. Eletronic searches related terms, held in databases (1980-2016): Pubmed (via Medline), Lilacs (via Scielo) and Google Scholar. Through pre-defined protocol, we identified relevant studies. We excluded case reports. Aspects of diagnosis and treatment were synthesized for analysis and tables. Quantitative analyzes were followed by their dispersion variables. Fourteen studies were included. All studies were considered as level IV evidence. Most studies consider aspects of clinical history and provocative maneuvers. There is no consensus on the use of electromyography, and methods are heterogeneous. Studies have shown that surgical treatment (muscle release and neurolysis) has variable success rate, ranging from 20 to 96.5%. Some studies applied self reported scores, though the heterogeneity of the population does not allow inferential analyzes on the subject. few complications reported. Most studies consider the diagnosis of compressive radial nerve syndromes essentially clinical. The most common treatment was combined muscle release and neurolysis, with heterogeneous results. There is a need for comparative studies. Level of Evidence III, Systematic Review.
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Diagnosis and Treatment of Work-Related Proximal Median and Radial Nerve Entrapment. Phys Med Rehabil Clin N Am 2015; 26:539-49. [DOI: 10.1016/j.pmr.2015.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Pieber K, Herceg M, Paternostro-Sluga T, Schuhfried O. Optimizing stimulation parameters in functional electrical stimulation of denervated muscles: a cross-sectional study. J Neuroeng Rehabil 2015; 12:51. [PMID: 26048812 PMCID: PMC4458019 DOI: 10.1186/s12984-015-0046-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/02/2015] [Indexed: 01/05/2023] Open
Abstract
Background To counteract denervation atrophy long-term electrical stimulation with a high number of muscle contractions has to be applied. This may lead to discomfort of the patient and negative side effects like burns. A functional effective muscle contraction induced by the lowest possible stimulation intensity is desirable. In clinical practice a selective stimulation of denervated muscles with triangular pulses is used. The aim of the study was to evaluate the influence of polarity and pulse duration on the stimulation intensity of triangular pulses in denervated muscles in patients with peripheral nerve lesions. Methods Twenty-four patients with denervated extensor digitorum communis muscle and twenty-four patients with denervated tibialis anterior muscle due to peripheral nerve lesions were included. Four different combinations of triangular pulses with various duration and polarity were delivered randomly to the denervated muscles. The threshold intensity to induce a functional effective muscle contraction was noted. One-way within subject ANOVA was used to assess changes in intensity. An alpha level of p less than or equal to 0.05 was the criterion for statistical significance. Results Patients with a denervated tibialis anterior muscle presented significant lower intensities inducing a functional effective muscle contraction in favor of the stimulation with a duration of 200 ms and a polarity with the cathode proximally applied. No significant differences could be shown between the different stimulation protocols in case of denervated extensor digitorum communis muscle. Conclusions We recommend electrical stimulation of the denervated tibialis anterior muscle with triangular current with a duration of 200 ms and a polarity with the cathode proximally applied.
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Affiliation(s)
- Karin Pieber
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Malvina Herceg
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | | | - Othmar Schuhfried
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Peri AM, Milazzo L, Meroni L, Antinori S. Radiculoneuropathy associated with acute hepatitis E. Dig Liver Dis 2013; 45:963-4. [PMID: 23796551 DOI: 10.1016/j.dld.2013.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/23/2013] [Accepted: 05/02/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Anna Maria Peri
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, L. Sacco Hospital, Milan, Italy
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Wang LH, Weiss MD. Anatomical, Clinical, and Electrodiagnostic Features of Radial Neuropathies. Phys Med Rehabil Clin N Am 2013. [DOI: 10.1016/j.pmr.2012.08.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rehabilitation of brachial plexus and peripheral nerve disorders. HANDBOOK OF CLINICAL NEUROLOGY 2013; 110:499-514. [DOI: 10.1016/b978-0-444-52901-5.00042-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Dimberg EL. Electrodiagnostic evaluation of ulnar neuropathy and other upper extremity mononeuropathies. Neurol Clin 2012; 30:479-503. [PMID: 22361371 DOI: 10.1016/j.ncl.2011.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Upper extremity mononeuropathies are some of the common disorders seen in neurophysiology laboratories. Electrophysiologic studies rely on accurate localization based on knowledge of applicable anatomy and features of history and physical examination. Careful electrodiagnostic studies provide an accurate diagnosis, help localize the lesion site, exclude alternate diagnoses, reveal unsuspected diagnoses, determine pathophysiology of lesions, and assess severity, timeframe, and prognosis of lesions. This article discusses the electrodiagnostic approach to ulnar neuropathy, proximal median neuropathy, radial neuropathy, musculocutaneous neuropathy, axillary neuropathy, suprascapular neuropathy, and long thoracic neuropathy. Pertinent aspects of the history and physical examination, nerve conduction studies, and electromyography are presented.
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Affiliation(s)
- Elliot L Dimberg
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Arnold WD, Krishna VR, Freimer M, Kissel JT, Elsheikh B. Prognosis of acute compressive radial neuropathy. Muscle Nerve 2012; 45:893-5. [DOI: 10.1002/mus.23305] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Lo Y, Fook-Chong S, Leoh T, Dan Y, Tan Y, Lee M, Gan H, Chan L. Rapid ultrasonographic diagnosis of radial entrapment neuropathy at the spiral groove. J Neurol Sci 2008; 271:75-9. [DOI: 10.1016/j.jns.2008.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 03/20/2008] [Accepted: 03/27/2008] [Indexed: 10/22/2022]
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Bilgin NG, Ozge A, Mert E, Yalçinkaya DE, Kar H. Importance of Electromyography and the Electrophysiological Severity Scale in Forensic Reports. J Forensic Sci 2007; 52:698-701. [PMID: 17456098 DOI: 10.1111/j.1556-4029.2007.00427.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Forensic reports on traumatic peripheral nerve injuries include dysfunction degrees of extremities, which are arranged according to the Turkish Penalty Code. The aim of this study is to discuss the role and importance of electromyography while preparing forensic reports in the cases of traumatic peripheral nerve injuries and the usefulness of scoring systems. A modified global scale, recommended by Mondelli et al., was used to assess the electrophysiological impairment of each peripheral nerve. Forensic reports of 106 patients, reported between 2002 and 2004, were evaluated. Thirty-four percent of the cases were reported as "total loss of function," 41.5% were reported as "functional disability," and there were no dysfunctions in the other cases in forensic reports that were prepared based on Council of Social Insurance Regulations of Health Processes and Guide prepared by the Council of Forensic Medicine and profession associations of forensic medicine. When we rearranged these forensic reports based on the electrophysiological severity scale (ESS), it was clearly found that all of the score 2 cases and 86.7% of the score 3 cases corresponded to "functional disability" and 91.4% of the score 4 cases correspond to "total loss of function." We found a significant correlation between the ESS and functional evaluation in peripheral nerve injury cases. Evaluation of functional disabilities in peripheral nerve injuries with the ESS represents a standardized and objective method used for forensic reports.
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Affiliation(s)
- Nursel Gamsiz Bilgin
- Faculty of Medicine, Department of Forensic Medicine, Mersin University, Tip Fakültesi Adli Tip Anabilim Dali, 33079 Mersin, Turkey.
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