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Hones KM, Cueto RJ, Ndjonko LC, Raymond BT, Buchanan TR, Aibinder WR, Srinivasan RC, Wright TW, King JJ, Hao KA. Establishing the diagnosis of radial tunnel syndrome: a systematic review of published clinical series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2813-2821. [PMID: 38782802 DOI: 10.1007/s00590-024-04003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Radial tunnel syndrome (RTS) is a controversial diagnosis due to non-specific exam findings and frequent absence of positive electromyography (EMG) and nerve conduction study (NCS) findings. The purpose of this study was to identify the methods used to diagnose RTS in the literature. METHODS We queried PubMed, Embase, Web of Science, and Cochrane databases per PRISMA guidelines. Extracted data included article and patient characteristics, diagnostic assessments utilized and their respective findings, and treatments. Objective data were summarized descriptively. The relationship between reported diagnostic findings (i.e., physical exam and diagnostic tests) and treatments was assessed via a descriptive synthesis. RESULTS Our review included 13 studies and 391 upper extremities. All studies utilized physical exam in diagnosing RTS; most commonly, patients had tenderness over the radial tunnel (381/391, 97%). Preoperative EMG/NCS was reported by 11/13 studies, with abnormal findings in 8.9% (29/327) of upper extremities. Steroid and/or lidocaine injection for presumed lateral epicondylitis was reported by 9/13 studies (46/295 upper extremities, 16%), with RTS being diagnosed after patients received little to no relief. It was also common to inject the radial tunnel to make the diagnosis (218/295, 74%). The most common reported intraoperative finding was narrowing of the PIN (38/137, 28%). The intraoperative compressive site most commonly reported was the arcade of Frohse (142/306, 46%). CONCLUSIONS There is substantial heterogeneity in modalities used to diagnose RTS and the reported definition of RTS. This, in conjunction with many patients having concomitant lateral epicondylitis, makes it difficult to compare treatment outcomes for RTS. LEVEL OF EVIDENCE Level III. Systematic review of retrospective and prospective cohort studies.
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Affiliation(s)
- Keegan M Hones
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Robert J Cueto
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Laura C Ndjonko
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, USA
| | - Brittany T Raymond
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | | | - William R Aibinder
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Thomas W Wright
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA
| | - Joseph J King
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA.
| | - Kevin A Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
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Braun N, Save AV, Lee SK, Wolfe SW. Nomenclature of the radial nerve: distinguishing between the deep branch of the radial nerve and the posterior interosseous nerve. J Hand Surg Eur Vol 2024:17531934241254706. [PMID: 38833555 DOI: 10.1177/17531934241254706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
To address an inconsistency in the nomenclature of the anatomy and compressive syndromes of the deep branch of the radial nerve, we advocate for a single compression syndrome that presents along a spectrum from pain to posterior interosseous nerve palsy.
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Affiliation(s)
| | - Ameya V Save
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Steve K Lee
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Scott W Wolfe
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY, USA
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Abate B, Cozzolino A, Pederzini LA, Celli A. Current concepts of surgical approach for radial nerve entrapment around the elbow. J ISAKOS 2024; 9:476-481. [PMID: 38453022 DOI: 10.1016/j.jisako.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
Radial nerve entrapment is an uncommon diagnosis. The entrapment can occur at any location within the course of the nerve distribution, but the most frequent location of entrapment occurs around the elbow and involves the posterior interosseous nerve. Several potential sites of radial nerve entrapment around the elbow are identified: the capsular tissue of the radiocapitellar joint; hypertrophic crossing branches of leash of henry; the leading proximal tendinous and medial edge of extensor carpi radialis brevis; the arcade of Frohse and distal border of the supinator between its two heads. The arcade of Frohse is the most common site of compression. The aim of this manuscript is to describe the common surgical methods to approach the radial nerve entrapments around the elbow and define the preferred surgical approach based on the site of compression.
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Affiliation(s)
- Biagio Abate
- Hesperia Hospital, Department of Orthopaedic and Traumatology Surgery, Shoulder and Elbow Unit, Modena, 41124, Italy
| | - Andrea Cozzolino
- Department of Public Health, Federico II University, Napoli 80126, Italy
| | - Luigi Adriano Pederzini
- Nuovo Ospedale di Sassuolo, Department of Orthopaedic, Traumatology and Arthroscopic Surgeries, Modena 41049, Italy
| | - Andrea Celli
- Hesperia Hospital, Department of Orthopaedic and Traumatology Surgery, Shoulder and Elbow Unit, Modena, 41124, Italy.
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Martinelli F, Celli A, Celli L. Belated posterior interosseous nerve palsy with chronic radial head dislocation: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:324-327. [PMID: 38706677 PMCID: PMC11065743 DOI: 10.1016/j.xrrt.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Federico Martinelli
- Upper Limb and Peripheral Nerve Surgery Unit, Hesperia Hospital, Modena, Italy
| | - Andrea Celli
- Upper Limb and Peripheral Nerve Surgery Unit, Hesperia Hospital, Modena, Italy
| | - Luigi Celli
- Upper Limb and Peripheral Nerve Surgery Unit, Hesperia Hospital, Modena, Italy
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Zhang JY, Manirajan A, Wolf JM. The Epidemiology of Radial Tunnel Syndrome and Its Overlap With Lateral Epicondylitis. J Hand Surg Am 2023; 48:1172.e1-1172.e7. [PMID: 37923487 DOI: 10.1016/j.jhsa.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/19/2023] [Accepted: 03/09/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE Radial tunnel syndrome (RTS) is characterized by nerve compression affecting the posterior interosseous nerve branch in the forearm, and its symptoms often overlap with those of lateral epicondylitis (LE). The purpose of this study was to examine the epidemiology of RTS, frequency of injections and surgical release, and overlap of RTS with LE. METHODS We queried the PearlDiver database to identify RTS in patients older than 18 years. Demographic data, diagnostic or therapeutic injection within 30 days of diagnosis, surgical release within 1 year of diagnosis, and 90-day postoperative complication rates were evaluated. Using International Classification of Diseases, 10th Revision, laterality codes, we also determined the number of patients who had same-side RTS and LE and the proportion of patients who subsequently underwent simultaneous RT release and LE debridement. RESULTS The prevalence of RTS in a representative United States insurance database was 0.091%, and the annual incidence was 0.0091%. There were 75,459 patients identified with an active RTS diagnosis. The mean age at the time of diagnosis was 52 years (range, 18-81 years), 55% were women, and 1,833 patients (2.4%) underwent RT release within 1 year. Fewer than 3% of the patients received an injection within 30 days of RTS diagnosis. The 90-day postoperative complication rates were low: 5% of the patients required hospital readmission and 2.1% underwent revision surgery. Approximately 5.7% of the patients with RTS also had a diagnosis of LE on the same side within 6 months of RTS diagnosis. In patients with ipsilateral RTS and LE who underwent surgery, 59.1% underwent simultaneous RT release and LE debridement, whereas 40.9% underwent isolated radial tunnel release. CONCLUSIONS The analysis of a large insurance database showed that the diagnosis of RTS is rarely assigned, suggesting that the incidence of this nerve compression is low. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
| | | | - Jennifer Moriatis Wolf
- Department of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL
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Tang JB. 10 Hypotheses in Hand Surgery. Hand Clin 2022; 38:357-366. [PMID: 35985761 DOI: 10.1016/j.hcl.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
I have put together 10 topics and labeled them as hypotheses, which outline my preferred practices. The topics relate to questionable nerve compression, double crush syndrome of nerves, motion therapy after surgery, delayed primary tendon repair, proximal pole fracture of the scaphoid, short splint, and indications for postoperative hand elevation. I found no proof whether my preferred methods are better than or inferior to alternative methods that others use. The 10 hypotheses are presented to stimulate thinking, clinical observation, or investigations and highlight several areas of research. Investigation into these hypotheses may avoid unnecessary treatment or improve postsurgical comfort for patients and long-term outcomes of treatment.
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China.
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Tang JB. Some Misconceptions in the Treatment of Cubital Tunnel Syndrome, Radial Tunnel Syndrome, and Median Nerve Compression in the Forearm. Hand Clin 2022; 38:321-328. [PMID: 35985756 DOI: 10.1016/j.hcl.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article discusses ulnar, median, and radial nerve compression in the proximal forearm and elbow and some possible common misconceptions. In particular, the ligament of Struthers extremely rarely causes ulnar neuropathy. Lacertus syndrome and flexor superficialis-pronator syndrome can be diagnosed separately. Surgical release can be through a small incision. Acronyms for compression to radial nerve in proximal forearm can be simplified to radial tunnel syndrome, which includes a mild type (classical radial tunnel syndrome) and a severe type (posterior interosseous nerve (PIN) compression).
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
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Jehle C, Kelsey Snapp W. The value of difficult-topic critical analysis in textbooks for young surgeons. J Hand Surg Eur Vol 2021; 46:1118-1119. [PMID: 34474614 DOI: 10.1177/17531934211042510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Charles Jehle
- Department of Orthopaedics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - W Kelsey Snapp
- Department of Plastic Surgery, Brown University Alpert Medical School, Providence, RI, USA
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Tang JB. Median nerve compression: lacertus syndrome versus superficialis-pronator syndrome. J Hand Surg Eur Vol 2021; 46:1017-1022. [PMID: 34210205 DOI: 10.1177/17531934211024092] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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