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Li Y, Nan G, Chen J, Jiang Y, Zhu W. Radial nerve palsy in the newborn combined with congenital radial head dislocation: Case report and literature review. Medicine (Baltimore) 2024; 103:e37146. [PMID: 38306529 PMCID: PMC10843491 DOI: 10.1097/md.0000000000037146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/11/2024] [Indexed: 02/04/2024] Open
Abstract
RATIONALE Radial nerve palsy in the newborn and congenital radial head dislocation (CRHD) are both rare disorders, and early diagnosis is challenging. We reported a case of an infant with concurrent presence of these 2 diseases and provide a comprehensive review of the relevant literature. The purpose of the study is to share diagnostic and treatment experiences and provide potentially valuable insights. PATIENT CONCERNS A newborn has both radial nerve palsy and CRHD, characterized by limited wrist and fingers extension but normal flexion, normal shoulder and elbow movement on the affected side, characteristic skin lesions around the elbow, and an "audible click" at the radial head. The patient achieved significant improvement solely through physical therapy and observation. DIAGNOSES The patient was diagnosed with radial nerve palsy in the newborn combined with CRHD. INTERVENTIONS The patient received regular physical therapy including joint function training, low-frequency pulse electrical therapy, acupuncture, paraffin treatment, as well as overnight splint immobilization. OUTCOMES The child could actively extend the wrist to a neutral position and extend all fingers. LESSONS If a neonate exhibits limited extension in the wrist and fingers, but normal flexion, along with normal shoulder and elbow movement, and is accompanied by skin lesions around the elbow, there should be a high suspicion of radial nerve palsy in the newborn.
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Affiliation(s)
- Yunlong Li
- Pediatric Orthopedics, Dongguan Children’s Hospital, Dongguan City, China
| | - Guoxin Nan
- Pediatric Orthopedics, Dongguan Children’s Hospital, Dongguan City, China
| | - Jiahui Chen
- Pediatric Orthopedics, Dongguan Children’s Hospital, Dongguan City, China
| | - Yongyao Jiang
- Pediatric Orthopedics, Dongguan Children’s Hospital, Dongguan City, China
| | - Weiyue Zhu
- Intensive Care Unit, Dongguan Nancheng Hospital, Dongguan City, China
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Thaper A, Miller ME. Ultrasound-Guided Hydrodissection Is a Safe and Effective Nonsurgical Treatment for Superficial Radial Sensory Neuropathy. J Ultrasound Med 2019; 38:3359-3361. [PMID: 31115093 DOI: 10.1002/jum.15030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Akshay Thaper
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Matthew E Miller
- Department of Physical Medicine and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Lloret L, Hayhoe S. A Tale of Two Foxes - Case Reports: 1. Radial Nerve Paralysis Treated with Acupuncture in a Wild Fox 2. Acupuncture in a Fox with Aggressive and Obsessive Behaviour. Acupunct Med 2018; 23:190-5. [PMID: 16430128 DOI: 10.1136/aim.23.4.190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Case 1 This is believed to be the first report of acupuncture treatment for traumatic radial nerve paralysis in a wild fox. From the first treatment, improvement in the range of mobility and sensation of the limb was evident. Additionally, the attitude of this wild animal changed from fear and aggression to complete cooperation: he lay peacefully during every treatment in a calm, drowsy state. Case 2 This reports the calming effects of acupuncture on a fox which had been showing aggressive behaviour and obsessive circling following toxoplasma infection.
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Abstract
Zusammenfassung. Obwohl der laterale Ellbogenschmerz viele mögliche Ursachen hat, wird er immer noch zu oft reflexartig mit dem Tennisarm gleichgesetzt. Zwei aktuelle Studien zeigen jedoch, dass 75 % der Patienten mit chronischem, lateralem Ellbogenschmerz unter einer Ellbogeninstabilität und nicht einem Tennisarm leiden. Der vorliegende Mini-Review soll die wichtigsten Differenzialdiagnosen des lateralen Ellbogenschmerzes in Ursache, Diagnostik, Behandlungsansatz sowie «pitfalls» und «red flags» beleuchten.
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Affiliation(s)
- Patrick Vavken
- 1 alphaclinic Zürich
- 2 Division of Sports Medicine, Children's Hospital Boston, Harvard Medical School, Boston, USA
- 3 Center for Population and Development Studies, Harvard School of Public Health, Cambridge, USA
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Abstract
OBJECTIVE Bassoonists seem to have a high recorded prevalence of performance-related upper limb symptoms. Yet, the background for their symptoms has not been established. This study aimed to diagnose and treat the pathology that caused severe upper limb symptoms in a bassoon/contrabassoon musician in order to allow him to continue his professional career in a symphony orchestra. METHODS A detailed neurological bedside examination was undertaken and targeted physiotherapy offered. RESULTS The physical examination demonstrated weakness, atrophy, and nerve trunk soreness, indicating an affliction of the posterior interosseous nerve (radial tunnel syndrome) or its muscular branches. The risk factors during bassoon playing are comparable to those reported from industrial exposures. The patient was able to resume playing after treatment by nerve mobilisation.
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Affiliation(s)
- Jørgen R Jepsen
- Department of Occupational Medicine, Hospital of South-Western Jutland Esbjerg, Østergade 81-83, DK-6700 Esbjerg, Denmark. Tel +45 79182285, fax +45 79182294.
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Larsen D. 'Saturday night palsy'. Emerg Nurse 2007; 15:24-25. [PMID: 18225674 DOI: 10.7748/cnp.v1.i3.pg12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Abstract
Current best evidence for the conservative management of radial tunnel syndrome (RTS) consists primarily of expert opinion and inferences taken from studies on other nerve compressions and related syndromes. There are limited data reported in the literature of this particular disorder. This article reviews literature on modalities, therapeutic exercise, ergonomic interventions, and cortical reorganization, and how they may be considered for intervention with RTS. The author's preferred method of treatment, as based on theoretical constructs, for RTS is presented. Definitive evidence in the literature to support the conservative interventions suggested is lacking. Suggestions for clinical management and study are included in this therapist's clinical perspective.
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Affiliation(s)
- Carla K Cleary
- St. Dominic Hand Management Center, Jackson, Mississippi 39216, USA.
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Blinov AP, Mikhaĭlovichev II. [Neurological complication after plexus anesthesia]. Anesteziol Reanimatol 2006:79. [PMID: 17061597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Abstract
Nerve compression syndromes of the upper extremity occur at predicable locations. The diagnosis of nerve compression or nerve entrapment is based on the neurologic and electrodiagnostic examinations. The anatomy, neurophysiology, and electrodiagnosis of nerve compression are discussed. Common and uncommon compression and entrapment syndromes of the upper extremity are described. Errors in diagnosis occur when the neurologic or electrodiagnostic examinations are incomplete or inaccurate.
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Affiliation(s)
- Hal M Corwin
- Division of Physical Medicine and Rehabilitation, University of Louisville Health Sciences Center, 3900 Kresge Way, Suite 56, Louisville, KY 40207, USA.
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Abstract
PURPOSE Evidence that acupuncture is effective for any type of motor nerve injury is limited to case reports and case series but these findings indicate benefit. Observation that the radial nerve has the most rapid recovery of all peripheral nerves suggests that acupuncture might benefit treatment of "Saturday Night Palsy," a syndrome of radial-nerve compression. TREATMENT A 41-year-old female with a 1-week history of inability to write or extend the right wrist received 1 acupuncture treatment utilizing the Lung and Large Intestine meridians in the forearm, with the 2 meridians interconnected using the Luo and Yuan points. A cockup wrist splint was then applied. CONCLUSIONS Wrist motion with gravity neutralized returned immediately after treatment. As the day progressed, the patient reported increasing strength in wrist and finger extension. The next day, the patient cancelled the second acupuncture treatment, as her hand had recovered. Examination 4 months later revealed normal wrist and finger extension, sensation, and return of the brachioradialis reflex. The patient was symptom-free 1-year postinjury. Acupuncture potentially facilitates recovery and may enhance treatment of peripheral motor nerve injury.
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Affiliation(s)
- Paul J Millea
- Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Ren LX, Bai QT, Zhang TC, Wang YS, Zhao W, Zhang M, Liu DL. [Anatomical and clinical study of the supinator syndrome evoked embitterment test]. Zhonghua Wai Ke Za Zhi 2004; 42:465-8. [PMID: 15144640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To explore the mechanism and feasibility of the supinator syndrome evoked embitterment test from anatomy and clinic. METHODS 25 cases of The supinator syndrome were reviewed. 18 of them were male and 7 were female. Drop finger deformation were apparent in 25 cases and The supinator syndrome evoked embitterment test was positive for All patients. Operative neurolysis was done in 8 cases, conservation treatment 17 cases; 92 cadaver upper extremities were dissected for a study the relationship between supinator tunnel and posterior interosseous nerve. RESULTS 22 cases had been followed up for an average of 9 months. 16 cases had a full recovery and 6 cases, a partial recovery. the anatomical study shows that The posterior interosseous nerve was compressed by Forhse arcade and the distal border of the supinator muscle during passive pronation forearm. CONCLUSION The supinator syndrome evoked embitterment test was a new test for the diagnosis of supinator syndrome, it was found to be more sensitive and specific than the others test.
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Affiliation(s)
- Long-xi Ren
- Department of Orthopeadic, Chuiyangliu Hospital, Beijing 100020, China
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Waugh EJ, Jaglal SB, Davis AM, Tomlinson G, Verrier MC. Factors associated with prognosis of lateral epicondylitis after 8 weeks of physical therapy. Arch Phys Med Rehabil 2004; 85:308-18. [PMID: 14966719 DOI: 10.1016/s0003-9993(03)00480-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To identify key factors associated with outcomes of patients who underwent 8 weeks of physical therapy (PT) for lateral epicondylitis. DESIGN Multicenter prospective design with inception cohort of lateral epicondylitis patients commencing PT. Baseline clinical examinations were conducted by 1 physical therapist; self-report outcome measures were completed at baseline and 8 weeks later. SETTING Nine private sports medicine clinics and 2 hospital outpatient departments in Ontario, Canada. PARTICIPANTS Eighty-three patients with unilateral lateral epicondylitis identified by the treating physical therapists. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The final scores of the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and a vertical pain visual analog scale (VAS) were used as the dependent variables. RESULTS The final prognostic model for the 8-week DASH scores included the baseline score (95% confidence interval [CI], 0.34-0.66), sex (female) (95% CI, 3.3-14.5), and self-reported nerve symptoms (95% CI, 0.8-13.8). The model for the 8-week VAS scores included the baseline score (95% CI, 0.01-0.37), sex (female) (95% CI, 0.4-18.2), and self-reported nerve symptoms (95% CI, 4.7-25.5). A subanalysis indicated that women were more likely than men to have work-related onsets, repetitive keyboarding jobs, and cervical joint signs. Among women, these factors were associated with higher final DASH and VAS scores. CONCLUSIONS Women and patients who report nerve symptoms are more likely to experience a poorer short-term outcome after PT management of lateral epicondylitis. Work-related onsets, repetitive keyboarding jobs, and cervical joint signs have a prognostic influence on women.
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Affiliation(s)
- Esther J Waugh
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
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Abstract
We report a humeral fracture associated with complete radial nerve palsy, where immediate nerve recovery followed decompression. This uncommon type of nerve lesion is referred to as axonamonosis and is not included in the traditional Seddon nerve injury classification.
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Affiliation(s)
- A J N Marsh
- Department of Orthopaedics, Mayday University Hospital, London Road, Thornton Heath, Surrey, UK
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Cognet JM, Fabre T, Durandeau A. [Persistent radial palsy after humeral diaphyseal fracture: cause, treatment, and results. 30 operated cases]. Rev Chir Orthop Reparatrice Appar Mot 2002; 88:655-62. [PMID: 12457110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
PURPOSE OF THE STUDY Radial palsy is a serious complication of humeral shaft fractures. The risk results from the anatomic position of the radial nerve which turns around the distal portion of the humeral shaft, in contact with the bone. As a rule, radial palsy regresses spontaneously, but in a few cases surgery may be required to achieve neurological recovery. We conducted a retrospective study of thirty cases of radial palsy after humeral fracture treated surgically. Our objective was to define causes of non-recovery and assess therapeutic efficacy, searching for the characteristic features of the fractures involved. MATERIAL AND METHODS We limited our analysis to post-humeral fracture radial palsies, which were operated due to the absence of neurological recovery. We recorded the type of fracture, treatment used to achieve bone healing, surgical approach, and type of radial nerve surgery. The series included 30 patients, predominantly male, mean age 38.4 years. The fractures were situated in the middle or lower third of the humeral shaft. Most were spiral fractures. Plate fixation (30%) or nailing (33%) were generally used for fixation. There were six cases of iatrogenic palsy, all after plate fixation. A revision procedure was required in one-third of the cases due to nonunion. Exploration of the radial nerve demonstrated compression at the intermuscular septum in one-third of the cases and a direct conflict with the fixation plate in one-fifth of the cases. Neurolysis was required in 23 cases, nerve grafts in five and first-intention tendon transfer in two. RESULTS Results of nerve surgery were assessed with the Alnot classification at a mean follow-up of 6.3 years. Outcome was rated good or very good in 22 patients, fair in one and poor (failure) in three. First-intention tendon transfers were performed in two patients and two patients were lost to follow-up. Mean delay to recovery was seven months after neurolysis and fifteen months after nerve grafts. DISCUSSION Our experience and data in the literature suggest that several factors could be involved in persistent radial palsy after humeral shaft fracture. The greatest risk of radial nerve injury or absence of recovery after the primary lesion is encountered after fracture of the lower third of the humerus, spiral fracture, and plate fixation. Particular features observed in our series were nonunion and compression in the intermuscular septum.
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Affiliation(s)
- J M Cognet
- Service de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67098 Strasbourg, France.
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Oestreicher M, Tschantz P. [Compression of the median and radial nerves of the proximal forearm]. Rev Med Suisse Romande 2001; 121:367-8. [PMID: 11450195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Abstract
BACKGROUND The purpose of this study is to present the results of closed fixation of humeral shaft fractures with multiple intramedullary Kirschner wires. METHODS Twenty-nine humeral shaft fractures in patients 14 to 60 years old were treated by closed fixation with multiple intramedullary Kirschner wires. Each patient was placed supine on the table and was administered general anesthesia. The fractured arm was held vertically up by a transolecranon traction, while the C-arm was kept parallel to the ground and opposite to the affected arm. A cortical window was created approximately 1.5 cm proximal to the olecranon fossa, after splitting the triceps. Under fluoroscopic control, multiple Kirschner wires were introduced retrograde therein, into the medullary cavity, to reach the humeral head. The wire tips were kept splayed to stabilize the fracture. Postoperatively, the limb was supported by an arm sling. RESULTS Twenty-five fractures (86.4%) healed with excellent clinical and functional results, in an average of 11 weeks. Union was delayed in two patients, and one fracture had a nonunion after repeated trauma. Movements at the shoulder and the elbow were excellent to good in 27 patients (93%), whereas 2 patients (6.8%) had significant limitation of extension at the elbow. CONCLUSION This technique has been found simple and effective in providing a stable fixation of transverse and short oblique fractures of the humeral diaphysis. Further study is required to evaluate this procedure in more extensive fracture patterns, as well as to compare the results with other methods of internal fixation.
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Affiliation(s)
- S A Qidwai
- King Khalid Hospital, Najran Region, Kingdom of Saudi Arabia
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De Smet L, Van Raebroeckx T, Van Ransbeeck H. Radial tunnel release and tennis elbow: disappointing results? Acta Orthop Belg 1999; 65:510-3. [PMID: 10675947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
In a retrospective study, 19 patients with 20 decompressions of the posterior interosseous nerve for radial tunnel syndrome were reviewed. The results were evaluated using Roles and Maudsley's criteria; they were found to be consistent with those previously reported: i.e. 75% favorable outcomes. Despite this finding only 8 patients (40%) stated they were satisfied. The main reason was residual pain. Shorter delay between the onset of symptoms and surgical treatment as well as simultaneous release of the lateral epicondylar muscles was found to influence positively patient satisfaction. These findings suggest that the scoring system used in the present study and also in previous studies is inappropriate. They also cast some doubt on the role of compression of the posterior interosseous nerve in the pathogenesis of chronic lateral elbow pain.
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Affiliation(s)
- L De Smet
- Department of Orthopedic Surgery, U.Z. Pellenberg, Katholieke Universiteit Leuven, Belgium
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