Future Considerations in the Diagnosis and Treatment of Compressive Neuropathies of the Upper Extremity

Graesser, Elizabeth A.; Dy, Christopher J.; Brogan, David M.

doi:10.1016/j.jhsg.2022.10.009

Cited by 3 publications

(2 citation statements)

References 112 publications

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“…However, this hypothesis cannot be excluded, as the diameter of septocutaneous arteries seemed smaller than the diameter of muscular branches, although not objectively measured. Additional data, especially in vivo ultrasonography, may be necessary to con rm of in rm this hypothesis and further study radial sensory branch vascularization [9].…”

Section: Discussionmentioning

confidence: 96%

“…This vascular network may be involved in compression of the PIN at the level of the supinator, in a similar manner to which the recurrent radial artery acts in the proximal aspect of the radial tunnel [13]. This plexus may also be a focus of investigation during the workup of radial tunnel syndrome, using advanced ultrasonography techniques that allow visualization of lower-velocity blood ow and smaller vessels without contrast [9]. Interestingly, despite its close proximity, only a small proportion of the distal PIN's vascular supply was found to arise from the PIA.…”

Section: Discussionmentioning

confidence: 99%

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Vascular supply of the radial nerve and its terminal branches: an anatomical study

Daoulas,

Sivakumar,

Houziaux

et al. 2024

Preprint

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Purpose The aim of this cadaveric study was to further describe the vascular supply of the radial, posterior interosseous and superficial radial nerves. Methods 11 cadaveric upper limbs, injected with colored latex, were dissected. Vascular afferents to the radial nerve, superficial radial nerve (SRN) and posterior interosseous nerve (PIN) were described and located. Their origin was identified and its distance to interepicondylar line was measured. Results The radial nerve had an average of 3 vascular afferents (2-5), of septomuscular origin in 54% of cases. 46% came from adjacent arteries. The PIN had an average of 8 vascular afferents (6-12), arising from septomuscular branches in 82% of cases. The PIN was vascularized in 100% of cases by a large arterial plexus originating from the supinator muscle between its two heads. The SRN had an average of 4 vascular afferents (3-5). Before crossing the septum of the brachioradialis, vascularization was predominantly septomuscular; after crossing the septum, the nerve was exclusively vascularized by septocutaneous arteries. Conclusion This is the first study to describe the vascularization of the radial nerve and its terminal branches along their entire length. Our results are in line with the data available in the literature. An arterial plexus between the two heads of the supinator was surrounding the PIN in all cases. This vascular plexus might be involved in dynamic compression of the posterior interosseous nerve.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Vascular supply of the radial nerve and its terminal branches: an anatomical study

Daoulas,

Sivakumar,

Houziaux

et al. 2024

Preprint

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Carpal tunnel syndrome

Dahlin,

Zimmerman,

Calcagni

et al. 2024

Nat Rev Dis Primers

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Painful nerve compression beyond the carpal tunnel: recognizing the lacertus syndrome

Al-Hashimi,

Ferembach,

Martinel

et al. 2024

Plast Aesthet Res

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The most common nerve compression in the upper extremity is that of carpal tunnel syndrome. Although generally recognized and treated, as much as a 20% failure rate is reported. Recent publications are indicating that one of the sources of persistent median nerve symptoms may be missed proximal median nerve entrapments, of which the lacertus fibrosus represents a principal cause of compression, and rarely other sites such as the flexor superficialis arch or pronator teres. Compression by the lacertus fibrosus is called lacertus syndrome, and as this is a clinically diagnosed entity, only rarely confirmed using electrodiagnostic or imaging studies, it is frequently overlooked. Clinicians regularly treating patients with carpal tunnel syndrome or patients with signs of median nerve neuropathy should be aware of the lacertus fibrosus as a possible compression site. In this review, we will define lacertus syndrome, describe its clinical manifestations and diagnosis, and demonstrate surgical techniques used to treat it.

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Future Considerations in the Diagnosis and Treatment of Compressive Neuropathies of the Upper Extremity

Cited by 3 publications

References 112 publications

Vascular supply of the radial nerve and its terminal branches: an anatomical study

Vascular supply of the radial nerve and its terminal branches: an anatomical study

Carpal tunnel syndrome

Painful nerve compression beyond the carpal tunnel: recognizing the lacertus syndrome

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