Neuritis Ossificans of the Radial Nerve

Abstract

Neuritis ossificans is a rare reactive process affecting the peripheral nerves that is challenging to diagnose and treat. The usual presentation is mononeuropathy, pain, variable weakness, and a palpable mass along the nerve distribution. A paucity of literature exists on this disorder. It is often confused with myositis ossificans; many cases in the literature have reported myositic masses that have caused neuropathies. Diagnosing neuritis ossificans requires a high degree of clinical suspicion and excellent radiological and histopathological evaluation. The exact etiology of neuritis ossificans is unclear, but repeated localized trauma may be a factor. Treatment is mostly surgical, although conservative management with drugs has been reported to give good relief. The chance of iatrogenic nerve damage during microsurgical excision is high. This article describes a case of neuritis ossificans of the radial nerve, which was treated by surgical excision of the lesion without nerve resection. No iatrogenic neurodeficit occurred, and the patient made a full recovery. Neuritis ossificans should be considered in the differential diagnosis of painful mononeuropathies, particularly at atypical sites for compression neuropathy. Surgical resection of the mass may relieve pain and improve strength if the nerve can be sufficiently spared. Enucleation of this rare lesion is possible without neural compromise and should be considered as a treatment option for neuritis ossificans.

Sonographic diagnosis of neuritis ossificans of the median nerve

“…Neuritis ossificans, which is the heterotopic ossification in a peripheral nerve, is an extremely rare condition, and few cases have been reported in the literature . Previously reported sites include the ulnar, median, saphenous, tibial, sciatic, digital, common peroneal, cranial, lateral sural cutaneous, and radial nerves …”

“…1 Previously reported sites include the ulnar, 2 median, 3,4 saphenous, 5 tibial, 5-7 sciatic, 8 digital, 9 common peroneal, 1,7 cranial, 10 lateral sural cutaneous, 7 and radial nerves. 11,12…”