Nontraumatic paralysis of the radial nerve with multiple constrictions

Pan, Yuanjiang; Gao, Tian; Jianing, Wei; Wang, Shuhuan; Qingtai, LI; Tian, Wen

doi:10.1053/jhsu.2003.50007

Cited by 51 publications

(45 citation statements)

References 9 publications

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“…3 The patients were treated with neurolysis, nerve grafting, or neurorrhaphy. The etiology was suggested to be a focal inflammatory response around the feeding arteries in the perineurium.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of posterior interosseous nerve paralysis in a tennis player

Fujioka

Tsunemi

Tsukamoto

et al. 2014

Journal of Orthopaedics

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a b s t r a c tWe report a rare case of posterior interosseous nerve (PIN) paralysis in a tennis player. The PIN, a 2 cm section from a bifurcation point of the radial nerve, presented increased stiffness in the surgical findings and treated with free sural nerve grafting after excision of the degenerative portion of the PIN. We speculate that PIN paralysis associated with hourglass-like constriction can be caused and exacerbated by repetitive forearm pronation and supination in playing tennis.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of posterior interosseous nerve paralysis in a tennis player

Fujioka

Tsunemi

Tsukamoto

et al. 2014

Journal of Orthopaedics

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“…Recently, the pathological condition of spontaneous AIN palsy has been reported to be an hourglass like constriction seen in the fasciculus [4,5,[7][8][9]. This fascicular constriction has been reported in both the AIN and the posterior interosseous nerve (PIN) [12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…The etiology of fascicular constriction is suspected to be mechanical torsion in the forearm, inflammatory response after infection and/or an autoimmune response, interfascicular edema and adhesion due to neuritis, interfascicular compartment syndrome followed by interfascicular scar formation, and a change in the viscoelasticity of the fascicules due to aging [4,5,[7][8][9][12][13][14][15]. Interestingly, there is a report of fascicular constriction secondary to necrotic arteritis in the perineurium [12].…”

Section: Discussionmentioning

confidence: 99%

“…Conservative treatment is initially performed for spontaneous AIN palsy, since many patients show a satisfactory return of function with no recurrence within three months [4,5,[7][8][9]. This period is significant, since most cases of neuralgic amyotrophy, hereditary neuropathy with liability to develop pressure palsies, and other palsies due to neurapraxia should recover within this period [4,[8][9][10][11][12][13][14][15]. However, treatment after this period is still the source of debate.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies also showed that muscle power after interfascicular neurolysis was significantly better than that after conservative treatment [4,5], and so they recommended that interfascicular neurolysis should be performed within six months of onset [8]. There are also reports which show that if the palsy is due to fascicular constriction, the constriction should be surgically treated within one year for functional recovery [13,14]. Thus, our therapeutic approach for spontaneous AIN palsy was to treat conservatively for at least three months after onset, and if no sign of recovery was seen during this period, to perform interfascicular neurolysis on those who agreed to surgical exploration [7,9].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Spontaneous anterior interosseous nerve palsy with Churg–Strauss syndrome

Ochi¹,

Homma²,

Tazaki³

et al. 2010

Mod Rheumatol

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A 74-year-old woman diagnosed with Churg-Strauss syndrome (CSS) complained of difficulty in flexing her left thumb and index finger. Electromyography demonstrated isolated anterior interosseous nerve (AIN) palsy, with no other peripheral neuropathy. We diagnosed this case as spontaneous AIN palsy complicated with CSS, the first case of this kind. Surgical treatment should be considered if no sign of recovery is seen within six months of onset.

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Ultrasonographic identification of nerve pathology in neuralgic amyotrophy: Enlargement, constriction, fascicular entwinement, and torsion

et al. 2015

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Objective: To characterize the ultrasonographic findings on nerves in neuralgic amyotrophy.Methods: Fourteen patients with neuralgic amyotrophy were examined using high resolution ultrasound.Results: Four types of abnormalities were found: 1. Focal or diffuse nerve / fascicle enlargement (57%), 2. incomplete nerve constriction (36%), 3. complete nerve constriction with torsion (50%) (hourglass-like appearance), and 4. fascicular entwinement (28%). Torsions were confirmed intraoperatively and occurred on the radial nerve in 85% of the patients. A significant correlation was found between no spontaneous recovery of nerve function and constriction / torsion / fascicular entwinement (p=0.007). Conclusion:Ultrasonographic nerve pathology in neuralgic amyotrophy varies in order of severity from nerve enlargement to constriction to nerve torsion, with treatment moving from conservative to surgical. We postulate that the constriction caused by inflammation is the precursor of torsion and that the development of nerve torsion is facilitated by rotational movements of limbs.

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Nontraumatic paralysis of the radial nerve with multiple constrictions

Cited by 51 publications

References 9 publications

Surgical treatment of posterior interosseous nerve paralysis in a tennis player

Surgical treatment of posterior interosseous nerve paralysis in a tennis player

Spontaneous anterior interosseous nerve palsy with Churg–Strauss syndrome

Ultrasonographic identification of nerve pathology in neuralgic amyotrophy: Enlargement, constriction, fascicular entwinement, and torsion

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