Proximal Radial Compression Neuropathy

Abstract

Proximal radial nerve compression occurs infrequently and is diagnosed successfully even less frequently. A large clinical series of patients with proximal radial nerve compression neuropathy was reviewed to determine better the common symptoms, physical findings, and electrodiagnostic findings, and to identify the predictors of better or worse outcome after surgical decompression. Seventy-nine proximal radial compression neuropathies were treated in 71 patients by the same surgeon between 1991 and 2000. The most consistent symptoms were deep aching pain in the forearm, pain radiation to the neck and shoulder, and a "heavy" sensation of the affected arm. The most common physical findings were tenderness over the radial nerve at the supinator muscle level, pain on resisted supination, and the presence of a Tinel sign over the radial forearm. Electrophysiologic studies were of limited value in diagnosis, with 90% of patients having normal findings. On operation, prominent pathology of the posterior interosseous nerve was observed in 36 of 79 limbs (46%). Follow-up ranged from 12 to 86 months (mean, 21 months) with no significant complications or recurrence of symptoms. Of the 79 nerve decompressions, 77% had excellent recovery and 20% were judged to be good. Of 69 patients employed when treated, 60 resumed gainful employment, including 53 who returned to their regular jobs. Proximal radial compression neuropathies are uncommon but present with a basic constellation of symptoms and physical findings, and decompression can provide excellent relief of symptoms.

Analysis of proximal radial nerve injury in the arm

“…Tenderness of the radial nerve in the proximal forearm at the level of supinator muscle as seen in this study is an important fi nding in patients with radial nerve compression in the spiral grove. [11] Patients often complain of deep pain in the forearm. Most often detailed history and physical examination helps in localizing the level of lesion.…”

“…Among the patients with radial nerve compression in the spiral groove, only fi ve showed electrophysiologic abnormality. Only fi ve of the non-operated patients had abnormal electrophysiologic fi nding such as slower motor conduction velocity and increased polyphasic electromyoneurography (EMNG) patterns in wrist The causes of radial nerve palsy in the forearm include: elbow trauma, [3] and mass lesions in the forarm, [7,8], The common cause of radial nerve palsy is due to compression in the spiral grove, [9][10][11]. In addition to the causes seen in this series other cause of proximal radial nerve palsy include tourniquet application and intramuscular injection.…”

Diagnosis and Treatment of Work-Related Proximal Median and Radial Nerve Entrapment

“…[35][36][37][38][39][40][41] Surgery should include exploration of the radial nerve throughout its course to decompress it by resecting any compressive and/or constrictive structures. These may include any of the 5 sites of compression mentioned elsewhere in this article.…”

Posterior interosseous neuropathy: the diagnostic benefits of a multimodal approach to investigation

“…It is an important diagnosis to consider as patients often respond well to either conservative measures or timely surgical intervention, which has reported favorable outcomes in between 75 and 97% 2, 3 of selected cases. PIN may result from nerve compression, either spontaneous or secondary to external masses such as ganglions, lipomas, or a rheumatoid pannus affecting the radiocapitellar joint.…”