Spontaneous Radial Nerve Palsy due to an Unrecognized Myofibroma

Hinchcliff, Katharine M.; Rogers, Jessica; Sarohia, Dani; Hornick, Jason L.; Szabo, Robert M.

doi:10.2106/jbjs.cc.18.00284

Cited by 5 publications

(9 citation statements)

References 25 publications

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“…Recently, MRN has had a progressively increasing diagnostic and therapeutic role for neuromuscular diseases, given that it provides a direct assessment of intraneural architecture and integrity 23. Our imaging findings confirm the usefulness of MRN considering that different previous reports demonstrated normal RN appearance or distal diffuse nerve enlargement with indirect signs of denervation 1 2 8 20…”

Section: Discussionsupporting

confidence: 80%

“…In this context, nerve inflammation has been considered a triggering event, leading to intrafascicular oedema, local adhesion, scarring, fibrosis and endoneural ischaemia 2 6 13 17 20 21. Classic hourglass-like lesions are observed in cases of prolonged ischaemia,2 with the peak in the inflammatory response at 4 months 16. In our patient, the typical progression of symptoms pointed out to an inflammatory pathogenesis that was secondarily exacerbated by mechanical RN anchoring due to local adhesion and scarring.…”

Section: Discussionmentioning

confidence: 58%

“…Pan et al observed inflammatory cell infiltration (CD8-positive T-lymphocytes) in the nerve fibres and fascicles of HLC in histological specimens 16. In this context, nerve inflammation has been considered a triggering event, leading to intrafascicular oedema, local adhesion, scarring, fibrosis and endoneural ischaemia 2 6 13 17 20 21. Classic hourglass-like lesions are observed in cases of prolonged ischaemia,2 with the peak in the inflammatory response at 4 months 16.…”

Section: Discussionmentioning

confidence: 99%

“…The differentials for diagnosis of HLC are broad and include RN entrapment after muscular overexertion,1 unusual tumours2 and inflammatory NA 3 4. The acuteness of symptoms development, as well as progression and fluctuation, indicated that the neurological injury was more compatible with a focal inflammatory lesion of the RN.…”

Section: Differential Diagnosismentioning

confidence: 99%

“…In a patient facing spontaneous non-traumatic mononeuropathy, several pathophysiological mechanisms have been proposed, including compression neuropathy by normal and aberrant anatomy,1 2 mass lesions,2 inflammatory neuralgic amyotrophy (NA)3 4 and hourglass-like constrictions (HLC) 5–19. According to McGraw,12 HLC was first described in English literature in 1976 by Englert.…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous radial nerve palsy with hourglass-like constriction

Bretas,

Araújo,

Ugarte

et al. 2023

BMJ Case Rep

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Hourglass-like constriction (HLC) is an uncommon spontaneous mononeuropathy that is typically characterised by a sudden onset of pain followed by palsy, affecting branches of the radial (posterior interosseous nerve) and median nerves (anterior interosseous nerve). HLC of the radial nerve (RN) is rare, with only a few reported cases. Here, we report a case of a man who presented with acute wrist and finger drop due to the HLC of the RN. Surgery was recommended 5 months after clinical observation, when the lesion was resected and primarily repaired, resulting in satisfactory recovery. There is still much that remains unknown about HLC, especially for RN. The current understanding points out an inflammatory disease that should be treated conservatively for 3–7 months. The surgical technique depends mostly on the severity and extent of constriction; however, considering only RN constrictions, primary repair by neurorrhaphy or nerve grafts resulted in better functional outcomes.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Differential Diagnosismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spontaneous radial nerve palsy with hourglass-like constriction

Bretas,

Araújo,

Ugarte

et al. 2023

BMJ Case Rep

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Radial nerve myofibroma: a rare benign tumor with perineural infiltration. Illustrative case

Wu¹,

Cook

Amrami

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Myofibromas are benign mesenchymal tumors, classically presenting in infants and young children in the head and neck region. Perineural involvement, especially in peripheral nerves within the upper extremity, is extremely rare in myofibromas. OBSERVATIONS The authors present the case of a 16-year-old male with a 4-month history of an enlarging forearm mass and rapidly progressive dense motor weakness in wrist, finger, and thumb extension. Preoperative imaging and fine needle biopsy confirmed the diagnosis of a benign isolated myofibroma. Given the dense paralysis, operative management was indicated, and intraoperative exploration showed extensive involvement of tumor within the radial nerve. The infiltrated nerve segment was excised along with the tumor, and the resulting 5-cm nerve gap was reconstructed using autologous cabled grafts. LESSONS Perineural pseudoinvasion can be an extremely rare and atypical feature of nonmalignancies, resulting in dense motor weakness. Extensive nerve involvement may still necessitate nerve resection and reconstruction, despite the benign etiology of the lesion.

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Isolated Radial Nerve Palsy in a Newborn Due to a Congenital Myofibroma: A Rare Case of Peripheral Nerve Injury

Chiellino,

Fortini,

Castellani

et al. 2024

Children

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Isolated musculoskeletal infantile myofibroma is a rare tumor of pediatric age. The majority of cases are seen in children under two years old, but it can occur at any age as a painless enlarging mass that involves bone, skin, or soft tissue, typically accompanied by compression symptoms. Perineural involvement is extremely rare in myofibromas. Neurological impairment can occur during infancy but isolated nerve palsy, particularly in peripheral nerves within the upper extremity, is very uncommon. Neonatal radial nerve palsy is a rare entity caused by different conditions. Among these, we mention local tumors affecting peripheral nerves, such as myofibroma. There are few cases described in the literature, which mainly concern adult patients. The authors present a case of congenital isolated radial nerve palsy in a newborn with MF of the right elbow, which resulted in impairment of the wrist and finger extension. Following a six-month monitoring period, the patient underwent surgical treatment to restore function to his right wrist and hand. This involved excising the infiltrated radial nerve segment associated with palliative surgery. Despite the benignity of this lesion, severe nerve damage and perineural involvement may require surgical treatment with nerve resection and reconstruction.

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Spontaneous Radial Nerve Palsy due to an Unrecognized Myofibroma

Cited by 5 publications

References 25 publications

Spontaneous radial nerve palsy with hourglass-like constriction

Spontaneous radial nerve palsy with hourglass-like constriction

Radial nerve myofibroma: a rare benign tumor with perineural infiltration. Illustrative case

Isolated Radial Nerve Palsy in a Newborn Due to a Congenital Myofibroma: A Rare Case of Peripheral Nerve Injury

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