Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve

Dang, Alan C.; Rodner, Craig M.

doi:10.1016/j.jhsa.2009.10.016

Cited by 135 publications

(122 citation statements)

References 78 publications

(66 reference statements)

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“…The clinical picture of PIoN neuropathy can be explained by its anatomical features [1][2][3][4][5][6]. PIoN first innervates and then pierces the supinator muscle.…”

Section: Discussionmentioning

confidence: 99%

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Posterior Interosseous Neuropathy in Polo Riders A Specific Sport-Related Mononeuropathy

Bendersky¹,

Carlos²,

Daniel³

et al. 2017

MOJOR

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Submit Manuscript | http://medcraveonline.com usually due to direct trauma [8]. The most common movement in polo riders is alternative pronosupination with the right arm, and forced pronation or supination with the riding arm. Such muscular overuse may lead to injury to PIoN. Case Reports Case report n°1NR, a 38-year-old healthy male, presented with progressive finger extension weakness. He had been training during the amateur polo session, when he noticed pain at the lateral side of his left elbow. The next few days he could not extend completely his third finger. Three months after onset, he reported pain at the left elbow and weakness of wrist and finger extensors. On physical examination, he showed subtle muscle atrophy in the left posterior forearm. Strength examination was 2/5 in extension of the metacarpophalangeal joints. Wrist extension was 3/5, with radial deviation (Figure 1). Sensation and reflexes were intact. Electrodiagnostic studies revealed an axonal-demyelinating lesion of the left PIoN at the elbow, with sparing of proximal radial innervated muscles and preservation of sensory radial nerve. Magnetic resonance imaging (MRI) of the left elbow showed abnormal signal intensity in extensorum digitorum communis and indicis proprius, suggestive of denervation. The patient underwent descompressive surgery, and intraoperative findings confirmed the entrapment (Figure 2). At 6 months follow-up, he was almost completely recovered. Case report n°2HE, a 54 years-old healthy male, noticed a progressive loss of strength in fingers extension and thumb abduction during the last year, beginning in the last three fingers and later involving the others. He was an amateur polo player, and he also used to play tennis. On presentation, he had tenderness over the lateral epycondile, 2/5 weakness of wrist extensors and the metacarpophalangeal joints 2nd to 5th, and radial deviation of the hand (Figure 1). Electrodiagnostic tests and MRI showed similar results to those of patient n°1. The patient was then referred for surgical decompression, with full recovery at 1 year follow-up. AbstractPosterior interosseous neuropathy is an entrapment of the deep branch of the radial nerve in the forearm. The deep branch of the radial nerve is primarily a motor nerve, and compression of this nerve may lead to weakness in finger and thumb extension without sensory abnormalities. We present two cases of polo riders suffering of posterior interosseous neuropathy, confirmed both by electrodiagnostic testing and by surgical exploration in one case. We review the anatomic course and distribution of the posterior interosseous nerve, the clinical picture of its injury, and discuss the probable mechanism of entrapment in polo players.

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“…The clinical picture of PIoN neuropathy can be explained by its anatomical features [1][2][3][4][5][6]. PIoN first innervates and then pierces the supinator muscle.…”

Section: Discussionmentioning

confidence: 99%

“…It accounts for less than 0.7% of all upper limb nerve compression syndromes [1][2][3][4][5][6][7]. The clinical picture is characterized by weakness of the posterior forearm muscles, with normal sensory examination [2,[5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Posterior Interosseous Neuropathy in Polo Riders A Specific Sport-Related Mononeuropathy

Bendersky¹,

Carlos²,

Daniel³

et al. 2017

MOJOR

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“…Oysa, radial sinir tuzak nöropatisi olanlarda, bileğin ve başparmağın hareketlerinden bağımsız olarak istirahatte dahi ağrı veya uyuşma şikâyeti gözlenebilmektedir. 2 Yüzeyel radial sinir tuzak nöropatisinde, bizim olgumuzdaki gibi, genellikle spontan düzelme izlenir. Sıklıkla kompresyona bağlı izlenmesi nedeni ile sıkı bandajların (bileklik, saat kayışı gibi) uzaklaştı-rılması önerilmektedir.…”

Section: Discussionunclassified

“…Kortikosteroid enjeksiyonunun etkisi net değildir. 2 Cerrahi dekompresyon konservatif tedaviden fayda görülmediğinde uygulanabilir. 6 Posttravmatik skarların neden olduğu radial sinir basılarında cerrahi tedavi ön planda düşünülmelidir.…”

Section: Discussionunclassified

Depilation Position Causing Wartenberg Syndrome: Case Report

Sun¹,

Genç²,

Kasapoğlu³

et al. 2016

Turkiye Klinikleri J Case Rep

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Ö ÖZ ZE ET T Tuzak nöropatiler, üst ekstremitedeki ağrı, motor güçsüzlük ve duyu defisitlerinde sık karşılaşılan nedenlerden biridir. Periferik sinirlerin seyirleri sırasında belirli anatomik bölgelerde tuzaklanmaları sonucu gelişmektedir. Radial sinir, elin dorsal yüzünün duyusunu sağlar ve özellikle el bileği düzeyinde kompresyona bağlı olarak tuzaklanma gösterir. Bu durum Wartenberg sendromu olarak adlandırılmaktadır. Bu çalışmada, 30 yaşındaki kadın olgunun, kozmetik amaçlı epilasyon prosedürü sırasında uzun süreli el bileği basısı nedeni ile oluşan radial sinirin yüzeyel dalının kompresyonunun sebep olduğu geçici Wartenberg sendromu sunulmuş ve bu tip eksternal uygulamalar sırasında pozisyona bağlı radial tuzak nöropatisi gelişebileceğine dikkat çekmek amaçlan-mıştır.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Radial sinir; sinir basısı sendromları; tüy alma A AB BS S T TR RA AC CT T Entrapment neuropathy is a common cause of pain, motor weakness and sensory disturbance of the upper extremities. It occurs due to entrapment of the peripheral nerves at points where they are vulnerable to compression on their path down the extremities. Radial nerve is responsible for sensory supply of dorsum of the hand. It is especially susceptible to entrapment at the wrist. This condition is called Wartenberg's syndrome. In this case report we present a 30 yearold female patient with entrapment of the radial nerve caused by a prolonged compression of superficial radial nerve during positioning for a depilation procedure with cosmetic purposes. K Ke ey y W Wo or rd ds s: : Radial nerve; nerve compression syndromes; hair removal T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J C Ca as se e R Re ep p 2 20 01 16 6; ;2 24 4( (1 1) 1 Radial tuzaklanma en sık el bileğinde yüzeyel interosseöz dalda görülmektedir ve sıklığı %0,003 olarak bildirilmiştir.2 Radial sinirin yüzeyel dalı travma, irritasyon ve kompresyona yüksek oranda açıktır.1 Bu çalışmada, ilk kez bir epilasyon prosedürü sırasında, pozisyona bağlı oluşmuş kompresyonla radial sinir tuzak nöropatisi sunulmuştur. OLGU SUNUMUOtuz yaşındaki kadın olgu, sağ el bileğinden el dorsumuna doğru uzanan uyuşma ile başvurdu. Öz geçmişinde hastalık öyküsü olmayan olgunun, şi-Turkiye Klinikleri J Case Rep 2016;24 (1) 51

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“…7 Ultrasonography may assist in localizing the exact site of compression and excluding external compression by secondary causes. 5 Furthermore, real-time hydrodissection can be performed accurately to relieve the compression.…”

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confidence: 99%

Dynamic Ultrasonography for Supinator Syndrome: A Case Report

Chen

Wang

2017

Can. J. Neurol. Sci.

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Posterior interosseous neuropathy resulting from compression in the radial tunnel, also known as supinator syndrome, is usually diagnosed by clinical assessment and electrodiagnostic testing. 1,2 In the past decade, high-resolution ultrasonography has been applied to aid the diagnosis of entrapment neuropathies such as carpal tunnel syndrome and cubital tunnel syndrome. 3 In this case report, we present how dynamic ultrasonography was used to assist in the diagnosis and treatment of supinator syndrome.A 58-year-old right-handed man came to our clinic complaining of progressive left finger drop over the previous 3 to 4 months. He had no history of trauma or repetitive upper arm activities, nor did he have any neck, shoulder, or upper limb pain. His medical history included type 2 diabetes mellitus, hypertension, and dyslipidemia. Family history yielded no relevant details. On physical examination, he had full muscle strength for flexion in the left fingers and wrist; however, the muscle strength for extension of the left wrist was grade 4 with radial deviation and the muscle strengths for extension of the left second, third, fourth, and fifth fingers were grades 2, 2, 0, and 0, respectively. No obvious muscle atrophy or sensory impairment was found.The deep tendon reflexes of the biceps, brachioradialis, and triceps were normal. The Spurling test was negative.Cervical spine X-ray and magnetic resonance imaging showed mild foraminal narrowing at the left C3/4 level, mild spinal stenosis at the C3-T1 levels without obvious root or cord compression, and imaging of the roots showed no signs of an inflammatory disorder. Electrodiagnostic testing revealed normal conduction velocity with low-amplitude compound muscle action potential without conduction block between forearm and elbow in a left radial motor study, and superficial radial sensory tests were normal. In addition, no evidence of conduction block was found in other arm nerves. A blood test showed normal liver and renal function, but the glycated hemoglobin level was 8.8%. The patient admitted that he did not take oral hypoglycemic agents regularly.Ultrasonography was performed with an 18-MHz linear array transducer (Acuson S2000 Ultrasound System; Siemens, Munich, Germany). The probe was placed in parallel to the posterior interosseous nerve (PIN) and the PIN was examined with the forearm in the pronated and supinated positions, bilaterally, as shown in Figure 1. Compared with the right side, the left PIN showed marked compression and angulation by the superficial head of the supinator muscle in the supinated position. In-plane ultrasound-guided PIN hydrodissection was performed with a mixture of 0.5 ml 50% glucose water and 4.5 ml 1% xylocaine ( Figure 2). The patient was also instructed to take oral hypoglycemic agents regularly and avoid strenuous or repetitive forearm activities. After treatment, the patient went abroad; hence, follow-up was carried out a month and a half later. He received no further treatment during this period. On manual muscle test, t...

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Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve

Cited by 135 publications

References 78 publications

Posterior Interosseous Neuropathy in Polo Riders A Specific Sport-Related Mononeuropathy

Posterior Interosseous Neuropathy in Polo Riders A Specific Sport-Related Mononeuropathy

Depilation Position Causing Wartenberg Syndrome: Case Report

Dynamic Ultrasonography for Supinator Syndrome: A Case Report

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