OBJECTIVE: To determine a diagnostic cut-off value for the cross-sectional area (CSA) of the radial nerve using ultrasonography for radial neuropathy located at the spiral groove (SG). METHODS: Seventeen patients with electrodiagnostic evidence of radial neuropathy at the SG and 30 healthy controls underwent ultrasonography of the radial nerve at the SG . The CSAs at the SG were compared in the patient and control groups. The CSA at the SG between the symptomatic and asymptomatic sides (ΔSx–Asx and Sx/Asx, respectively) were analyzed to obtain the optimal cut-off value. The relationship between the electrophysiological severity of radial neuropathy and CSA was also evaluated. RESULTS: Among the variables examined, there were statistically significant differences in the CSA between the patient and control groups, ΔSx–Asx, and Sx/Asx at the SG. In a receiver operating characteristics analysis, the cut-off CSA was 5.75 mm² at the SG (sensitivity 52.9%, specificity 90%), 1.75 mm² for ΔSx–Asx (sensitivity 58.8%, specificity 100%), and 1.22 mm² for Sx/Asx (sensitivity 70.6%, specificity 93.3%) in diagnosing radial neuropathy at the SG. There was no significant correlation between CSA and electrophysiological severity score for either patient group. CONCLUSION: The reference value obtained for CSA of the radial nerve at the SG may facilitate investigation of radial nerve pathologies at the SG.
Diagnostic Imaging ; Humans ; Pathology ; Radial Nerve ; Radial Neuropathy* ; Reference Values ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography*

Cryolipolysis has become available for the noninvasive reduction of adipose tissue. A 33-year-old woman presented with wrist drop of the right arm that had first appeared 7 days previously. She had undergone cryolipolysis on both upper arms immediately prior to the onset of symptoms. A nerve conduction study showed radial neuropathy proximal to the elbow, and ultrasonography revealed focal swelling of the radial nerve at the spiral groove. Although cryolipolysis has been known as a safe method, nerve injury can result from compression and/or hypothermia during the procedure.
Adipose Tissue ; Adult ; Arm ; Elbow ; Female ; Humans ; Hypothermia ; Lipolysis ; Methods ; Neural Conduction ; Radial Nerve ; Radial Neuropathy* ; Ultrasonography ; Wrist

The reported cases of upper limb nerve injury followed by needle procedure such as intramuscular injection or routine venipuncture are rare. However, it should not be overlooked, because neurological injury may cause not only minor transient pain but also severe sensory disturbance, hand deformity and motor dysfunction with poor recovery. Recognizing competent level of anatomy and adept skill of needle placement are crucial in order to prevent this complication. If a patient notices any experience of abnormal pain or paresthesia during the needle procedures, an administrator should be alert to the possibility of nerve injury and should withdraw the needle immediately. Careful monitoring of the injection site for hours is required for early detection of nerve injury.
Administrative Personnel ; Catheterization, Peripheral ; Hand Deformities ; Humans ; Injections, Intramuscular* ; Median Neuropathy ; Needles ; Paresthesia ; Peripheral Nerve Injuries ; Phlebotomy* ; Radial Neuropathy ; Ulnar Neuropathies ; Upper Extremity*

Radial nerve entrapment or compression in the upper extremity is relatively rare compared to medial nerve or ulnar nerve entrapment and compression. Various syndrome types are defined according to the location of radial nerve entrapment and the pattern of symptom expression. In the upper arm, Saturday night palsy or honeymoon palsy occurs. Around the elbow, posterior interosseous nerve entrapment syndrome, which involves pure motor symptoms, and radial tunnel syndrome, which mainly involves pain symptoms, can develop. Finally, superficial radial nerve entrapment occurs in the distal forearm and has the symptom of painful or abnormal sensory disturbances of the hand. Conservative treatment is usually the first choice for radial nerve neuropathy, unless there is motor paralysis. Surgical treatment can be considered if there is no improvement after adequate conservative treatment.
Arm ; Elbow ; Forearm ; Hand ; Nerve Compression Syndromes ; Paralysis ; Radial Nerve* ; Radial Neuropathy ; Ulnar Nerve Compression Syndromes ; Upper Extremity

Among autologous breast reconstruction techniques, breast reconstruction using the latissimus dorsi musculocutaneous flap is widely used, offering advantages including the relative simplicity of the procedure and the reliable and consistent vascularity of the flap. Accordingly, more than 500 cases have been performed in the past 8 years at Kyungpook National University Medical Center. This study reports on a rare case involving a radial nerve neuropathy complication which was experienced for the first time at the medical center. The current case demonstrates that in addition to common complications, such as seroma of the donor site and scarring, additional intraoperative complications in areas unrelated to the surgical site can occur, including radial nerve neuropathy in the opposite arm.
Academic Medical Centers ; Arm ; Breast* ; Cicatrix ; Female ; Gyeongsangbuk-do ; Humans ; Intraoperative Complications ; Mammaplasty* ; Myocutaneous Flap ; Paralysis* ; Radial Nerve* ; Radial Neuropathy ; Seroma ; Superficial Back Muscles* ; Tissue Donors

Objective To evaluate the diagnostic value of high-frequency ultrasound in the diagnosis of supinator syndrome (SD). Methods Ten patients with supinator syndrome (SD group) and 20 healthy volunteers (control group) underwent ultrasonographic examination. Axial and long-axis views of the radial nerve were taken where the nerves enters the supinator muscle entrance. The maximum transverse diameter and anteroposterior diameter were also measured. Results High-frequency ultrasound clearly revealed the images and course of radial nerve deep branch in two groups. The SD group had swollen nerves and the maximum transverse diameter and anteroposterior diameter were (3.50?0.39)mm and (4.30?0.47)mm,respectively,which were significantly larger than in the control group [(1.10?0.17)mm,t=-29.67,P=0.00;(1.00?0.16)mm,t=-36.72,P=0.00). The causes (including synovial cyst nearby and radial artery recurrent branch) of nerve entrapment were revealed directly in 4 patients in SD group. Conclusions High-frequency ultrasound can clearly display the radial nerve deep branch around the elbow joint. SD patients have swollen nerves at the entrance of the supinator muscle,where the diameters of these nerves are abnormally enlarged.
Case-Control Studies ; Elbow Joint ; diagnostic imaging ; Healthy Volunteers ; Humans ; Nerve Compression Syndromes ; diagnostic imaging ; Radial Nerve ; diagnostic imaging ; Radial Neuropathy ; diagnostic imaging ; Ultrasonography

PURPOSEFractures of the humeral shaft are common and account for 3%-5% of all orthopedic injuries. This study aims to estimate the incidence of radial nerve palsy and its outcome when the anterior approach is employed and to analyze the predictive factors.

METHODSThe study was performed in the department of orthopaedics unit of a tertiary care trauma referral center. Patients who underwent surgery for acute fractures and nonunions of humerus shaft through an anterior approach from January 2007 to December 2012 were included. We retrospectively analyzed medical records, including radiographs and discharge summaries, demographic data, surgical procedures prior to our index surgery, AO fracture type and level of fracture or nonunion, experience of the operating surgeon, time of the day when surgery was performed, and radial nerve palsy with its recovery condition. The level of humerus shaft fracture or nonunion was divided into upper third, middle third and lower third. Irrespective of prior surgeries done elsewhere, the first surgery done in our institute through an anterior approach was considered as the index surgery and subsequent surgical exposures were considered as secondary procedures.

RESULTSOf 85 patients included, 19 had preoperative radial nerve palsy. Eleven (16%) patients developed radial nerve palsy after our index procedure. Surgeons who have two or less than two years of surgical experience were 9.2 times more likely to induce radial nerve palsy (p=0.002). Patients who had surgery between 8 p.m. and 8 a.m. were about 8 times more likely to have palsy (p=0.004). The rest risk factor is AO type A fractures, whose incidence of radial nerve palsy was 1.3 times as compared with type B fractures (p =0.338). For all the 11 patients, one was lost to follow-up and the others recovered within 6 months.

CONCLUSIONContrary to our expectations, secondary procedures and prior multiple surgeries with failed implants and poor soft tissue were not predictive factors of postoperative deficit. From our study, we also conclude that radial nerve recovery can be reasonably expected in all patients with a postoperative palsy following the anterolateral approach.

Adult ; Female ; Fractures, Ununited ; surgery ; Humans ; Humeral Fractures ; surgery ; Incidence ; Male ; Postoperative Complications ; epidemiology ; etiology ; Radial Neuropathy ; epidemiology ; etiology ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Numbness on the hand occurs infrequently after a transradial cardiac catheterization (TRC). The symptom resembles that of neuropathy. We, therefore, investigated the prevalence, the predicting factors and the presence of neurological abnormalities of numbness, using a nerve conduction study (NCS). SUBJECTS AND METHODS: From April to December 2013, all patients who underwent a TRC were prospectively enrolled. From among these, the patients who experienced numbness on the ipsilateral hand were instructed to describe their symptoms using a visual analogue scale; subsequently, NCSs were performed on these patients. RESULTS: Of the total 479 patients in the study sample, numbness occurred in nine (1.8%) following the procedure. The NCS was performed for eight out of the nine patients, four (50%) of which had an abnormal NCS result at the superficial radial nerve. A larger sheath and history of myocardial infarction (p=0.14 and 0.08 respectively) tended towards the occurrence of numbness; however, only the use of size 7 French sheaths was an independent predictor for the occurrence of numbness (odds ratio: 5.50, 95% confidence interval: 1.06-28.58, p=0.042). The symptoms disappeared for all patients but one, within four months. CONCLUSION: A transient injury of the superficial radial nerve could be one reason for numbness after a TRC. A large sheath size was an independent predictor of numbness; therefore, large sized sheaths should be used with caution when performing a TRC.
Cardiac Catheterization* ; Cardiac Catheters* ; Hand ; Humans ; Hypesthesia* ; Myocardial Infarction ; Neural Conduction* ; Prevalence ; Prospective Studies ; Radial Nerve* ; Radial Neuropathy

BACKGROUND AND PURPOSE: The objective of this study was to determine diagnostic and prognostic values of proximal radial motor conduction in acute compressive radial neuropathy. METHODS: Thirty-nine consecutive cases of acute compressive radial neuropathy with radial conduction studies-including stimulation at Erb's point-performed within 14 days from clinical onset were reviewed. The radial conduction data of 39 control subjects were used as reference data. RESULTS: Thirty-one men and eight women (age, 45.2+/-12.7 years, mean+/-SD) were enrolled. All 33 patients in whom clinical follow-up data were available experienced complete recovery, with a recovery time of 46.8+/-34.3 days. Partial conduction block was found frequently (17 patients) on radial conduction studies. The decrease in the compound muscle action potential area between the arm and Erb's point was an independent predictor for recovery time. CONCLUSIONS: Proximal radial motor conduction appears to be a useful method for the early detection and prediction of prognosis of acute compressive radial neuropathy.
Action Potentials ; Arm ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Male ; Prognosis ; Radial Neuropathy*

A 34-year-old male patient visited the emergency room with complaint of right wrist drop and foot drop. The day before, he was intoxicated and fell asleep in a room containing barbeque briquettes; After waking up, he noticed that his right wrist and foot were dropped. Upon physical examination, his right wrist extensor, thumb extensor, ankle dorsiflexor, and big toe extensor showed Medical Research Council (MRC) grade 1 power. The initial laboratory tests suggested rhabdomyolysis induced by unrelieved pressure on the right side during sleep. Right foot drop was improved after conservative care and elevated muscle enzyme became normalized with hydration therapy with no resultant acute renal failure. However, the wrist drop did not show improvement and a hard mass was palpated on the follow-up physical examination. Ultrasonography and magnetic resonance imaging studies were conducted and an abnormal mass in the lateral head of the tricep was detected. Axonopathy was suggested by the electrodiagnostic examination. A surgical decompression was done and a fibrotic cord lesion compressing the radial nerve was detected. After adhesiolysis, his wrist extensor power improved to MRC grade 4. Herein, we describe a compressive radial neuropathy associated with rhabdomyolysis successfully treated with surgery and provide a brief review of the related literature.
Acute Kidney Injury ; Adult ; Ankle ; Decompression, Surgical ; Emergency Service, Hospital ; Fibrosis ; Follow-Up Studies ; Foot ; Head ; Humans ; Magnetic Resonance Imaging ; Male ; Physical Examination ; Radial Nerve ; Radial Neuropathy* ; Rhabdomyolysis* ; Thumb ; Toes ; Ultrasonography ; Wrist