Abstract
Background:Non-traumatic radial nerve palsy (RNP) caused by local tumors is a rare and uncommon entity.Methods:A 62-year-old female presented with a left non-traumatic RNP, initially starting with weakness only. It was caused by a benign giant lipoma at the proximal forearm that was misdiagnosed over a period of 2 years. The slowly growth of the tumor led to an irreparable overstretching-related partial nerve disruption. For functional recovery of the patient, a triple tendon transfer procedure had to be performed.Results:Four months after surgery, the patient was completely able to perform her activities of daily living again. At the 10-months follow-up, strength of wrist extension, thumb's extension and abduction, and long fingers II-V extension had all improved to grade 4 in Medical Research Council scale (0-5). In order to restore motion, the patient reported that she would undergo the same triple tendon transfer procedure a second time where necessary. Due to the initially misdiagnosed tumor, there was an overall delayed duration of time for functional recovery of the patient.Conclusion:The triple tendon transfer procedure offers a useful and reliable method to restore functionality for patients sustaining irreparable RNP. However, it must be noted critically with our patient that this procedure probably would have been avoided. Initially, there was weakness only by entrapment of the radial nerve. RNP caused by local tumors are uncommon but known from the literature, and so it should be considered generally in differential diagnosis of non-traumatic RNP.
Highlights
Radial nerve palsy (RNP) is a severe injury mostly occurs by shaft fractures of the humerus and/or iatrogenic lesions by surgical procedures
The lesion led to a closed overstretching-related partial disruption of the radial nerve which required a triple tendon transfer procedure to restore the functionality of her wrist and hand
Isolated non-traumatic or “non-trauma-related” RNP is a very rare entity. It can be caused by cervical spine disorders (C7 radiculopathy), acute peripheral neuropathy (Guillain-Barré syndrome), neuromuscular disorders, acute viral infection (Herpes zoster), focal non-specific inflammations, specific inflammatory diseases such as rheumatoid arthritis or lupus erythematosus associated with Jaccuod's arthritis, amyloidosis, and systemic malignancy such as non-Hodgkin's lymphoma [14 - 24]. Another important cause for the pathogenesis of isolated non-traumatic RNP can be local radial nerve entrapment by benign or malign tumors arising from the bone, nerve, and soft tissue that was described in single cases only [25 - 28]
Summary
Radial nerve palsy (RNP) is a severe injury mostly occurs by shaft fractures of the humerus and/or iatrogenic lesions by surgical procedures. Non-traumatic RNP is a rare entity, and it can be caused by various conditions. One of these conditions are local tumors potentially leading to nerve compression similar to a compartment syndrome. The lesion led to a closed overstretching-related partial disruption (i.e. neurotmesis) of the radial nerve which required a triple tendon transfer procedure to restore the functionality of her wrist and hand. Non-traumatic radial nerve palsy (RNP) caused by local tumors is a rare and uncommon entity
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