Radial Nerve Distribution Research Articles

Brachial Neuropathy After Hemodialysis Shunt Placement Under Axillary Blockade

Brachial Neuropathy After Hemodialysis Shunt Placement Under Axillary Blockade

Symptoms Experienced by Patients with Carpal Tunnel Syndrome

Patients with carpal tunnel syndrome (CTS) sometimes report sensory symptoms outside the median nerve distribution. This study was designed to provide a more detailed assessment of these symptoms. Patients with clinical suspicion of upper limb neuromuscular lesions were divided into those with electrodiagnostic (EDX) evidence of CTS, and those without. CTS patients with superimposed nerve abnormalities were excluded. Motor and sensory symptoms were assessed in the exclusive CTS patients. Over 50% of patients with exclusive CTS reported tingling or numbness over the whole hand, ulnar or radial nerve distributions. Some patients reported symptoms proximal to the wrist. Sensory signs did not extend beyond the median nerve distribution. Numbness and nocturnal pain were predictive of positive EDX evidence of CTS. Sensory symptoms outside the distribution of the median nerve are common in CTS. For enhanced sensitivity in diagnosis it is useful to be aware of these "atypical" symptoms. Reports of numbness and nocturnal pain are strong indicators of CTS.

An unusual transcapitate fracture of the wrist

A patient sustained a crush-type hyperextension injury to his wrist, and presented to the emergency department (ED) with wrist pain, swelling, and paresthesias along the median and superficial radial nerve distributions. His initial radiographic study was interpreted as showing a radial styloid fracture. The next day, he returned for a scheduled revisit with continued wrist pain and swelling. He also had loss of two-point discrimination in the median nerve distribution and loss of thumb opposition. Repeat radiographs were interpreted as showing not only a radial styloid fracture, but also a fracture of the capitate with the proximal fragment rotated 180° in the sagittal plane. The patient was admitted for surgery, and did well, with good return of function. The unusual position of the capitate fracture obscured the common signs of fracture recognition and thus went unnoticed on the patient's initial ED visit. However, in light of the patient's disproportionate symptoms with seemingly negative diagnostic study results, appropriate follow-up care was given, and definitive treatment was appropriately rendered.

Assessment of functional morbidity in the radial forearm free flap donor site.

To quantitate the functional morbidity to the hand and wrist due to the harvest of a radial forearm free fasciocutaneous flap. Case-control study with age-matched control groups. Tertiary care hospital. A consecutive sample of 21 patients who underwent a radial forearm free flap reconstruction of the head and neck from June 1993 to February 1995 constitute the experimental group. Thirteen of those eligible patients participated in the study. Two control groups were identified. One cohort included 13 patients with head and neck cancer who underwent free tissue transfer other than the radial forearm flap. The other cohort consisted of 16 subjects who were healthy volunteers, patients without cancer, or patients who were considered to be cured of cancer. OUTCOME-MEASURES: Wrist range of motion, grip strength, and sensation in the radial, ulnar, and median nerve distributions on the hands, bilaterally. No significant differences (P > .05) were detected between the groups for the modalities that were tested. There is minimal functional morbidity associated with the harvest of the radial forearm free fasciocutaneous flap.

Donor site morbidity of radial forearm flaps. A clinical and ultrasonographic evaluation.

Harvesting of a forearm flap based on the radial artery has been thought to cause functional or circulatory problems in the donor hand. Eighteen patients were examined three to 24 months after a radial forearm flap had been raised. The function of both hands was studied for grip strength, mobility of the wrist and elbow joints, and sensitivity of the area served by the superficial radial nerve. The patients were interviewed and the cosmetic result was evaluated. Duplex ultrasonography and colour Doppler ultrasonography of both ulnar arteries were done, and the brachial arteries were measured as controls. Angle-corrected peak flow velocity (cm/s) in the ulnar artery of the donor forearm was significantly increased at the level of the wrist compared with the control forearm (100.9 compared with 73.1 cm/s, p = 0.017), as was the ulnar: brachial peak flow velocity ratio (1.18 compared with 0.76, p = 0.001). The grip strength of the donor hand was weaker by 11.9% (86.5 compared with 72.2 Kp), 10 (56%) had areas of sensory loss over the radial nerve distribution, and seven of the 18 patients complained of cold intolerance. Four patients considered the donor site result so bad that they would not have chosen the operation had they known what the result would look like. The radial forearm flap donor site is not without problems, and the patients must be carefully selected and properly informed preoperatively.

High radial nerve palsy caused by a humeral exostosis: A case report

3/l/ T-l High radial nerve palsy is a syndrome manifested by loss of extrinsic musculotendinous extensor function (i.e., wrist extension, extension of the index, long, ring, and small fingers at the metacarpophalangeal joints, thumb extension at the metacarpophalangeal and interphalangeal joints) and diminished or absent sensibility in the radial nerve distribution on the radial dorsal hand and radial digits. It may be due to open or closed trauma or, rarely, an intrinsic nontraumatic factor such as a fibrous band or com-