Treatment Of Radial Nerve Palsy Research Articles

Comparison of nerve versus tendon transfer for radial nerve palsy

ObjectiveThis study aims to investigate the choice of intervention time and operation mode between nerve and tendon transfer for the treatment of radial nerve palsy (RNP). Methods46 RNP patients underwent nerve transfer (n = 22) and tendon transfer (n = 24). The intraoperative blood loss, main incision length, operation duration, and length of hospital stay and follow-up period of patients in these two groups were recorded and compared. The range of motion (ROM) of the elbow, wrist, fingers, and thumb, the hand grip and pinch strength, the Disabilities of Arm, Shoulder, and Hand (DASH) and the 36-Item Short Form Health Survey (SF-36) scores were measured and compared preoperatively and postoperatively between the two groups. ResultsThe ROM of thumb and the hand grip strength of patients in the nerve transfer group were greater than that in the tendon transfer (P < 0.05). Both of the two groups indicated significant improvements in the ROM of elbow, wrist, finger, thumb and the hand grip and pinch strength (P < 0.05) postoperatively. The DASH scores decreased significantly at 6 months (P < 0.05) and 12 months (P < 0.05) after surgery in both groups, while the postoperative SF-36 scores significantly increased (P < 0.05). There was no significant difference in postoperative DASH and SF-36 scores between the two groups (P > 0.05). ConclusionIn summary, both nerve and tendon transfer techniques are effective treatments for RNP. Nerve transfer is particularly advantageous for early RNP, while tendon transfer is suitable for patients with radial nerve injury more than one year.

Evaluation of radial nerve palsy treatment: tendon transfer with the flexor carpi radialis combination

Introduction: Radial nerve palsy, a common peripheral nerve injury, significantly impacts the quality of life of affected individuals. The standard treatment is tendon transfer, but the optimal choice of tendon transfers remains a subject of ongoing debate. This study aimed to evaluate the treatment of radial nerve palsy through tendon transfer with the flexor carpi radialis combination in a Bangladeshi population. Methods: This observational study was conducted over 18 weeks at the Department of Orthopedic Surgery of 3 medical college hospitals in Bangladesh. Forty adult patients with radial nerve palsy were selected based on specific inclusion criteria. Participants were evaluated preoperatively and postoperatively using the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Complications were also recorded. Results: The majority of participants were male (77.5%) and had right-sided injuries (72.5%). The most common cause of injury was humerus shaft injury (55.0%). The most common site of injury was middle third of the humerus shaft (67.50%). Postoperatively, 85.0% achieved an "Excellent" grade. Complications were minimal, with 90% of participants experiencing no complications. Conclusions: Tendon transfer with the flexor carpi radialis combination appears to be an effective treatment for radial nerve palsy, with significant improvements in DASH scores postoperatively and minimal complications. Further research is needed to confirm these findings and compare the effectiveness of this treatment with other tendon transfer combinations.

Treatment of Radial Nerve Palsy in Paediatric Humeral Shaft Fractures. STROBE-Compliant Investigation.

Background and Objectives:Due to the rarity of radial nerve palsy in humeral shaft fractures in the paediatric population and the lack of data in the literature, the purpose of our study was to report the treatment results of six children who sustained a radial nerve injury following a humeral shaft fracture. Materials and Methods: We treated six paediatric patients with radial nerve palsy caused by a humeral shaft fracture in our department from January 2011 to June 2022. The study group consisted of four boys and one girl aged 8.6 to 17.2 (average 13.6). The mean follow-up was 18.4 months. To present our results, we have used the STROBE protocol designed for retrospective observational studies. Results:We diagnosed two open and four closed humeral shaft fractures. Two simple transverse AO 12A3c; one simple oblique AO 12A2c; two simple spiral AO 12A1b/AO 12A1c and one intact wedge AO 12B2c were recognized. The humeral shaft was affected in the distal third five times and in the middle third one time. In our study group, we found two cases of neurotmesis; two entrapped nerves within the fracture; one stretched nerve over the bone fragments and one case of neuropraxia. We found restitution of the motor function in all cases. For all patients, extensor muscle strength was assessed on the grade M4 according to the BMRC scale (except for a patient with neuropraxia-M5). The differences in patients concerned the incomplete extension at the radiocarpal and metacarpophalangeal (MCP) joints. Conclusions: In our small case series, humeral shaft fractures complicated with radial nerve palsy are always challenging medical issues. In paediatric patients, we highly recommend an US examination where it is possible to be carried out to improve the system of decision making. Expectant observation with no nerve exploration is reasonable only in close fractures caused by low-energy trauma. Early surgical nerve exploration related with fracture stabilisation is highly recommended in fractures after high-energy trauma, especially in open fractures and where symptoms of nerve palsy appear at any stage of conservative treatment.

Treatment of Radial Nerve Palsy Associated with Humeral Shaft Fracture

Radial nerve palsy associated with humeral shaft fracture is divided into primary paralysis immediately after injury and secondary paralysis after reduction or surgery. There are conflicting opinions about the timing and necessity of early neuro-exploration for patient with primary paralysis. The main cause of radial nerve injury is nerve contusion and it has high natural recovery rate without any treatment on nerves. However, if the nerve is damaged, early neuro-exploration is needed to increase the possibility of full recovery, prevent secondary nerve damage by the bone or scar tissue and predict prognosis. Through this, there is an advantage to plan future treatment. Based on the study of these patients, when internal fixation is indicated, early surgical exploration of the radial nerve should be considered to minimize poor prognosis and conflict with the patient.

Review of the Studies on Korean Medicine Treatment of Radial Nerve Palsy

Review of the Studies on Korean Medicine Treatment of Radial Nerve Palsy

Tendon Harvest for Treatment of Radial Nerve Palsy Using Endoscopic Technique.

BACKGROUNDEndoscopic method for many surgeries with minimal access is proposed to be effective for preventing the excessive scar formation, reducing pain, cosmesis, and the early return to work. Surgical outcomes of endoscopic and open methods for tendon harvest in treatment of radial nerve palsy were evaluated.METHODSIn a randomized single-blind clinical trial study, 10 patients with radial nerve palsy who referred to the Plastic Surgery Department of the Fatimah Zahra Hospital, Iran University of Medical Sciences, Tehran, Iran were divided into two equal groups. Flexor carpi radialis (FCR), flexor carpi ulnaris (FCU) and the palmaris longus (PL) tendons were harvested by endoscopic or open techniques. The outcomes (tendon harvest time, rate of post-surgical pain, amount of pain medication, patient satisfaction, amount of scar, and length of scar) are measured. RESULTSThere was no significant difference in time of surgery between two methods. Vancouver scar scale, cosmetic satisfaction, severity of postoperative pain and also drugs for pain relief after tendon harvest surgery were significantly lower in endoscopic method than open method.CONCLUSIONRegarding the low invasiveness, high satisfaction rate of patients, low pain severity, low scar and the little need for opiate to reduce pain in the endoscopic method, endoscopic tendon harvest technique for radial nerve palsy seems to have priority over open method.

Primary exploration for radial nerve palsy associated with unstable closed humeral shaft fracture.

The treatment of radial nerve palsy caused by closed humeral shaft fracture is a matter of debate. The purpose of this study is to evaluate the outcome of early surgical management of radial nerve palsy in patients with unstable closed humeral shaft fractures and to determine whether patients with this injury should be surgically explored. Medical records of 15 consecutive patients who had undergone open reduction and internal fixation for unstable closed humeral shaft fractures were reviewed. Injury mechanisms, radiographs, intraoperative findings of the injured nerve, and clinical improvement were analyzed. Of the 15 patients, two were injured during simple falls, two during baseball pitching, one by a fall from a height, one during skiing, and one by direct machine impaction during work. Fracture locations were middle humerus in six patients, middle-distal in eight patients, and middle-proximal in one patient. Fracture patterns were transverse fracture in six patients, butterfly segment fracture in four patients, oblique segment fracture in three patients, and spiral fracture in two patients. Eleven patients showed macroscopically intact nerves, and four had total nerve transection. All four patients with total nerve transection were injured in traffic accident. Of these four patients, one showed comminuted fracture with butterfly fragment on the middle-distal shaft and the other three showed displaced transverse fracture on the middle to middle-distal shaft area. Transected nerves were directly repaired in two patients. In the other two patients, humerus shortening and nerve grafting were performed because of mangled nerve endings. All patients who had intact nerves showed fully recovered function at the last follow-up. For radial nerve palsy accompanied by unstable humeral shaft fracture, primary exploration of the radial nerve and open reduction and plate fixation of the fracture should be considered as a treatment of choice. High-energy trauma, fracture location at the middle-distal humerus, and simple transverse fracture or comminuted fracture with butterfly fragment seems to be risk factors for radial nerve transection.

Current Treatment of Radial Nerve Palsy Following Fracture of the Humeral Shaft

The association between radial nerve injury and humeral shaft fracture was described by Berkeley surgeons Holstein and Lewis, 1 Holstein A. Lewis G.B. Fractures of the humerus with radial-nerve paralysis. J Bone Joint Surg. 1963; 45A: 1382-1388 Google Scholar who observed radial nerve palsy in the setting of spiral fractures of the distal third of the humeral shaft wherein “the distal bone fragment is always displaced proximally with its proximal end deviated radialward” and that “the radial nerve is caught in the fracture site.” Subsequent reports have described cases of radial nerve palsy following fractures of the middle third of the shaft of the humerus as well. 2 Ekholm R. Adami J. Tidermark J. Hansson K. Törnkvist H. Ponzer S. Fractures of the shaft of the humerus, an epidemiological study of 401 fractures. J Bone Joint Surg. 2006; 88B: 1469-1473 Google Scholar , 3 Shao Y.C. Harwood P. Grotz M.R.W. Limb D. Giannoudis P.V. Radial nerve palsy associated with fractures of the shaft of the humerus. J Bone Joint Surg. 2005; 87B: 1647-1652 Google Scholar , 4 Kettelkamp D.B. Alexander H. Clinical review of radial nerve injury. J Trauma. 1967; 7: 424-432 Crossref PubMed Scopus (61) Google Scholar , 5 Packer J.W. Foster R.R. Garcia A. Grantham S.A. The humeral fracture with radial nerve palsy: is exploration warranted?. Clin Orthop. 1972; 88: 34-38 Crossref PubMed Scopus (66) Google Scholar , 6 Pollock F.H. Drake D. Bovill E.G. Day L. Trafton P.G. Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg. 1981; 63A: 239-243 Google Scholar , 7 Samardžić M. Grujičić D. Milinković Z.B. Radial nerve lesions associated with fractures of the humeral shaft. Injury. 1990; 21: 220-222 Abstract Full Text PDF PubMed Scopus (69) Google Scholar , 8 DeFranco M.J. Lawton J.N. Radial nerve injuries associated with humeral fractures. J Hand Surg. 2006; 31A: 655-663 Abstract Full Text Full Text PDF Scopus (95) Google Scholar A recently published anatomical study by Carlan et al. emphasizes that the radial nerve is at risk of injury in these 2 regions: (1) along the posterior mid-aspect of the humerus where the nerve lies in direct contact with the periosteum and (2) along the distal lateral humerus where the nerve pierces the lateral intermuscular septum. 9 Carlan D. Pratt J. Patterson J.M.M. Weiland A.J. Boyer M.I. Gelberman R.H. The radial nerve in the brachium: an anatomic study in human cadavers. J Hand Surg. 2007; 32A: 1177-1182 Google Scholar

Median to radial nerve transfer for treatment of radial nerve palsy

The purpose of this study is to report a surgical technique of nerve transfer to restore radial nerve function after a complete palsy due to a proximal injury to the radial nerve. The authors report the case of a patient who underwent direct nerve transfer of redundant or expendable motor branches of the median nerve in the proximal forearm to the extensor carpi radialis brevis and the posterior interosseous branches of the radial nerve. Assessment included degree of recovery of wrist and finger extension, and median nerve function including pinch and grip strength. Clinical evidence of reinnervation was noted at 6 months postoperatively. The follow-up period was 18 months. Recovery of finger and wrist extension was almost complete with Grade 4/5 strength. Pinch and grip strength were improved postoperatively. No motor or sensory deficits related to the median nerve were noted, and the patient is very satisfied with her degree of functional restoration. Transfer of redundant synergistic motor branches of the median nerve can successfully reinnervate the finger and wrist extensor muscles to restore radial nerve function. This median to radial nerve transfer offers an alternative to nerve repair, graft, or tendon transfer for the treatment of radial nerve palsy.

Transfer of a single flexor carpi ulnaris tendon for treatment of radial nerve palsy

Between 1993 and 2002, 108 patients with isolated and persisting radial nerve palsy, underwent transfer of the flexor carpi ulnaris tendon alone to extensor digitorum communis, extensor indicis proprius and extensor pollicis longus. Only patients with sufficient flexor carpi ulnaris muscle power (grade M5) underwent this procedure. Long-term functional results were reviewed at a mean postoperative follow up of 48 (range 3-120) months. In comparison with the contralateral hand, the range of extension of the wrist was less but extension of the fingers and the MCP joints were similar to that of the normal hand. All patients improved functionally and could cope with their routine activities. Most were able to return to their previous jobs. There was no obvious difference in the end result of using this single transfer from our previous results using the three tendon transfers which are commonly used to treat radial nerve palsy. The single flexor carpi ulnaris tendon transfer has some advantages in terms of simplicity, shorter operation time, less morbidity and less surgical scars.

오공(蜈蚣) 약침(藥鍼)을 병행한 요골신경마비 치험 1례(例)

Objective : The purpose of this study is to report the patient with radial nerve palsy, who improved by Scolopendrae Corpus Herbal-Acupuncture and other Oriental medical treatments. Methods : The patient was managed by Scolopendrae Corpus Herbal-Acupuncture, body acupuncture, physical theraphy and herbal medicine. We took picture of the patient`s wrist and checked the power of muscles. Result : After 4 week treatment, the movement and power of wrist was restored to nearly normal range. Conclusions : The results suggest that combination of Scolopendrae Corpus Herbal-Acupuncture and other Oriental medical treatments is good method for treatment of radial nerve palsy. But further studies are required to concretely prove the effectiveness of this methods.

Clinical experiences in tendon transfers for radial nerve palsy by a new method of Wiedemann.

Many modifications of tendon transfers have been described in the treatment of radial nerve palsy. Controversy persists over the muscles of choice to get the best results in motion of wrist and fingers. Patients with radial nerve palsy and treated by the methode of Merle d'Aubigne in neurophysiological tests showed that the pronator teres did not work very well for extending the wrist. Thinking about the neurophysiologic principles it seemed that the flexor digitorum superficialis of the middle and ring fingers would make a better substitute for the wrist extension. From 1994 to 1997 four patients with radial nerve palsy had a transfer of the flexor digitorum superficialis tendons from the middle and ring fingers to the tendons of extensor carpi radialis longus and brevis additional the flexor carpi ulnaris and palmaris longus transfers. The functional recovery of two patients has been tested. The functional range of wrist motion of this two patients has been better than in patients with pronator teres transfers. It can be concluded that the new modification of tendon transfers is a good way of treatment of radial nerve palsy and should be done further.

Clinical experiences with a new Wiedemann method of radial replacement operation

Many modifications of tendon transfers have been described in the treatment of radial nerve palsy. Controversy persists over the muscles of choice to get the best results in motion of wrist and fingers. Patients with radial nerve palsy and treated by the method of Merle d'Aubigne in neurophysiological tests showed that the pronator teres did not work very well for extending the wrist. Thinking about the neurophysiologic principles it seemed that the flexor digitorum superficialis of the middle and ring fingers would make a better substitute for the wrist extension. From 1994 to 1997 four patients with radial nerve palsy had a transfer of the flexor digitorum superficialis tendons from the middle and ring fingers to the tendons of extensor carpi radialis longus and brevis additional the flexor carpi ulnaris and palmaris longus transfers. The functional recovery of two patients has been tested. The functional range of wrist motion of this two patients has been better than in patients with pronator teres transfers. It can be concluded that the new modification of tendon transfers is a good way of treatment of radial nerve palsy and should be done further.

Flexor carpi ulnaris transfer for radial nerve palsy: Functional testing of long-term results

Controversy persists over the use of the flexor carpi ulnaris for transfer to the extensor digitorum communis in the treatment of radial nerve palsy. Six patients with complete, irreparable radial nerve palsies were treated in part with the flexor carpi ulnaris to extensor digitorum communis tendon transfer (standard transfers: pronator teres to extensor carpi radialis brevis, flexor carpi ulnaris to extensor digitorum communis, and palmaris longus to the rerouted extensor pollicis longus) and were functionally tested for long-term results. The average follow-up time was 8 years (range, 3-15). A control group was comprised of 10 volunteers of similar demographics. This study evaluates the long-term functional recovery in three categories: range of motion, dynamic power of wrist motion, and functional ability as determined by work simulation techniques. The activities simulated were swinging a hammer, sawing wood, tightening screws, and using pliers. A functional range of motion was maintained in all patients, and the power of wrist motion was sufficient to perform all activities of daily living. The work simulation testing revealed no significant difference between the tendon transfer patients and control group with respect to hand dominance and normal variance. All patients were able to perform the simulated work with the same variance in power as the control group. Despite the obvious anatomic loss, wrist function is not significantly impaired after flexor carpi ulnaris tendon transfer for radial nerve palsy.

Tendon Transfer for Old Radial Nerve Paralysis

There have been many reports in the medical literature of the successful treatment of radial nerve palsy by tendon transplantation. The history of these operations since Drobnik's description, 4 in 1896, has also been reviewed. The work of Sir Robert Jones, 6 in 1916, crystallized the thinking on this subject and has been the basis of subsequent surgery. Many reports followed, chronicling the successful treatment of radial nerve palsy with various modifications of the Jones technique. The largest series of cases were accumulated in the experience of military surgeons during the great world wars. Experience in civilian practice is limited to the occasional cases. The purpose of this paper is to report the successful treatment of a case of radial nerve palsy coming to surgery 24 years after nerve injury. In our patient we were concerned with the limiting factors in tendon transfer many years after the destruction of the

Tendon transfer for old radial nerve paralysis.

There have been many reports in the medical literature of the successful treatment of radial nerve palsy by tendon transplantation. The history of these operations since Drobnik's description, 4 in 1896, has also been reviewed. The work of Sir Robert Jones, 6 in 1916, crystallized the thinking on this subject and has been the basis of subsequent surgery. Many reports followed, chronicling the successful treatment of radial nerve palsy with various modifications of the Jones technique. The largest series of cases were accumulated in the experience of military surgeons during the great world wars. Experience in civilian practice is limited to the occasional cases. The purpose of this paper is to report the successful treatment of a case of radial nerve palsy coming to surgery 24 years after nerve injury. In our patient we were concerned with the limiting factors in tendon transfer many years after the destruction of the