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Goyal N, Luchetti TJ, Blank AT, Cohen MS. Atraumatic, Progressive, and Painful Elbow Contracture From a Ganglion Cyst. J Hand Surg Am 2021; 46:345.e1-345.e3. [PMID: 32690340 DOI: 10.1016/j.jhsa.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/20/2020] [Accepted: 06/09/2020] [Indexed: 02/02/2023]
Abstract
Ganglion cysts are benign soft tissue tumors that often occur adjacent to joints or tendons. We report a case of an elbow joint ganglion cyst in a patient who presented with a painful, progressive elbow contracture. The patient was successfully treated with resection of the subbrachialis ganglion cyst combined with an anterior capsular release and an ulnar nerve decompression to recover elbow motion. This case highlights the value of advanced imaging in patients presenting with an atraumatic, painful, and progressive elbow contracture.
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Affiliation(s)
- Nitin Goyal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
| | - Timothy J Luchetti
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Alan T Blank
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Mark S Cohen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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Purohit S, Prabhakar A, Raj A, Marathe N, Shah S. A rare case of posterior interosseous nerve palsy due to ganglion cyst arising from supinator muscle. J Clin Orthop Trauma 2020; 11:665-667. [PMID: 32684708 PMCID: PMC7355069 DOI: 10.1016/j.jcot.2020.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/26/2022] Open
Abstract
Here we present a rare case of ganglion cyst of the elbow joint arising from supinator muscle causing posterior interosseous nerve (PIN) palsy in a 40-year-old female who presented with weakness in finger extension and carrying out routine activities with right hand since 2 weeks. Patient had pain over the right forearm radiating to the right hand since 3 months. She also noted a swelling in the right forearm, which was gradually increasing in size since last 1 month. Atraumatic PIN compression is uncommon and is usually caused by compression of PIN in the arcade of Frohse, by radial recurrent artery, and fibrous band around the radiocapitellar joint. Reports of PIN palsy caused by ganglionic cyst in the elbow joint are rare and case reports regarding the same are sparingly reported. Here we report a case of PIN palsy secondary to ganglion cyst arising from supinator muscle, which recovered completely after excision of the ganglion cyst.
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Affiliation(s)
- Shaligram Purohit
- Department of Orthopedics, 6th Floor, Multistorey Building, Seth G.S Medical College & King Edward Memorial Hospital, Parel, Mumbai, 400012, India
| | - Akil Prabhakar
- Department of Orthopedics, LTMMC & Hospital, Sion, Mumbai, India
| | - Aditya Raj
- Department of Orthopedics, 6th Floor, Multistorey Building, Seth G.S Medical College & King Edward Memorial Hospital, Parel, Mumbai, 400012, India,Corresponding author. Department of Orthopedics, 6th Floor, Multistorey Building, Seth G.S Medical College & King Edward Memorial Hospital, Parel, Mumbai, 400012, India.
| | - Nandan Marathe
- Department of Orthopedics, 6th Floor, Multistorey Building, Seth G.S Medical College & King Edward Memorial Hospital, Parel, Mumbai, 400012, India
| | - Swapneel Shah
- Department of Orthopedics, 6th Floor, Multistorey Building, Seth G.S Medical College & King Edward Memorial Hospital, Parel, Mumbai, 400012, India
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Lee SJ, Hyun YS, Baek SH, Seo JH, Kim HH. Posterior Interosseous Nerve Palsy Caused by a Ganglion of the Arcade of Frohse. Clin Shoulder Elb 2018; 21:252-255. [PMID: 33330185 PMCID: PMC7726401 DOI: 10.5397/cise.2018.21.4.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/14/2018] [Accepted: 10/22/2018] [Indexed: 11/25/2022] Open
Abstract
A 51-year-old male who is right-handed visited the outpatient for right fingers-drop. The patient’s fingers, including thumb, were not extended on metacarpophalangeal joint. The active motion of the right wrist was available. The electromyography and nerve conduction velocity study were consistent with the posterior interosseous neuropathy. Further evaluation was done with the magnetic resonance imaging for finding the space-occupying lesion or any possible soft tissue lesion around the radial nerve pathway. On magnetic resonance imaging, the ganglion cyst, which was about 1.8 cm in diameter, was observed on the proximal part of the superficial layer of the supinator muscle (Arcade of Frohse). The surgical excision was done on the base of ganglion cyst at the base of stalk of cyst which looked to be connected with proximal radioulnar joint capsule. The palsy had completely resolved when the patient was observed on the outpatient department a month after the operation.
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Affiliation(s)
- Seung Jin Lee
- Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Yoon Suk Hyun
- Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Seung Ha Baek
- Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Ji Hyun Seo
- Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
| | - Hyun Ho Kim
- Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Seoul, Korea
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Abstract
Ganglion of the anterolateral elbow is rare and may be associated with compression neuropathy of the radial nerve or its branches. Open ganglionectomy implies extensive soft tissue dissection. We present a case of anterolateral elbow ganglion without any compression neuropathy. This was successfully treated with endoscopic ganglionectomy.
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Affiliation(s)
- Tun Hing Lui
- 1 Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR, China
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Kim Y, Ha DH, Lee SM. Ultrasonographic findings of posterior interosseous nerve syndrome. Ultrasonography 2017; 36:363-369. [PMID: 28494524 PMCID: PMC5621806 DOI: 10.14366/usg.17007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 12/24/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the ultrasonographic findings associated with posterior interosseous nerve (PIN) syndrome. Methods Approval from the Institutional Review Board was obtained. A retrospective review of 908 patients' sonographic images of the upper extremity from January 2001 to October 2010 revealed 10 patients suspicious for a PIN abnormality (7 male and 3 female patients; mean age of 51.8±13.1 years; age range, 32 to 79 years). The ultrasonographic findings of PIN syndrome, including changes in the PIN and adjacent secondary changes, were evaluated. The anteroposterior diameter of the pathologic PIN was measured in eight patients and the anteroposterior diameter of the contralateral asymptomatic PIN was measured in six patients, all at the level immediately proximal to the proximal supinator border. The size of the pathologic nerves and contralateral asymptomatic nerves was compared using the Mann-Whitney U test. Results Swelling of the PIN proximal to the supinator canal by compression at the arcade of Fröhse was observed in four cases. Swelling of the PIN distal to the supinator canal was observed in one case. Loss of the perineural fat plane in the supinator canal was observed in one case. Four soft tissue masses were noted. Secondary denervation atrophy of the supinator and extensor muscles was observed in two cases. The mean anteroposterior diameter of the pathologic nerves (n=8, 1.79±0.43 mm) was significantly larger than that of the contralateral asymptomatic nerves (n=6, 1.02±0.22 mm) (P=0.003). Conclusion Ultrasonography provides high-resolution images of the PIN and helps to diagnose PIN syndrome through visualization of its various causes and adjacent secondary changes.
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Affiliation(s)
- Youdong Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Doo Hoe Ha
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sang Min Lee
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Rodriguez Miralles J, Natera Cisneros L, Escolà A, Fallone JC, Cots M, Espiga X. Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve. Orthop Traumatol Surg Res 2016; 102:791-4. [PMID: 27562829 DOI: 10.1016/j.otsr.2016.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 04/14/2016] [Accepted: 05/30/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Two types of ganglion cysts at the elbow have been described depending on their anatomic location. Type A ganglion cyst is located proximal to the arcade of Frohse, and type B distal to it. Compressive neuropathies of the radial nerve at the level of the radial tunnel may lead to two different clinical entities with different clinical manifestations. These different conditions depend on which branch is involved. Although compression of the deep motor branch due to a ganglion cyst has been previously described, affection of the superficial sensory branch is considered much rarer. The aim of this study was to describe a series of patients in which painful and dysesthetic symptoms arose from superficial radial nerve compression due to type A ganglion cysts coming from the radiocapitellar joint. METHODS A review of currently available literature about the disease was carried out. The clinical, histological and radiological records of a series of eight cases (seven patients) with compression of the superficial radial nerve diagnosed and treated between 2008 and 2011 were retrospectively reviewed. All patients complained of pain and dysesthesia at the lateral aspect of the elbow. All patients were initially diagnosed and managed as lateral epicondylitis. Persistence of the symptoms was evidenced in all patients after a course of six months of non-operative management. Magnetic resonance imaging was performed and revealed the presence of a mass compatible with a ganglion cyst coming from the radiocapitellar joint, pushing up the superficial sensory branch of the radial nerve and compressing it against the extensor carpi radialis brevis. Surgical excision was performed in all cases. RESULTS Histology confirmed the diagnosis of ganglion cysts. Histological findings consisted of dense fibrous tissue, with no synovial or epithelial lining and mucoid material with foamy macrophages. The mean follow-up after surgical excision was 28months (range 24-30). The symptoms subsided in all cases. No complications were registered during the follow-up. CONCLUSION Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve. Our series of eight cases may suggest that this pathology might not be as rare as it was thought before. This evidence may be useful for the orthopaedic population, who may have another differential diagnosis when managing cases of painful symptoms located in the lateral aspect of the elbow. TYPE OF STUDY Therapeutic study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J Rodriguez Miralles
- Hospital General de Catalunya, Street Pedro i Pons 1, 08190 Sant Cugat del Vallés, Barcelona, Spain; Consorci Hospitalari de Vic, Street Francesc Pla 'El Vigatà' 1, 08500 Vic, Barcelona, Spain
| | - L Natera Cisneros
- Hospital General de Catalunya, Street Pedro i Pons 1, 08190 Sant Cugat del Vallés, Barcelona, Spain; Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, street Sant Quintí 89, 08026 Barcelona, Spain.
| | - A Escolà
- Hospital General de Catalunya, Street Pedro i Pons 1, 08190 Sant Cugat del Vallés, Barcelona, Spain
| | - J C Fallone
- Hospital General de Catalunya, Street Pedro i Pons 1, 08190 Sant Cugat del Vallés, Barcelona, Spain
| | - M Cots
- Hospital General de Catalunya, Street Pedro i Pons 1, 08190 Sant Cugat del Vallés, Barcelona, Spain
| | - X Espiga
- Hospital del Mar, Parc de Salut Mar, street Passeig Marítim 25-29, 08003 Barcelona, Spain
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Lämmer AB, Schwab S, Schramm A. Ultrasound in dual nerve impairment after proximal radial nerve lesion. PLoS One 2015; 10:e0127456. [PMID: 25992766 PMCID: PMC4439062 DOI: 10.1371/journal.pone.0127456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/15/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction Sonography in classical nerve entrapment syndromes is an established and validated method. In contrast, few publications highlight lesions of the radial nerve, particularly of the posterior interosseus nerve (PIN). Method Five patients with a radial nerve lesion were investigated by electromyography, nerve conduction velocity and ultrasound. Further normative values of 26 healthy subjects were evaluated. Results Four patients presented a clinical and electrophysiological proximal axonal radial nerve lesion and one patient showed a typical posterior interosseous nerve syndrome (PINS). The patient with PINS presented an enlargement of the PIN anterior to the supinator muscle. However four patients with proximal lesions showed an unexpected significant enlargement of the PIN within the supinator muscle. Conclusion High-resolution sonography is a feasible method to demonstrate the radial nerve including its distal branches. At least in axonal radial nerve lesions, sonography might reveal abnormalities far distant from a primary proximal lesion site clearly distinct from the appearance in classical PINS.
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Affiliation(s)
- Alexandra B Lämmer
- Department of Neurology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
- * E-mail:
| | - Stefan Schwab
- Department of Neurology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Axel Schramm
- Department of Neurology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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9
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Symptomatic elbow ganglion causing pronator syndrome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e109. [PMID: 25289303 PMCID: PMC4173829 DOI: 10.1097/gox.0000000000000046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 12/17/2013] [Indexed: 11/26/2022]
Abstract
Summary: Descriptions of ganglion cysts date back to 400 BC. Ganglions causing peripheral nerve compression have been described most notably at the wrist. Ganglion compression of the median nerve at the elbow is rare. We report a case of a palmar elbow ganglion causing median nerve compression and the clinical presentation of pronator syndrome. After removal of the ganglion and median nerve decompression, the patient’s symptoms fully resolved.
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Sirrajelhak M, Fnini S, Arssi M, Garch A. [Compression of the superficial branch of the radial nerve by a synovial ganglion of the elbow (about one case and literature review)]. ACTA ACUST UNITED AC 2013; 32:255-7. [PMID: 23747101 DOI: 10.1016/j.main.2013.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/27/2013] [Accepted: 04/17/2013] [Indexed: 11/16/2022]
Abstract
Compression of the radial nerve at the elbow is quite rare; entrapment of its superficial branch is exceptional. Extrinsic compression is the most frequent etiology. Magnetic resonance imaging plays a major role in the diagnosis, and early surgical excision or echoguided drainage - in case of synovial ganglion - allows a total recovery. The authors report the case of a compression of the superficial branch of radial nerve by an elbow synovial cyst treated by surgical resection.
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Affiliation(s)
- M Sirrajelhak
- Service de Traumatologie-Orthopédie Pavillon, CHU Ibn Rochd, 32, Quartier des Hôpitaux, Casablanca, Maroc.
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11
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Abstract
Peripheral nerve entrapments are frequent. They usually appear in anatomical tunnels such as the carpal tunnel. Nerve compressions may be due to external pressure such as the fibular nerve at the fibular head. Malignant or benign tumors may also damage the nerve. For each nerve from the upper and lower limbs, detailed clinical, electrophysiological, imaging, and therapeutic aspects are described. In the upper limbs, carpal tunnel syndrome and ulnar neuropathy at the elbow are the most frequent manifestations; the radial nerve is less frequently involved. Other nerves may occasionally be damaged and these are described also. In the lower limbs, the fibular nerve is most frequently involved, usually at the fibular head by external compression. Other nerves may also be involved and are therefore described. The clinical and electrophysiological examination are very important for the diagnosis, but imaging is also of great use. Treatments available for each nerve disease are discussed.
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Affiliation(s)
- P Bouche
- Department of Clinical Neurophysiology Salpêtrière Hospital, Paris, France.
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12
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Quignon R, Marteau E, Penaud A, Corcia P, Laulan J. Les paralysies du nerf interosseux postérieur. À propos de 18 cas et revue de la littérature. ACTA ACUST UNITED AC 2012; 31:18-23. [DOI: 10.1016/j.main.2011.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Revised: 09/19/2011] [Accepted: 11/26/2011] [Indexed: 11/27/2022]
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13
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Linda DD, Harish S, Stewart BG, Finlay K, Parasu N, Rebello RP. Multimodality Imaging of Peripheral Neuropathies of the Upper Limb and Brachial Plexus. Radiographics 2010; 30:1373-400. [DOI: 10.1148/rg.305095169] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Brown JM, Tung THH, Mackinnon SE. Median to radial nerve transfer to restore wrist and finger extension: technical nuances. Neurosurgery 2010; 66:75-83; discussion 83. [PMID: 20124928 DOI: 10.1227/01.neu.0000354364.13224.c8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Traditional methods for restoring finger and wrist extension following radial nerve palsy include interposition nerve grafting or tendon transfers. We have described the utilization of distal nerve transfers for the restoration of radial nerve function in the forearm. OBJECTIVE We review the neuroanatomy of the forearm and outline the steps required for the implementation of this transfer. METHODS AND RESULTS We use a step-by-step procedural outline and detailed photographs, line drawings, and video to describe the procedure. CONCLUSION This approach is technically feasible and is a reconstructive option for patients with this nerve deficit.
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Affiliation(s)
- Justin M Brown
- Department of Neurological Surgery and Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Washington University Medical Center, St. Louis, Missouri 63110-1093, USA.
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Vasak N, Dorr J, Freund M, Friedl W. Radial Palsy Caused by Ganglion of the Elbow. Eur J Trauma Emerg Surg 2010; 36:254-6. [PMID: 26815870 DOI: 10.1007/s00068-009-9023-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 08/09/2009] [Indexed: 10/20/2022]
Abstract
Ganglion of the humeroradial joint is a relatively rare condition, which may cause local compressive neuropathy. It is usually diagnosed in adults. Sonography of peripheral nerves can be of high value in finding the exact localization of the nerve lesion. We present a case of a healthy 55-year-old woman with radial palsy caused by an elbow ganglion which was resolved following a surgical procedure.
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Affiliation(s)
| | - Jan Dorr
- Klinikum Aschaffenburg, Aschaffenburg, Germany
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16
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Dang AC, Rodner CM. Unusual compression neuropathies of the forearm, part I: radial nerve. J Hand Surg Am 2009; 34:1906-14. [PMID: 19969199 DOI: 10.1016/j.jhsa.2009.10.016] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 10/17/2009] [Indexed: 02/02/2023]
Abstract
Peripheral compression neuropathies are familiar to the hand surgeon. Although compression neuropathies of the forearm are far less common than those of the wrist (namely, carpal tunnel syndrome), for the patient suffering from one of these neuropathies, a missed diagnosis has far-reaching consequences. In this 2-part review (I: Radial Nerve; II: Median Nerve), several compression neuropathies of the forearm are examined. We will first discuss compression neuropathies affecting the radial nerve: (1) posterior interosseous nerve syndrome, (2) radial tunnel syndrome, and (3) superficial radial nerve compression (Wartenberg's syndrome).
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Affiliation(s)
- Alan C Dang
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT
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Compression of the radial nerve at the elbow by a ganglion: two case reports. J Med Case Rep 2009; 3:7258. [PMID: 19830153 PMCID: PMC2726493 DOI: 10.4076/1752-1947-3-7258] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Accepted: 01/22/2009] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Radial nerve compression by a ganglion in the radial tunnel is not common. Compressive neuropathies of the radial nerve in the radial tunnel can occur anywhere along the course of the nerve and may lead to various clinical manifestations, depending on which branch is involved. We present two unusual cases of ganglions located in the radial tunnel and requiring surgical excision. CASE PRESENTATION A 31-year-old woman complained of difficulty in fully extending her fingers at the metacarpophalangeal joint for 2 weeks. Before her first visit, she had noticed a swelling and pain in her right elbow over the anterolateral forearm. The extension muscle power of the metacarpophalangeal joints at the fingers and the interphalangeal joint at the thumb had decreased. Sonography and magnetic resonance imaging of the elbow revealed a cystic lesion located at the area of the arcade of Frohse. A thin-walled ovoid cyst was found against the posterior interosseous nerve during surgical excision. Pathological examination was compatible with a ganglion cyst. The second case involved a 36-year-old woman complaining of numbness over the radial aspect of her hand and wrist, but without swelling or tumor in this area. The patient had slightly decreased sensitivity in the distribution of the sensory branch of the radial nerve. There was no muscle weakness on extension of the fingers and wrist. Surgical exposure defined a ganglion cyst in the shoulder of the division of the radial nerve into its superficial sensory and posterior interosseous components. There has been no disease recurrence after following both patients for 2 years. CONCLUSION Compression of nerves by extraneural soft tissue tumors of the extremities should be considered when a patient presents with progressive weakness or sensory changes in an extremity. Surgical excision should be promptly performed to ensure optimal recovery from the nerve palsy.
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Furuta T, Okamoto Y, Tohno E, Minami M, Nishiura Y, Ohtomo K. Magnetic resonance microscopy imaging of posterior interosseous nerve palsy. Jpn J Radiol 2009; 27:41-4. [PMID: 19373531 DOI: 10.1007/s11604-008-0290-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 10/10/2008] [Indexed: 10/20/2022]
Abstract
Posterior interosseous nerve palsy, also called deep radial nerve syndrome, is a neuropathy caused by radial nerve entrapment or compression at the level of the supinator muscle. Although imaging studies are not necessary for diagnosing this syndrome because of its characteristic clinical manifestations, the causes of palsy, which include mass lesions, or precise anatomical findings can sometimes be demonstrated by imaging. Magnetic resonance (MR) findings of posterior interosseous nerve palsy have been described as involving atrophy of related muscles caused by denervation, a common secondary change of this nerve disorder. We present a case in which the swollen posterior interosseous nerve itself could be directly depicted by MR imaging using a 4.7-cm microscopy coil in a patient with neuropathy.
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Affiliation(s)
- Toshihiro Furuta
- Department of Radiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan.
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McFarlane J, Trehan R, Olivera M, Jones C, Blease S, Davey P. A ganglion cyst at the elbow causing superficial radial nerve compression: a case report. J Med Case Rep 2008; 2:122. [PMID: 18439267 PMCID: PMC2373786 DOI: 10.1186/1752-1947-2-122] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 04/25/2008] [Indexed: 11/10/2022] Open
Abstract
Introduction We report a rare case of a ganglion cyst at the elbow causing neurological symptoms by stretching the superficial radial nerve alone. Ganglia associated with radial nerve palsy at the elbow have been reported previously involving the deep branch of the posterior interosseous nerve and the superficial radial nerve, but not the superficial radial nerve alone. Case presentation A 45-year-old woman presented with a 4-month history of a painful lump in the anterior aspect of her left elbow associated with altered sensation in the dorsoradial aspect of her left hand. There was no history of trauma or any exacerbating factors. On examination the altered sensation was in the superficial radial nerve distribution and she had a positive Tinel's sign over the site of the swelling which was located over the anterior aspect of the radiocapitellar joint. Conclusion The unique clinical symptoms and signs of our diagnosis of superficial radial nerve compression were confirmed by magnetic resonance imaging and then operative findings.
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Affiliation(s)
- John McFarlane
- Department of Orthopaedics, Kingston Hospital, Galsworthy Road, Kingston-upon-Thames, Surrey, UK.
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