Distal Conduction Blocks
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand in Pediatric Regional Anesthesia, 2019
The radial nerve is the largest terminal branch of the brachial plexus. It lies posterior to the brachial artery and inclines backwards, following a spiral curve around the posterior aspect of the humerus, between the medial and lateral heads of the triceps muscle (Figure 1.57). On emerging from behind the humerus, at its lateral side, it pierces the lateral intermuscular septum, slightly above the external condyle (Figure 1.55), and reaches the front of the lateral condyle through the space between the brachialis and brachioradialis muscles (anterior compartment of the arm). At this level, it divides into four branches (superficial, cutaneous, muscular, and deep branches). The radial nerve supplies the lateral edge of the arm, forearm, and hand (Figures 1.59 and 1.60B).
Musculoskeletal trauma
Ian Greaves, Keith Porter, Chris Wright in Trauma Care Pre-Hospital Manual, 2018
Pain is located to the upper arm, deformity may be present, although it is less likely with proximal fractures in the elderly where significant and early proximal bruising may be seen. The radial nerve winds around the midshaft of the humerus as it runs towards the elbow. Signs of radial nerve involvement include wrist drop and altered sensation to the back of the hand. Pre-hospital management includes analgesia and the application of a splint. For patients with an isolated humeral fracture, a ‘collar and cuff’ may suffice. This has the effect of utilising the lower arm and elbow as a weight to pull the humerus out to length and maintain anatomical reduction. If the patient has multisystem injuries and is lying flat, the arm should be allowed to rest in a position of comfort. Malleable splints may be useful for midshaft fractures.
Diabetic Neuropathy
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
With carpal tunnel syndrome, there is a sensory deficit in the palmar aspect of the first three fingers that follows the development of paresthesias, pain, numbness, swelling, or prickling of the fingers. The symptoms are often felt in a variety of situations, including during rest, performing activities with the hands such as typing on a computer keyboard, or when driving a vehicle. Peroneal nerve palsy causes footdrop, which is weakened dorsiflexion and eversion of the foot, and sometimes a sensory deficit within the anterolateral aspect of the lower leg, dorsum of the foot, or in the webbed space between the first and second metatarsals. While L5 radiculopathy causes similar abnormalities, it usually weakens hip abduction by affecting the gluteus medius and weak foot inversion (tibialis posterior). Common symptoms of radial nerve palsy include wristdrop, which is weakness of the wrist and finger extensors, plus loss of sensation in the dorsal aspect of the first dorsal interosseous muscle. Similar motor abnormalities are caused by C7 radiculopathy. Compression of the ulnar nerve near the elbow may cause paresthesias, plus a sensory deficit in the fifth digit and the medial half of the fourth digit. There may be weakness and atrophy of the thumb adductor, fifth digit abductor, and the interosseous muscles. If chronic ulnar palsy is severe, a clawhand deformity will occur. Sensory symptoms are similar to those caused by C8 root dysfunction that is secondary to cervical radiculopathy. The difference is that radiculopathy usually affects more proximal aspects of the C8 dermatome.
End-to-side neurotization with the phrenic nerve in restoring the function of toe extension: an experimental study in a rat model
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Xiaotian Jia, Chao Chen, Jianyun Yang, Cong Yu
The donor nerve being transferred to the major trunk of the radial nerve is the major surgical method used to restore the motion of digit extension. However, the radial nerve included both sensory and motor nerve fibers from the origin to the elbow level. The mismatch of sensory and motor nerve fibers is inevitable. Lin et al. and Wang et al. [1,2] suggested that the extensor digitorum and extensor pollicis muscles are mainly innervated by the posterior division of the lower trunk of the brachial plexus. According to the anatomy they suggested that, the nerve fibers which innervate the extensor digitorum muscles mainly originate from the lower trunk [7] and only the posterior division of the lower trunk takes part in the combination of the radial nerve. We agreed to the opinion stated by them.
Brachial distal biceps injuries
Published in The Physician and Sportsmedicine, 2019
Drew Krumm, Peter Lasater, Guillaume Dumont, Travis J. Menge
The biceps brachii muscle is made up of a short head and a long head. The short head originates on the coracoid process, while the long head originates on the supraglenoid tubercle. They each insert on the radial tuberosity. This muscle’s main action is to supinate the forearm, but it also assists in elbow flexion. Since the short head has a more distal attachment on the tuberosity than the long head, it is a greater contributor to elbow flexion. The long head attaches to the apex of the tuberosity and is a greater contributor to supination than the short head. The biceps is innervated by the musculocutaneous nerve and receives its blood supply from branches of the brachial artery. On clinical exam, the distal biceps tendon may be mistaken for the lacertus fibrosus, also known as the bicipital aponeurosis, which originates from the short head of the biceps and helps protect the neurovascular bundle in the antecubital fossa. The lateral antebrachial cutaneous nerve (LABCN), which is the terminal cutaneous branch of the musculocutaneous nerve, is at risk for injury in operative repair of distal biceps avulsion injuries. It is located between the biceps and brachialis muscles and pierces the deep fascia just lateral to the distal biceps tendon. The nerve is located in the subcutaneous tissue of the antecubital fossa and supplies sensation to the lateral aspect of the forearm. The radial nerve is also at risk for injury. The radial nerve is located between the brachioradialis and brachialis near the distal humerus. It bifurcates into the posterior interosseous nerve and radial sensory nerve in the antecubital fossa [6].
Evaluation of A Better Approach for Open Reduction Of Severe Gartland Type III Supracondylar Humeral Fracture
Published in Journal of Investigative Surgery, 2021
Yuxi Su, Guoxin Nan
Two patients developed ulnar nerve injury postoperatively. In these patients, the medial K-wires were removed 1 day postoperatively, and new K-wires were fixed laterally; the patients recovered after 1 month. Usually, the ulnar nerve is damaged by K-wires; hence, removal of the K-wires may help the ulnar nerve recover. All patients with preoperative radial nerve injuries recovered within 1–2 months postoperatively. One patient with a cephalic vein injury developed severe arm swelling on the second day postoperatively. By raising the affected limb, the plasters were taken off, and the swelling was relieved on the third day. Only one patient needed neurological repair. Only one patient had artery rupture, the continuity of blood vessel was still existed, but the intima of blood vessel was obviously damaged, thrombosis was formed, and blood flow was interrupted. But when we observed the blood supply of the forearm, it did not appear to be bad; hence, we ligated the vessel. It recovered well postoperatively.
Related Knowledge Centers
- Anconeus Muscle
- Brachial Plexus
- Motor Neuron
- Posterior Interosseous Nerve
- Ulnar Nerve
- Nerve
- Triceps
- Posterior Compartment of The Forearm
- Cutaneous Innervation
- Ring Finger