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Video Abstract
2021
:12;
507
doi:
10.25259/SNI_673_2021

Right radial nerve decompression for refractory radial tunnel syndrome

Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona, United States.
Department of Plastic Surgery, Mayo Clinic, Phoenix, Arizona, United States.
Corresponding author: Shelley S. Noland, M.D., Assistant Professor, Department of Surgery, Division of Plastic Surgery; Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, United States. noland.shelley@mayo.edu
Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Singh R, Lee YS, Kouloumberis PE, Noland SS. Right radial nerve decompression for refractory radial tunnel syndrome. Surg Neurol Int 2021;12:507.

Abstract

Background:

Radial tunnel syndrome arises due to compression of the radial nerve through the radial tunnel.[1,5] The radial nerve divides into superficial and deep branches in the forearm. The deep branch travels posteriorly through the heads of the supinator where compression commonly occurs.[3,9,7] This syndrome results in pain in the hand and forearm with no motor weakness.[8] This condition can be treated conservatively with splinting and anti-inflammatory medication.[2,4,6] For cases of refractory radial tunnel syndrome, surgical management can be considered. Herein, we have presented a step-by-step video guide on how to perform a radial nerve decompression with a review of the relevant anatomy and surgical considerations.

Case Description:

A 68-year-old right-handed woman presented to the Mayo Clinic (Scottsdale, AZ) with the right elbow pain which radiated to the forearm causing significant difficulties with daily tasks. She had been dealing with worsening symptoms for 4 months. The patient’s history of gardening and clinical presentation allowed for diagnosis of radial tunnel syndrome. After conservative measures failed and other differential diagnoses were excluded, surgical decompression was recommended to treat her symptoms. The patient’s right arm was marked preoperatively between the brachioradialis and extensor carpi radialis longus (ECRL) muscles. The posterior cutaneous nerve of the forearm was identified which allowed for the determination of the interval between the brachioradialis and ECRL. Separation of the two muscles allowed for the identification of the radial sensory nerve. A nerve stimulator was used to confirm the sensory nature of this nerve. The nerve to the extensor carpi radialis brevis (ECRB) was identified and retracted with a vessel loop. Dorsal to the nerve to the ECRB is the posterior interosseous nerve (PIN), which was identified and retracted with a vessel loop. The fascia of the ECRB was divided both longitudinally and transversely and the supinator below was identified. The supinator muscle was carefully divided to further decompress the PIN. Informed consent for publication of this material was obtained from the patient.

Conclusion:

The patient tolerated the procedure well and reported significantly reduced pain at 7-month follow-up. To the best of our knowledge, video tutorials on this procedure have not been published. This video can serve as an educational guide for peripheral nerve specialists dealing with similar lesions.

Keywords

Radial nerve
Peripheral nerve
Decompression
Radial tunnel syndrome

[Video 1]-Available on:

www.surgicalneurologyint.com

Annotations[1-9]

  1. 0:38 – Risks and benefits of procedure.

  2. 1:01 – Patient positioning.

  3. 5:15 – Procedure start.

  4. 6:15 – Disease background.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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