Surgical Procedures

Superficial Radial Sensory Nerve Release with Tenotomy of the Brachioradialis Tendon

The superficial radial sensory nerve can be entrapped between the brachioradialis and extensor carpi radialis longus tendons as the radial sensory nerve courses superficially from its deep origin. Compression of the radial sensory nerve presents with numbness and/or pain on the dorsal radial aspect of the hand. Pronation of the hand exacerbates these symptoms as the interval between these two tendons decreases. Decompression of the radial sensory nerve involves a muscle tenotomy of the brachioradialis tendon. The brachioradialis is expendable as the biceps brachii and brachialis provides redundant function for elbow flexion. The lateral antebrachial cutaneous nerve has a superficial course to the radial sensory nerve and the branches of this nerve are protected during decompression. In this case, the patient presented with a radial nerve palsy nine months following a humeral fracture treated with an open reduction and internal fixation. Electrodiagnostic studies revealed fibrillations and motor unit potentials predicting recovery of the radial nerve. A posterior interosseous nerve release was performed and the patient recovered radial motor nerve function thereafter, however the patient continued with complaints of numbness and tingling in the radial sensory nerve territory. Provocative tests were elicited at the radial sensory nerve entrapment point and the patient underwent the decompression of the radial sensory nerve by neurolysis and tenotomy of the brachialis tendon.

Standard 170201

Extended 170201

POSITION

Supine with forearm and hand prepped and draped with use of a tourniquet and IV regional Bier block technique.

INCISION

A linear incision is made on the lateral aspect of the forearm along just volar to the interval of the brachioradialis and extensor carpi radialis longus tendon. A palpable landmark includes the lateral aspect of the radius.

POST-OPERATIVE MANAGEMENT

Marcaine is carefully injected in the incision and a bulk dressing is applied. Unrestricted range of movement is initiated 2-3 days post-operatively.

REFERENCES

  1. Colbert SH, Mackinnon SE. Nerve compression in the upper extremity. Mo Med. 2008 Nov-Dec;105(6):527-35. PMID: 19052017. PMID: 19052017.
  2. Mackinnon SE. Surgical approach to the radial nerve. Tech Hand Up Extrem Surg. 1999 Jun;3(2):87-98.
  3. Mackinnon SE, Dellon AL, Hudson AR, Hunter DA. Histopathology of compression of the superficial radial nerve in the forearm. J Hand Surg Am. 1986 Mar;11(2):206-10. PMID: 3958448.
  4. Dellon AL, Mackinnon SE. Radial sensory nerve entrapment in the forearm. J Hand Surg Am. 1986 Mar;11(2):199-205. PMID: 3958447.
  5. Ehrlich W, Dellon AL, Mackinnon SE. Classical article: Cheiralgia paresthetica (entrapment of the radial nerve). A translation in condensed form of Robert Wartenberg’s original article published in 1932. J Hand Surg Am. 1986 Mar;11(2):196-9. PMID: 3515740
  6. Mackinnon SE, Dellon AL. The overlap pattern of the lateral antebrachial cutaneous nerve and the superficial branch of the radial nerve. J Hand Surg Am. 1985 Jul;10(4):522-6. PMID: 4020063.

Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

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