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.
Supine with forearm and hand prepped and draped with use of a tourniquet and IV regional Bier block technique.
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.
Marcaine is carefully injected in the incision and a bulk dressing is applied. Unrestricted range of movement is initiated 2-3 days post-operatively.
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