Category: Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Neurodegenerative Disease (e.g. MS, Parkinson's disease)
Radial compressive neuropathy was defined as entrapment of radial nerve at specific locations. Symptoms includes muscle weakness or pain. The usual cause of entrapment was previous humeral shaft fracture or prolonged mechanical compression with idiopathic etiology uncommon. Current treatments include nonsteroidal anti-inflammatory drugs, physical therapy, hydrodissection by 5% dextrose or surgery.
Design : Case report
Setting : Medical center
Participants (or Animals, Specimens, Cadavers) : A 31 year-old unemployed male without systemic disease complained about difficulty in extending left wrist and fingers for 5 days. He denied previous trauma nor changing sleeping position. Symptoms were accompanied with left external elbow dull pain. Examinations showed dropped wrist and poor extension of fingers but full muscle power in first dorsal interosseous muscle and abductor pollicis brevis muscle. Nerve conduction study and electromyogram revealed absence of CMAPs in left radial nerve and acute denervational change in left extensor digitorum communis muscle. MRI of left arm showed no mass lesions nor abnormal vascular flow. Sonography found notch sign with loss of internal echotexture, and increase cross-sectional area of radial nerve below spiral groove and posterior interosseous nerve within supinator muscle.
Interventions : Dextrose 5% in water was injected for hydrodissection over the entrapment. After one month of intervention, persist left wrist and finger extension difficulty was complained. Followed up sonography found total 3 entrapments over left radial nerve between spiral groove and elbow, with loss of internal echotexture. Dextrose 5% in water was once again given for hydrodissection.
Main Outcome Measure(s) : Left wrist and finger were still paralysis after four month since the event happened.
Results : The patient was transferred to plastic surgery department for tendon transposition.
Ultrasonographic diagnosis of idiopathic radial compressive neuropathy with multiple entrapments. Hydrodissection was done twice but in vain.
Ying-ting Yeh– Residence, Department of Physical Medicine and Rehabilitation Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, Tainan, Tainan