eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Radial Nerve Entrapment: Workup

Author: Mark Stern, MD, Former Chief, Department of Orthopedic Surgery, Cedars-Sinai Medical Center
Contributor Information and Disclosures

Updated: Sep 2, 2009

Workup

Imaging Studies

  • Radiographs
    • In a suspected entrapment of the radial nerve in the arm, obtain radiographs to detect or rule out a fracture, healing callus, or tumor as the cause of entrapment.
    • In radial tunnel syndrome and posterior interosseous nerve syndrome, obtain radiographs to detect or rule out elbow or forearm fractures, dislocations or instabilities, tumors, and arthrosis.
  • MRI is useful in detecting tumors such as lipomas and ganglions, as well as aneurysms and rheumatoid synovitis.

Other Tests

  • Electromyographic (EMG) and nerve conduction study results are abnormal in radial nerve injuries in the middle and distal third of the humerus. EMGs help to locate the site of injury and help the clinician monitor the nerve recovery over time. EMGs may not be positive for 3-6 weeks following injury. By 4 months' postinjury, nerve recovery should be demonstrable. EMG may be performed initially to provide a baseline, but unless the nerve is severed, no changes will be observed for 3-6 weeks.
  • All electrodiagnostic test results are within normal limits in radial tunnel syndrome.
  • In posterior interosseous nerve syndrome, nerve conduction studies and EMGs usually are abnormal and help to determine the site of compression. These findings may not become abnormal for 3-6 weeks after injury. Serial EMGs usually are not necessary once the diagnosis is established but can be used to document improved or worsening nerve function. If the medial branch of the posterior interosseous nerve is compressed, EMG and conduction studies reveal abnormal function of the extensor carpi ulnaris, the extensor digitorum communis, and the extensor digiti quinti. If only the lateral branch is compressed, then abnormal function of the abductor pollicis longus, the extensor pollicis longus and brevis, and the extensor indicis proprius is revealed. The site of compression is localized by all function proximal to the compression being normal and all function distal to the compression being abnormal.

Diagnostic Procedures

  • In order to help differentiate lateral epicondylitis from radial tunnel syndrome, a cortisone and lidocaine (Xylocaine) injection may be used. An injection into the area of the lateral epicondyle should resolve almost all of the symptoms of lateral epicondylitis, at least temporarily. An injection of cortisone and lidocaine into the area of the radial tunnel usually does not relieve, or incompletely relieves, the discomfort.
  • In de Quervain disease, an injection of cortisone and lidocaine into the tendon sheath of the extensor pollicis brevis and the abductor pollicis longus relieves the symptoms immediately and sometimes permanently. An injection of cortisone and lidocaine into the area of compression of the superficial radial nerve causes the symptoms to subside; however, numbness in the nerve distribution follows, and when the injection wears off, the symptoms return. A Tinel sign is present in patients with Wartenberg syndrome but usually not in those with de Quervain disease. The 2 conditions may be related. The inflammation from de Quervain disease causes an inflammation of the nerve. With resolution of 1 condition, the other may subside or be adequately treated with an injection.23

More on Radial Nerve Entrapment

Overview: Radial Nerve Entrapment
Workup: Radial Nerve Entrapment
Treatment: Radial Nerve Entrapment
Follow-up: Radial Nerve Entrapment
References
Further Reading
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References

  1. Edmonson AS, Crenshaw AH. Peripheral nerve injuries. In: Campbell's Operative Orthopedics. 6th ed. 1980:1678-9.

  2. Lubahn JD, Cermak MB. Uncommon nerve compression syndromes of the upper extremity. J Am Acad Orthop Surg. Nov-Dec 1998;6(6):378-86. [Medline].

  3. Ritts GD, Wood MB, Linscheid RL. Radial tunnel syndrome. A ten-year surgical experience. Clin Orthop. Jun 1987;(219):201-5. [Medline].

  4. Sunderland S. Nerves and Nerve Injuries. 2nd ed. 1978:127.

  5. Robson AJ, See MS, Ellis H. Applied anatomy of the superficial branch of the radial nerve. Clin Anat. Jan 2008;21(1):38-45. [Medline].

  6. Thomsen NO, Dahlin LB. Injury to the radial nerve caused by fracture of the humeral shaft: timing and neurobiological aspects related to treatment and diagnosis. Scand J Plast Reconstr Surg Hand Surg. 2007;41(4):153-7. [Medline].

  7. Toros T, Karabay N, Ozaksar K, Sugun TS, Kayalar M, Bal E. Evaluation of peripheral nerves of the upper limb with ultrasonography: a comparison of ultrasonographic examination and the intra-operative findings. J Bone Joint Surg Br. Jun 2009;91(6):762-5. [Medline].

  8. Clavert P, Lutz JC, Adam P, Wolfram-Gabel R, Liverneaux P, Kahn JL. Frohse's arcade is not the exclusive compression site of the radial nerve in its tunnel. Orthop Traumatol Surg Res. Apr 2009;95(2):114-8. [Medline].

  9. Lo YL, Fook-Chong S, Leoh TH, Dan YF, Tan YE, Lee MP, et al. Rapid ultrasonographic diagnosis of radial entrapment neuropathy at the spiral groove. J Neurol Sci. Aug 15 2008;271(1-2):75-9. [Medline].

  10. Noaman H, Khalifa AR, El-Deen MA, Shiha A. Early surgical exploration of radial nerve injury associated with fracture shaft humerus. Microsurgery. 2008;28(8):635-42. [Medline].

  11. Akhtar S, Arenas Prat J, Sinha S. Neuropraxia of the palmar cutaneous branch of the ulnar nerve during carpal tunnel decompression. Ann R Coll Surg Engl. May 2005;87(3):W1-2. [Medline].

  12. [Best Evidence] Zlowodzki M, Chan S, Bhandari M, Kalliainen L, Schubert W. Anterior transposition compared with simple decompression for treatment of cubital tunnel syndrome. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. Dec 2007;89(12):2591-8. [Medline].

  13. Matsubara Y, Miyasaka Y, Nobuta S, Hasegawa K. Radial nerve palsy at the elbow. Ups J Med Sci. 2006;111(3):315-20. [Medline].

  14. Yamazaki H, Kato H, Hata Y, Murakami N, Saitoh S. The two locations of ganglions causing radial nerve palsy. J Hand Surg Eur Vol. Jun 2007;32(3):341-5. [Medline].

  15. Szekeres M. Tenodesis extension splinting for radial nerve palsy. Tech Hand Up Extrem Surg. Sep 2006;10(3):162-5. [Medline].

  16. Gousheh J, Arasteh E. Transfer of a single flexor carpi ulnaris tendon for treatment of radial nerve palsy. J Hand Surg [Br]. Oct 2006;31(5):542-6. [Medline].

  17. Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br. Dec 2005;87(12):1647-52. [Medline].

  18. Henry M, Stutz C. A unified approach to radial tunnel syndrome and lateral tendinosis. Tech Hand Up Extrem Surg. Dec 2006;10(4):200-5. [Medline].

  19. Ferdinand BD, Rosenberg ZS, Schweitzer ME, Stuchin SA, Jazrawi LM, Lenzo SR. MR imaging features of radial tunnel syndrome: initial experience. Radiology. Jul 2006;240(1):161-8. [Medline].

  20. Stanley J. Radial tunnel syndrome: a surgeon's perspective. J Hand Ther. Apr-Jun 2006;19(2):180-4. [Medline].

  21. Seddon HJ. Surgical Disorders of the Peripheral Nerves. 1972:66-88.

  22. Spinner M. Injuries to the Major Branches of Peripheral Nerves of the Forearm. 2nd ed. 1978:234.

  23. Ilyas A, Ast M, Schaffer AA, Thoder J. De quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. Dec 2007;15(12):757-64. [Medline].

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Keywords

radial nerve entrapment, radial nerve palsy, radial tunnel syndrome, tenosynovitis, tendovaginitis, tendosynovitis, tenovaginitis, tendinous synovitis, posterior interosseous nerve syndrome, Wartenberg's syndrome, Wartenberg syndrome, Holstein-Lewis fracture, neuropraxia, neurotmesis, axonotmesis

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Contributor Information and Disclosures

Author

Mark Stern, MD, Former Chief, Department of Orthopedic Surgery, Cedars-Sinai Medical Center
Mark Stern, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, California Medical Association, and Western Orthopaedic Association
Disclosure: Nothing to disclose.

Medical Editor

A Lee Osterman, MD, Director of Hand Surgery Fellowship, Director, Philadelphia Hand Center; Director, Professor, Department of Orthopedic Surgery, Division of Hand Surgery, University Hospital, Thomas Jefferson University
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

N Ake Nystrom, MD, PhD, Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

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