Radial Nerve Entrapment Workup

  • Author: Mark Stern, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Feb 15, 2012
 

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.
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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.
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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.[25]
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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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

N Ake Nystrom, MD, PhD  Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center

Disclosure: Nothing to disclose.

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

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, Leonard M Miller 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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