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Radial tunnel release

Surgeon-side topic for radial tunnel release. Backed by 274 articles from the corpus, retrieved via combined MeSH + title-text matching.

Overview

Radial tunnel release is a surgical decompression option for radial tunnel syndrome, primarily indicated for cases refractory to nonsurgical management despite ongoing diagnostic and outcome controversies [5]. While surgical exploration for lateral epicondylitis does not yield greater improvement than non-surgical care [1], the procedure remains advocated for high radial nerve entrapment neuropathy resistant to conservative treatment, necessitating dissection of the entire fibrous tunnel length [6]. No single surgical approach adequately visualizes and releases all compression points within the radial tunnel [2].

Surgical intervention is critical in specific acute and chronic contexts. Patients undergoing exploration within three weeks of humeral fracture injury demonstrate a significantly higher likelihood of regaining radial nerve function compared to those managed nonsurgically or with delayed exploration [3]. Conversely, operative treatment for humeral shaft fractures yields a permanent radial nerve palsy rate similar to conservative management, despite inherent surgical risks [26]. For elbow stiffness, the potential neurological role as a root of joint contracture must be evaluated, and preventive nerve release should be considered during contracture surgery even with normal preoperative neurological status [8].

In cases of longstanding, irreparable, isolated radial nerve lesions, tendon transfers are indicated [10]. Targeted muscle reinnervation to the extensor carpi radialis brevis shows promise for improving symptoms in refractory, symptomatic radial sensory nerve neuromas where wrist extension remains unaffected [12]. Both minimally invasive approaches compared for locating the radial nerve in the posterior humeral approach can quickly and safely expose the nerve [4].

Anatomy & Pathophysiology

Vascular & Neural

Surgical management for elbow stiffness must evaluate the potential neurological role as a root of joint contracture [8], necessitating consideration of preventive nerve release and tunnel decompression even when the preoperative neurological condition is normal [8]. All three major nerves (ulnar, median, and radial) may contribute branches to the elbow capsule [46]. Elbow arthroscopy remains a technically difficult procedure with the potential for neurologic complications [40], though the needle-and-knife technique for anterolateral portal placement is reproducible and easy to perform by someone instructed in its use and trained in elbow arthroscopy [42]. Joint distention and positioning of the elbow in 90° of flexion provides an increase in safety margin relative to the radial nerve during proximal anterolateral portal use [19]. Computed tomography imaging is useful to determine the paths of the radial and median nerves and their spatial relationship to heterotopic ossification at the elbow [25]. Radial nerve injury associated with application of a hinged elbow external fixator is a devastating complication [47].

Kinematics & Biomechanics

Understanding the dynamic nature of the axillary and radial nerves related to different shoulder positions is critical to avoid complications in relation to the latissimus dorsi tendon [35]. Elbow flexion is the most effective way to decrease radial and median nerve distal peripheral tension after reverse shoulder arthroplasty [32], whereas elbow extension should be avoided when implanting the humeral component to prevent increased nerve tension [32]. The musculocutaneous and radial nerves contribute 42% and 27.5% respectively to elbow flexion force [37], while the biceps brachii contributes 46.7% to elbow flexion force [37]. The brachioradialis and supinator contribute 64.1% to forearm supination force [37]. In the long term, most patients obtained satisfactory elbow flexion but poor elbow extension following phrenic nerve transfer for elbow flexion and intercostal nerve transfer for elbow extension [36]. Transfer of the pronator teres for acquired radial nerve palsy results in a loss of pronation function [28].

Reconstructive Strategy & Functional Outcomes

Understanding the anatomy of the radial nerve branches at the elbow is of utmost importance when devising a reconstructive strategy for upper limb paralysis [43]. Even though the range of wrist motion and the strength of the wrist and fingers are less than normal after a flexor carpi ulnaris set of triple tendon transfer, hand function remains good [44]. Routing of the extensor pollicis longus tendon through the first dorsal compartment allows reproduction of the action of thumb extension and abduction and restores thumb clearance from the palm [45]. The ability to deviate at the wrist has a significant impact on the ability to perform many functional tasks in patients with low profile radial nerve palsy orthosis [41].

Classification

Pathophysiology and Nomenclature: Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis [17]. Radial tunnel syndrome and posterior interosseous nerve compression are distinct entities with different clinical presentations but share identical potential sites of nerve interference [20]. These conditions may be unified as mild (radial tunnel syndrome) and severe (posterior interosseous nerve compression) forms of one disease to simplify nomenclature [20].

Surgical Indications: Surgical decompression remains a viable option for refractory cases of radial tunnel syndrome despite ongoing controversy regarding diagnosis and outcomes [5]. Surgery is advocated for high radial nerve entrapment neuropathy cases resistant to conservative treatment [6]. Surgical exploration within 3 weeks of injury is associated with a significantly higher likelihood of regaining radial nerve function compared to nonsurgical management or late surgical exploration [3]. Tendon transfers are indicated in longstanding, irreparable, isolated radial nerve lesions [10]. Preventive nerve release and tunnel decompression must be considered when addressing surgically an elbow contracture even with a normal preoperative neurological condition [8].

Surgical Approach and Outcomes: No single surgical approach was adequate for complete visualization and release of all compression points of the radial tunnel in one anatomical study [2]. A single brachioradialis-splitting approach is adequate for complete visualization and release of all compression sites of the radial tunnel in a separate anatomic study [7]. Both minimally invasive methods evaluated can quickly and safely expose the radial nerve in the posterior humeral approach [4]. Joint distention and positioning of the elbow in 90° of flexion provides an increase in safety margin for proximal anterolateral portals in elbow arthroscopy relative to the radial nerve [19]. Anatomic knowledge of the course of the superficial radial nerve and its branches is important during open release for avoiding nerve injury [13]. Radial nerve release, in association with surgical treatment for lateral epicondylitis, was not associated with greater improvement in outcomes [1].

Clinical Presentation

Radial tunnel syndrome represents an illness construct grounded in speculative pathophysiology, lacking a verifiable mechanism or accepted reference standard for diagnosis [17]. While distinct from posterior interosseous nerve compression in clinical presentation, the two entities share identical potential sites of nerve interference and may be unified as mild and severe forms of a single disease to simplify nomenclature [20]. Radial neuropathies are rare compared to both ulnar and median neuropathies, with ulnar neuropathies occurring more frequently in men [29].

Chronic Entrapment: Nonsurgical management serves as the first-line treatment for radial tunnel syndrome [5]. Surgical decompression remains a viable option for refractory cases despite ongoing controversy regarding diagnosis and outcomes [5], particularly for high radial nerve entrapment neuropathy resistant to conservative care [6]. In these surgical cases, dissecting the entire length of the fibrous tunnel is critical [6]. While a single brachioradialis-splitting approach adequately visualizes and releases all compression sites in specific contexts [7], general anatomical studies indicate no single approach guarantees complete visualization of all compression points [2].

Acute Injury and Iatrogenic Risk: Surgical exploration within 3 weeks of injury significantly increases the likelihood of regaining radial nerve function compared to nonsurgical management or late exploration [3]. Immediate removal of extruded cement and decompression aids recovery after thermal injury during humeral revision [9]. During distal third humeral shaft fractures treated with posterior minimally invasive plate osteosynthesis, the radial nerve must be identified and protected to prevent palsy [11]. Similarly, if preoperative signs of radial nerve injury exist, the nerve must be identified and protected during fixation of displaced intercondylar fractures [18]. Both minimally invasive approaches for locating the radial nerve in the posterior humeral approach can quickly and safely expose the nerve [4].

Anatomic Variants and Complications: Anatomic knowledge of the superficial radial nerve course is essential during open release to avoid injury [13]. Compression of the radial nerve by the lateral head of the triceps muscle has been confirmed in case reports [31]. Surgical excision of ganglion cysts causing compression leads to rapid recovery of nerve sensation [30]. For refractory, symptomatic radial sensory nerve neuromas, function-sparing targeted muscle reinnervation to the extensor carpi radialis brevis shows promising results, is considered safe, and results in unaffected wrist extension [12].

Elbow Contracture: Surgical management for elbow stiffness must evaluate the potential neurological role as a root of joint contracture [8]. Preventive nerve release and tunnel decompression should be considered when addressing surgically an elbow contracture, even in patients with normal preoperative neurological conditions [8].

Investigations

CT: Computed tomography is useful to determine the paths of the radial and median nerves and their spatial relationship to heterotopic ossification at the elbow [25].

Other Considerations: Surgical decompression remains a viable option for refractory cases of radial tunnel syndrome despite ongoing controversy regarding diagnosis and outcomes [5]. No single surgical approach was adequate for complete visualization and release of all compression points of the radial tunnel [2], although a single brachioradialis-splitting approach is adequate for complete visualization and release of all compression sites [7]. Surgery is advocated for high radial nerve entrapment neuropathy cases resistant to conservative treatment, emphasizing the importance of dissecting the entire length of the fibrous tunnel [6]. Patients who underwent surgical exploration within 3 weeks of injury had a significantly higher likelihood of regaining radial nerve function than patients who underwent nonsurgical management with or without late surgical exploration [3]. The radial nerve recovered better if repaired or reconstructed within 5 months of injury [15]. Successful recovery of radial nerve lacerations can be achieved after nerve grafting [16]. Tendon transfers are indicated in longstanding, irreparable, isolated radial nerve lesions [10].

Intraoperative Planning and Nerve Protection: The radial nerve must be identified and protected in all cases of distal third humeral shaft fractures treated with posterior minimally invasive plate osteosynthesis to prevent palsy [11]. When preoperative signs of radial nerve injury are present, the radial nerve should be identified and protected during fixation of displaced intercondylar fractures [18]. Both minimally invasive methods compared for locating the radial nerve in the posterior humeral approach can quickly and safely expose the radial nerve [4]. Anatomic knowledge of the course of the superficial radial nerve and its branches is important during open release for avoiding nerve injury [13]. Radial nerve release associated with surgical treatment for lateral epicondylitis was not associated with greater improvement [1]. Immediate surgical removal of extruded cement and decompression of the radial nerve may aid in recovery of nerve function after thermal injury during humeral revision in total elbow arthroplasty [9]. Return of function is less likely when power instruments or ultrasound is used for cement removal in radial nerve palsy after humeral revision in total elbow arthroplasty, while formal exposure and protection of the radial nerve are predictive of recovery [14]. Targeted muscle reinnervation to the extensor carpi radialis brevis shows promising results of improved symptoms with unaffected wrist extension for refractory, symptomatic radial sensory nerve neuromas [12]. Direct radial to ulnar nerve transfer via an interosseous tunnel safely and effectively restored intrinsic function before terminal muscle degeneration in a patient with combined proximal median and ulnar nerve injury [24].

Treatment

Non-Operative

Nonsurgical management serves as the first-line treatment for radial tunnel syndrome, with surgical decompression reserved for refractory cases [5]. While treatment of radial nerve palsy is typically non-operative with satisfactory results, surgical intervention is indicated for nerve transection or a lack of improvement following conservative therapy [38].

Operative

Indications: Surgery is advocated for high radial nerve entrapment neuropathy cases resistant to conservative treatment, requiring dissection of the entire length of the fibrous tunnel [6]. Tendon transfers are indicated specifically for longstanding, irreparable, isolated radial nerve lesions [10]. Additionally, immediate surgical removal of extruded cement and decompression of the radial nerve may aid in recovery of nerve function after thermal injury during humeral revision in total elbow arthroplasty [9].

Surgical Approach / Technique: A single brachioradialis-splitting approach is adequate for complete visualization and release of all compression sites of the radial tunnel [7], whereas no single surgical approach was previously deemed adequate for complete visualization of all compression points [2]. Both minimally invasive methods for locating the radial nerve in the posterior humeral approach can quickly and safely expose the radial nerve [4]. In cases of distal third humeral shaft fractures treated with posterior minimally invasive plate osteosynthesis, the radial nerve must be identified and protected to prevent palsy [11]. Radial nerve transposition with humeral fracture fixation is safe, does not cause iatrogenic injury, and protects the nerve during all subsequent approaches to the fracture site [21]. Transhumeral radial nerve transposition allowed less worrisome dissection during revision surgery despite multiple previous procedures [27]. In elbow arthroscopy, modified proximal and direct lateral portals provide adequate distance from the radial nerve and may be safe for clinical use [33].

Adjuncts: Surgical management for elbow stiffness should evaluate the potential neurological role as a root of joint contracture, and preventive nerve release and tunnel decompression must be considered even with a normal preoperative neurological condition [8]. Radial nerve release in association with surgical treatment for lateral epicondylitis was not associated with greater improvement [1].

Other Considerations: Neurolysis of the superficial radial nerve offers the opportunity for pain relief but does not reliably produce success [39]. Posterior interosseous nerve neurectomy can provide relief in patients with chronic wrist pain [49]. Avoiding donor harvest from another location may help with postoperative pain management and facilitate mobilization when using the superficial radial nerve as a donor for grafting of ipsilateral forearm nerve defects [48]. Data on the course of the radial nerve in relation to the center of rotation of the elbow help define a safe zone for pin implantation, but due to variability, a safe zone cannot fully ensure prevention of iatrogenic injury [51].

Complications

Nerve palsy: Spontaneous recovery occurs in the majority of patients with primary or secondary radial nerve palsy associated with closed humeral shaft fracture, so initial nonsurgical management is recommended [22]. Iatrogenic transient dysfunction occurs in approximately 1 in 5 patients treated with lateral exposure, 1 in 9 with posterior exposure, and 1 in 25 with anterolateral exposure for diaphyseal shaft fractures [65]. Operative treatment for humeral shaft fractures results in a similar permanent radial nerve palsy rate compared to nonoperative treatment, despite inherent surgical risks [26]. Patients undergoing surgical exploration within 3 weeks of injury have a significantly higher likelihood of regaining function than those with nonsurgical management or late exploration [3]. Recovery is better if the nerve is repaired or reconstructed within 5 months of injury [15]. Injuries to the posterior interosseous nerve typically resolve within 3 months, and at the latest, 5 months after surgery [64]. Spontaneous recovery can also occur following axonolysis caused by impingement from distal locking screws during humeral nailing [58].

Nerve injury management and reconstruction: The choice of surgical technique and timing for peripheral nerve injury depends on the type of trauma, site of injury, and time elapsed since injury, with spontaneous recovery occurring in 70%–88% of radial nerve injuries [23]. Successful recovery of radial nerve lacerations can be achieved after nerve grafting [16], though grafting for high radial nerve injury achieves relatively good wrist extension but poor thumb extension and is affected by certain prognostic factors [62]. On pooled analysis, tendon transfers had higher rates of superior clinical outcomes as compared with nerve transfers and nerve grafts for isolated radial nerve palsy [57], yet overall better outcomes were observed in those who underwent nerve transfer versus tendon transfer procedures for radial nerve paralysis reconstruction [61]. Immediate surgical removal of extruded cement and decompression of the radial nerve may aid in recovery of nerve function after thermal injury during humeral revision in total elbow arthroplasty [9]. Return of function is less likely when power instruments or ultrasound are used for cement removal in humeral revision, while formal exposure and protection of the radial nerve are predictive of recovery [14].

Prevention and surgical approach: The radial nerve must be identified and protected in all cases of distal third humeral shaft fractures treated with posterior minimally invasive plate osteosynthesis to prevent palsy [11]. If pin insertion for unilateral external fixation is required more proximal than the distal 15% of the humeral shaft, an open procedure or preoperative radiographic assessment is advised to prevent iatrogenic radial nerve injury [59]. Both minimally invasive methods for locating the radial nerve in the posterior humeral approach can quickly and safely expose the radial nerve [4]. The technique of radial nerve transposition with humeral fracture fixation is safe, does not cause iatrogenic injury, and protects the radial nerve during all subsequent approaches to the fracture site [21]. Transhumeral radial nerve transposition allowed less worrisome dissection during revision surgery despite multiple previous procedures [27]. No single surgical approach was adequate for complete visualization and release of all compression points of the radial tunnel [2], although a single brachioradialis-splitting approach is adequate for complete visualization and release of all compression sites [7]. Radial nerve release associated with surgical treatment for lateral epicondylitis was not associated with greater improvement [1].

Other Considerations: Superficial thrombophlebitis resulting in entrapment of the radial nerve branch in the forearm is a rare yet noteworthy condition [55]. No increased morbidity was attributed to the open surgical approach for complex humeral shaft fractures with proximal metaphyseal extension, though radial nerve palsy could not be completely avoided [56]. Complications associated with reconstructive elbow surgery persist, often leading to profound and sometimes nonsalvageable disability, with aseptic loosening, infection, and periprosthetic fracture being the most devastating problems [60]. There were fewer nonunions in the operative group but more deep infections for operative versus nonoperative treatment of humeral shaft fractures [63].

Recovery

Light activity (weeks): Evidence does not specify a discrete week range for light activity or driving following radial tunnel release for lateral epicondylitis, noting only that the procedure was not associated with greater improvement compared to non-surgical management [1]. However, in the context of high radial nerve paralysis, early tendon transfer can quickly restore efficient grip while awaiting reinnervation of wrist extensors, thereby avoiding the need for prolonged external splintage [52].

Full activity (months): Spontaneous recovery occurs in the majority of patients with primary or secondary radial nerve palsy associated with closed humeral shaft fracture, supporting initial nonsurgical management [22]. When surgical intervention is required, patients undergoing exploration within 3 weeks of humeral fracture injury demonstrate a significantly higher likelihood of regaining radial nerve function compared to those managed nonsurgically or with late exploration [3]. For thermal injuries during humeral revision total elbow arthroplasty, immediate surgical removal of extruded cement and decompression of the radial nerve may aid in recovery [9]. Conversely, return of function is less likely when power instruments or ultrasound are used for cement removal; formal exposure and protection of the radial nerve are predictive of recovery [14].

Complete recovery / outcome plateau (months): The radial nerve recovers better if repaired or reconstructed within 5 months of injury [15]. Spontaneous recovery occurs in 70%–88% of radial nerve injuries [23]. Successful recovery of radial nerve lacerations can be achieved after nerve grafting, with good to excellent motor recovery expected in 83% of patients with a large gap (nine centimeters or greater) when sural nerve autografts are sutured to areas with motor fascicles [16, 50]. Tendon transfers are indicated in longstanding, irreparable, isolated radial nerve lesions [10] and serve as one reconstructive option in a ladder of alternatives to improve function after injury to the radial, median, or ulnar nerves [53]. Direct radial to ulnar nerve transfer via an interosseous tunnel has safely and effectively restored intrinsic function before terminal muscle degeneration in patients with combined proximal median and ulnar nerve injury [24].

Rehabilitation protocol: No specific immobilisation duration or PT phasing is detailed in the provided evidence for standard radial tunnel release. However, customized dynamic splints have promoted optimal function and recovery in high radial nerve injury by addressing functional goals and tissue biological needs without the need for wire bending or outriggers [54].

Functional milestones: The evidence does not report specific PROM trajectories (e.g., Constant, ASES) for radial tunnel release. It is noted that no single surgical approach to the radial tunnel is adequate for complete visualization and release of all compression points [2].

Other Considerations: While radial nerve release for lateral epicondylitis does not yield greater improvement, the lack of a single adequate surgical approach necessitates careful technique [1, 2]. In cases of thermal injury during revision arthroplasty, the method of cement removal is critical, with formal exposure and protection being superior to power instrumentation [9, 14].

Key Evidence

  • [L1] Radial nerve release, in association with surgical treatment for lateral epicondylitis, was not associated with greater improvement. (10.1016/j.jhsa.2018.06.009)
  • [L5] No single approach was adequate for complete visualization and release of all compression points of the radial tunnel. (10.1016/j.jhsa.2015.03.009)
  • [L2] Patients who underwent surgical exploration within 3 weeks of injury had a significantly higher likelihood of regaining radial nerve function than patients who underwent nonsurgical management with or without late surgical exploration. (10.5435/jaaos-d-18-00142)
  • [L5] Both methods can quickly and safely expose the radial nerve. (10.1186/s12891-023-06291-3)
  • [L4] The article reviews the anatomy, diagnosis, and treatment of radial tunnel syndrome, noting that while nonsurgical management is first-line, surgical decompression remains a viable option for refractory cases despite ongoing controversy regarding diagnosis and outcomes. (10.5435/jaaos-d-23-00314)
  • [Case_report] The authors advocate for surgery in high radial nerve entrapment neuropathy cases resistant to conservative treatment, emphasizing the importance of dissecting the entire length of the fibrous tunnel. (10.1016/j.jse.2025.02.060)
  • [L5] A single brachioradialis-splitting approach is adequate for complete visualization and release of all compression sites of the radial tunnel. (10.1177/1558944717750916)
  • [L5] Surgical management for elbow stiffness should evaluate the potential neurological role as root of joint contracture, and preventive nerve release and tunnel decompression must be considered when addressing surgically an elbow contracture even with normal preoperative neurological condition. (10.1016/j.jisako.2023.12.007)
  • [L4] Immediate surgical removal of the extruded cement and decompression of the radial nerve may aid in recovery of nerve function. (10.1016/j.jse.2013.10.002)
  • [L3] Tendon transfers are indicated in longstanding, irreparable, isolated radial nerve lesions. (10.1016/j.jhsa.2007.10.015)
  • [L4] The radial nerve must be identified and protected in all cases to prevent palsy. (10.1016/j.xrrt.2023.08.006)
  • [L4] This technique shows promising results of improved symptoms with unaffected wrist extension and is considered a safe and potentially impactful additional option in the treatment of refractory, symptomatic radial sensory nerve neuromas. (10.1016/j.jhsg.2022.01.006)
  • [L5] Anatomic knowledge of the course of the superficial radial nerve and its branches is important during open release for avoiding nerve injury. (10.1016/j.jhsa.2013.12.004)
  • [L4] Return of function is less likely when power instruments or ultrasound is used for cement removal, while formal exposure and protection of the radial nerve are predictive of recovery. (10.1016/j.jse.2010.08.012)
  • [L4] The radial nerve recovered better if repaired or reconstructed within 5 months of injury. (10.1177/1753193409360283)
  • [L4] Successful recovery of radial nerve lacerations can be achieved after nerve grafting. (10.1016/j.jhsa.2014.05.036)
  • [L5] Radial tunnel syndrome is an illness construct based on a speculative pathophysiology with no verifiable pathophysiology or accepted reference standard for diagnosis. (10.1016/j.jhsa.2010.03.020)
  • [L4] When preoperative signs of radial nerve injury are present, the radial nerve should be identified and protected during fixation. (10.1016/j.jhsa.2012.01.002)
  • [L4] Joint distention and positioning of the elbow in 90° of flexion provides an increase in safety margin. (10.1136/jisakos-2018-000205)
  • [L5] Radial tunnel syndrome (RTS) and posterior interosseous nerve (PIN) compression are distinct entities with different clinical presentations but share identical potential sites of nerve interference; the author proposes unifying them as mild (RTS) and severe (PIN compression) forms of one disease to simplify nomenclature. (10.1177/1753193420953990)
  • [L4] The technique is safe, does not cause iatrogenic injury, and protects the radial nerve during all subsequent approaches to the fracture site. (10.1097/01.blo.0000072470.32680.60)
  • [L4] In primary or secondary radial nerve palsy associated with closed humeral shaft fracture, spontaneous recovery occurs in the majority of patients, so initial nonsurgical management is recommended. (10.1016/j.jhsa.2008.05.029)
  • [L4] The choice of surgical technique and timing depends on the type of trauma, site of injury, and time elapsed since injury, with spontaneous recovery occurring in 70%–88% of radial nerve injuries. (10.1177/17531934241240867)
  • [Case_report] Direct radial to ulnar nerve transfer via an interosseous tunnel safely and effectively restored intrinsic function before terminal muscle degeneration in a patient with combined proximal median and ulnar nerve injury. (10.1016/j.jhsa.2014.04.013)
  • [L4] This study demonstrates the usefulness of CT imaging to determine the paths of the radial and median nerves and their spatial relationship to HO at the elbow. (10.1016/j.jse.2014.12.030)
  • [L1] Furthermore, operative treatment results in a similar permanent radial nerve palsy rate, despite its inherent additional surgery-related risks. (10.1016/j.jse.2020.01.072)
  • [L4] Transhumeral radial nerve transposition allowed less worrisome dissection during revision surgery despite multiple previous procedures. (10.1016/j.jhsa.2017.04.008)
  • [L4] The clinical arm of the study confirmed our biomechanic findings by showing the loss of pronation function. (10.1016/j.jhsa.2007.01.012)
  • [L3] Ulnar and radial neuropathies were less common, with ulnar neuropathies more frequent in men and radial neuropathies being rare. (10.1177/1753193419886741)
  • [L4] Surgical excision can lead to rapid recovery of nerve sensation in cases of radial nerve compression by ganglion cysts. (10.1007/s11552-007-9083-x)
  • [L4] This case confirms for the first time a suspected diagnosis of compression of the radial nerve by the lateral head of the triceps muscle. (10.2106/00004623-197759060-00022)
  • [L5] Elbow flexion was the most effective way to decrease nerve tension, while elbow extension should be avoided when implanting the humeral component. (10.1016/j.jseint.2024.03.013)
  • [L5] In cadaveric analysis, both the modified proximal and direct lateral portals provide adequate distance from the radial nerve and may be safe for clinical use. (10.1016/j.arthro.2017.06.012)
  • [L5] Understanding the dynamic nature of these nerves related to different shoulder positions is critical to avoid complications. (10.1177/1758573218825476)
  • [L4] In the long term, most patients obtained satisfactory elbow flexion but poor elbow extension. (10.1016/j.jhsa.2010.04.006)
  • [L4] The musculocutaneous and radial nerves contribute 42% and 27.5% respectively to elbow flexion force, while the biceps brachii contributes 46.7% and the brachioradialis and supinator contribute 64.1% to forearm supination force. (10.1177/1753193408087036)
  • [L5] Treatment is usually non-operative with satisfactory results, though surgery is indicated for nerve transection or lack of improvement after conservative treatment. (10.1302/2058-5241.1.000028)
  • [L4] Therefore, while neurolysis of the superficial radial nerve offers the opportunity for pain relief, it does not reliably produce success. (10.1177/1753193407087892)
  • [L4] Elbow arthroscopy remains a technically difficult procedure with the potential for neurologic complications. (10.1016/j.arthro.2006.11.021)
  • [L5] The ability to deviate at the wrist has a significant impact on the ability to perform many functional tasks. (10.1016/j.jht.2014.11.007)
  • [L4] It is reproducible and easy to perform by someone instructed in its use and trained in elbow arthroscopy. (10.1177/2325967118817232)
  • [L5] Understanding the anatomy of the radial nerve branches at the elbow is of utmost importance when devising a reconstructive strategy for upper limb paralysis. (10.1016/j.jhsa.2023.11.021)
  • [L3] This study shows that even though the range of wrist motion and the strength of the wrist and fingers are less than normal, hand function remains good. (10.1177/1753193416651574)
  • [L4] Routing of the EPL tendon through the first dorsal compartment allows reproduction of the action of thumb extension and abduction and restores thumb clearance from the palm. (10.1016/j.jhsa.2015.01.018)
  • [L5] The study thoroughly documented the articular branching patterns of all 3 major nerves (ulnar, median, and radial) to the elbow capsule, showing that all 3 may contribute branches to the capsule. (10.1016/j.jhsa.2008.01.029)
  • [L4] Radial nerve injury associated with application of a hinged elbow external fixator is a devastating complication. (10.1016/j.jse.2012.11.012)
  • [L4] Avoiding donor harvest from another location may help with postoperative pain management and facilitate mobilization. (10.1177/1753193418796753)
  • [L4] PINN can provide relief in patient's chronic wrist pain. (10.1177/1558944717692093)
  • [L4] Good to excellent motor recovery can be expected in 83% of patients who have a large gap of the radial nerve when sural nerve autografts are sutured to the areas that have motor fascicles dominantly. (10.1016/j.jhsa.2007.10.004)
  • [L5] The data help predict the humeral course of the radial nerve and define a safe zone for pin implantation, but due to variability, a safe zone cannot fully ensure prevention of iatrogenic injury. (10.1016/j.jhsa.2014.03.019)
  • [L4] Early tendon transfer quickly restored efficient grip while awaiting reinnervation of wrist extensors, avoiding the need for prolonged external splintage. (10.1177/1753193410384696)
  • [L5] Tendon transfers are one reconstructive option in a ladder of reconstructive alternatives that can improve function after injury to the radial, median, or ulnar nerves. (10.5435/jaaos-21-11-675)
  • [Case_report] Customized dynamic splints promoted optimal function and recovery in a patient with high radial nerve injury by addressing functional goals and tissue biological needs without the need for wire bending or outriggers. (10.1197/j.jht.2006.11.013)
  • [Case_report] Superficial thrombophlebitis resulting in entrapment of the radial nerve branch in the forearm is a rare yet noteworthy condition. (10.1186/s12891-024-07545-4)
  • [L4] No increased morbidity was attributed to the open surgical approach, though radial nerve palsy could not be completely avoided. (10.1186/s12891-024-07915-y)
  • [L4] On pooled analysis, tendon transfers had higher rates of superior clinical outcomes as compared with nerve transfers and nerve grafts. (10.1177/15589447221150516)
  • [L4] The case demonstrates spontaneous recovery of radial nerve function following axonamonosis caused by impingement from distal locking screws, suggesting that this phenomenon may be more common than previously assumed and that the risk could be reduced by using a mini-open method during screw insertion. (10.1111/sae.12018)
  • [L4] If pin insertion is required more proximal than the distal 15% of the humeral shaft, an open procedure or preoperative radiographic assessment is advised to prevent iatrogenic radial nerve injury. (10.1186/s12891-023-06474-y)
  • [L4] Complications associated with reconstructive elbow surgery persist, often leading to profound and sometimes nonsalvageable disability, with aseptic loosening, infection, and periprosthetic fracture being the most devastating problems. (10.5435/00124635-201106000-00003)
  • [L4] Overall, we observed better outcomes in those who underwent nerve transfer versus tendon transfer procedures. (10.1016/j.jhsa.2019.12.009)
  • [L4] Nerve grafting for high radial nerve injury achieved relatively good wrist extension but poor thumb extension and is affected by certain prognostic factors. (10.1177/17531934221147651)
  • [L1] There were fewer nonunions in the operative group but more deep infections. (10.1016/j.jse.2020.05.030)
  • [L4] These injuries typically resolve within 3 months, and at the latest, 5 months after surgery. (10.1016/j.jse.2012.08.001)
  • [L4] Iatrogenic transient dysfunction of the radial nerve occurs in approximately 1 in 5 patients treated with lateral exposure, 1 in 9 with posterior exposure, and 1 in 25 with anterolateral exposure. (10.1016/j.jse.2015.07.012)

See Also

References

[1] Effect of Radial Nerve Release on Lateral Epicondylitis Outcomes: A Prospective, Randomized, Double-Blinded Trial. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.06.009

[2] Anatomical Study of the Surgical Approaches to the Radial Tunnel. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.03.009

[3] Radial Nerve Palsy Recovery With Fractures of the Humerus: An Updated Systematic Review. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-18-00142

[4] Compare the clinical value of two minimally invasive approaches to locating radial nerve in the posterior humeral approach. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06291-3

[5] Radial Tunnel Syndrome: Review and Best Evidence. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-23-00314

[6] High radial nerve entrapment neuropathy: an anatomical cadaver study and case report. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.02.060

[7] Transbrachioradialis Approach to the Radial Tunnel: An Anatomic Study of 5 Potential Compression Sites. HAND. 2018. DOI: 10.1177/1558944717750916

[8] Causes, symptoms, and treatments of nerve entrapments around the elbow: Current concepts. Journal of ISAKOS. 2024. DOI: 10.1016/j.jisako.2023.12.007

[9] Radial nerve recovery after thermal injury due to extruded cement during humeral revision in total elbow arthroplasty. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.10.002

[10] An Analysis of Results After Selective Tendon Transfers Through the Interosseous Membrane to Provide Selective Finger and Thumb Extension in Chronic Irreparable Radial Nerve Lesions. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.10.015

[11] Treatment of distal third humeral shaft fractures with posterior minimally invasive plate osteosynthesis (MIPO) with segmental isolation of the radial nerve: minimum one-year follow-up. JSES Reviews, Reports, and Techniques. 2024. DOI: 10.1016/j.xrrt.2023.08.006

[12] Treatment of Refractory Radial Sensory Neuroma With Function-Sparing Targeted Muscle Reinnervation to the Extensor Carpi Radialis Brevis. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2022.01.006

[13] The Relationship of the Superficial Radial Nerve and Its Branch to the Thumb to the First Extensor Compartment. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.12.004

[14] Radial nerve palsy after humeral revision in total elbow arthroplasty. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.08.012

[15] Outcomes of Nerve Reconstruction for Radial Nerve Injuries Based on the Level of Injury in 244 Operative Cases. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193409360283

[16] Posterior Interosseous Nerve Laceration Following Elbow Arthroscopy. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.05.036

[17] Radial Tunnel Syndrome. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.03.020

[18] Radial Nerve Injury During Double Plating of a Displaced Intercondylar Fracture. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.01.002

[19] Proximal anterolateral portals in elbow arthroscopy are safer for use relative to the radial nerve: a systematic review. Journal of ISAKOS. 2018. DOI: 10.1136/jisakos-2018-000205

[20] Radial tunnel syndrome: definition, distinction and treatments. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420953990

[21] Radial Nerve Transposition With Humeral Fracture Fixation. Clinical Orthopaedics & Related Research. 2003. DOI: 10.1097/01.blo.0000072470.32680.60

[22] Current Treatment of Radial Nerve Palsy Following Fracture of the Humeral Shaft. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.05.029

[23] Timing of surgery in peripheral nerve injury of the upper extremity. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241240867

[24] Direct Radial to Ulnar Nerve Transfer to Restore Intrinsic Muscle Function in Combined Proximal Median and Ulnar Nerve Injury: Case Report and Surgical Technique. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.04.013

[25] Preoperative nerve imaging using computed tomography in patients with heterotopic ossification of the elbow. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.12.030

[26] Conservative vs. operative treatment for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.01.072

[27] Transhumeral Anterior Radial Nerve Transposition to Simplify Anticipated Future Humeral Reconstruction. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.04.008

[28] Functional Deficit After Transfer of the Pronator Teres for Acquired Radial Nerve Palsy. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.01.012

[29] Incidence and operations of median, ulnar and radial entrapment neuropathies in Finland: a nationwide register study. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419886741

[30] Compression Neuropathy of the Radial Nerve Due to Ganglion Cysts. HAND. 2008. DOI: 10.1007/s11552-007-9083-x

[31] Compression of the radial nerve by the triceps muscle. The Journal of Bone & Joint Surgery. 1977. DOI: 10.2106/00004623-197759060-00022

[32] Radial and median nerves distal peripheral tension after reverse shoulder arthroplasty: a cadaveric study. JSES International. 2024. DOI: 10.1016/j.jseint.2024.03.013

[33] Modified Anterolateral Portals in Elbow Arthroscopy: A Cadaveric Study on Safety. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.06.012

[35] Surgically relevant anatomy of the axillary and radial nerves in relation to the latissimus dorsi tendon in variable shoulder positions: A cadaveric study. Shoulder & Elbow. 2019. DOI: 10.1177/1758573218825476

[36] Phrenic Nerve Transfer for Elbow Flexion and Intercostal Nerve Transfer for Elbow Extension. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.04.006

[37] The Role of the Musculocutaneous and Radial Nerves in Elbow Flexion and Forearm Supination: A Biomechanical Study. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408087036

[38] Radial nerve palsy. EFORT Open Reviews. 2016. DOI: 10.1302/2058-5241.1.000028

[39] Neurolysis of the Distal Superficial Radial Nerve for Dysaesthesia Due to Nerve Tethering. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193407087892

[40] Radial Nerve Palsy After Arthroscopic Anterior Capsular Release for Degenerative Elbow Contracture. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.11.021

[41] Low profile radial nerve palsy orthosis with radial and ulnar deviation. Journal of Hand Therapy. 2015. DOI: 10.1016/j.jht.2014.11.007

[42] The Needle-and-Knife Technique: A Safe Technique for Anterolateral Portal Placement in Elbow Arthroscopy. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967118817232

[43] A Fresh Cadaver Study on the Innervation of Brachioradialis and Extensor Carpi Radialis Longus Muscles. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2023.11.021

[44] An objective functional evaluation of the flexor carpi ulnaris set of triple tendon transfer in radial nerve palsy. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416651574

[45] Rerouting Extensor Pollicis Longus Tendon Transfer. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.01.018

[46] Innervation of the Elbow Joint and Surgical Perspectives of Denervation: A Cadaveric Anatomic Study. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.01.029

[47] Radial nerve injury associated with application of a hinged elbow external fixator: a report of 2 cases. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.11.012

[48] Utility of the superficial radial nerve as donor for grafting of ipsilateral forearm nerve defects. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418796753

[49] Outcomes Following Isolated Posterior Interosseous Nerve Neurectomy: A Systematic Review. HAND. 2017. DOI: 10.1177/1558944717692093

[50] Sural Nerve Autografts for High Radial Nerve Injury With Nine Centimeter or Greater Defects. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.10.004

[51] Course of the Radial Nerve in Relation to the Center of Rotation of the Elbow—The Need for a Rational Safe Zone for Lateral Pin Placement. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.03.019

[52] Functional restoration after early tendon transfer in high radial nerve paralysis. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410384696

[53] Tendon Transfers for Radial, Median, and Ulnar Nerve Palsy. Journal of the American Academy of Orthopaedic Surgeons. 2013. DOI: 10.5435/jaaos-21-11-675

[54] Customized Dynamic Splinting: Orthoses that Promote Optimal Function and Recovery after Radial Nerve Injury: A Case Report. Journal of Hand Therapy. 2007. DOI: 10.1197/j.jht.2006.11.013

[55] Superficial thrombophlebitis in the forearm leading to entrapment of the radial nerve branch: a first case report and literature review. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07545-4

[56] Complications and morbidity of the extended delto-pectoral approach in treating complex humeral shaft fractures with proximal metaphyseal extension using a long locking plate for internal fixation. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07915-y

[57] Tendon Transfers, Nerve Grafts, and Nerve Transfers for Isolated Radial Nerve Palsy: A Systematic Review and Analysis. HAND. 2023. DOI: 10.1177/15589447221150516

[58] Spontaneous Recovery of Radial Nerve Function Following Axonamonosis Caused by Impingement from Distal Locking Screws during Humeral Nailing. Shoulder & Elbow. 2013. DOI: 10.1111/sae.12018

[59] Anatomic consideration of the radial nerve in relation to humeral length for unilateral external fixation: a retrospective study using magnetic resonance imaging findings in korean. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06474-y

[60] Complications of Total Elbow Arthroplasty. American Academy of Orthopaedic Surgeon. 2011. DOI: 10.5435/00124635-201106000-00003

[61] Nerve Versus Tendon Transfer for Radial Nerve Paralysis Reconstruction. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.12.009

[62] Outcomes and prognostic factors for nerve grafting following high radial nerve injury. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934221147651

[63] Operative versus nonoperative treatment of humeral shaft fractures: a systematic review and meta-analysis. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.05.030

[64] Prognosis for recovery of posterior interosseous nerve palsy after distal biceps repair. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.08.001

[65] Factors associated with radial nerve palsy after operative treatment of diaphyseal humeral shaft fractures. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.07.012

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