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Atraumatic proximal radial nerve entrapment. Illustrative cases and systematic review of literature

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The aims of the present study were to describe atraumatic proximal radial nerve entrapment (PRNE) and potential strategies for management.

Materials and methods

We performed a comprehensive search of 4 electronic databases for studies pertaining to patients with atraumatic PRNE. Studies published between 1930 and 2020 were included. Clinical presentation, nerve conduction studies, electromyography, and treatment methods were reviewed. In order to outline management strategies, 2 illustrative cases of acute PRNE were presented.

Results

We analyzed 12 studies involving 21 patients with 22 PRNE (15 acute and 7 progressive). Sudden or repetitive elbow extension with forceful muscle contraction (n = 16) was the primary mechanism of injury. The two main sites of entrapment were the fibrous arch (n = 7) and hiatus of the lateral intermuscular septum (n = 7). Conservative treatment was performed in 4 patients and allowed for complete clinical recovery in all cases. The remaining 18 patients underwent epineurolysis (n = 16) or resection/repair of hourglass-like constriction (n = 2) between 1.5- and 120-months following diagnosis. Twelve patients experience complete recovery, while partial or no clinical recovery was reported in 1 and 4 cases, respectively; the outcome was unknown in 1 case.

Conclusions

Atraumatic PRNE is rare and remains challenging with respect to diagnosis and treatment. Current literature suggests that primary sites of entrapment are the fibrous arch and hiatus of the radial nerve at the time of forceful elbow extension.

Level of evidence

Case series (IV) & systematic review (I)

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Abbreviations

PRNE:

Atraumatic proximal radial nerve entrapment

HRN:

Hiatus for the radial nerve

NCS/EMG:

Nerve conduction studies/electromyography

MR:

Magnetic resonance

US:

Ultrasound

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Acknowledgements

We thank the society KeriMedical (Genève, Suisse), which funded the figure 5 of the present study.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not for profit sectors. None of the authors, or any member of their family, have received any financial remuneration related to the subject of the article.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Hôpital Pellegrin, Place Amélie Raba-léon 33076, 33000, Bordeaux, France

    Pierre Laumonerie

  2. Department of Orthopedics and Hand Surgery, Saint Antoine Hospital, 75012, Paris, France

    Benjamin Dufournier

  3. Department of Orthopedics, Hôpital Pierre-Paul Riquet, 31059, Toulouse, France

    Nicolas Vari, Ophélie Manchec & Pierre Mansat

  4. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA

    Meagan E. Tibbo

  5. Department of Neurology, Hôpital Pierre-Paul Riquet, 31059, Toulouse, France

    Pascal Cintas

  6. Department of Radiology, Hôpital Pierre-Paul Riquet, 31059, Toulouse, France

    Marie Faruch-Bifeld

Authors
  1. Pierre Laumonerie
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  2. Benjamin Dufournier
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  3. Nicolas Vari
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  6. Pascal Cintas
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  7. Pierre Mansat
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  8. Marie Faruch-Bifeld
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Contributions

LP: Data analysis and interpretation, critical revisions, manuscript review, statistical analysis, Study design, study supervision, technical and material support; DB: Data acquisition, Data analysis and interpretation; TME: Data analysis and interpretation, critical revisions, manuscript review; VN: Data acquisition. MO: Data acquisition; CP: Data acquisition., Study design, data analysis and interpretation, critical revisions, manuscript review, administration, technical and material support; MP: Critical revisions, manuscript review; FBM: Critical revisions, manuscript review, administration, technical and material support.

Corresponding author

Correspondence to Pierre Laumonerie.

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The authors report no conflicts of interest with respect the materials or methods used in this study or the findings specified herein.

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Laumonerie, P., Dufournier, B., Vari, N. et al. Atraumatic proximal radial nerve entrapment. Illustrative cases and systematic review of literature. Eur J Orthop Surg Traumatol 32, 811–820 (2022). https://doi.org/10.1007/s00590-021-03037-6

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  • DOI: https://doi.org/10.1007/s00590-021-03037-6

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