radial nerve
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Ztráta funkce radiálního nervu způsobuje významné omezení při používání ruky. Pacient není schopný extendovat zápěstí, natáhnout prsty a palec, a proto má velké potíže s úchopem předmětů. Právě ztráta schopnosti úchopu předmětů a slabá síla stisku v důsledku ztráty extenze zápěstí jsou největší handicapy, které pacienti pociťují. V případech, kdy je efekt rekonstrukcí nervu zatížen horšími funkčními výsledky by měl být součástí těchto procedur i šlachový transfer, který eliminuje případné negativní výsledky regenera¬ce nervu.
Loss of radiál nerve function causes significant limitation of hand usage. A patient is not able to extend the- ir wrist, fingers and thumbs, and consequently has great problems gripping objects. Gripping objects and poor grip strength, as a result of extension loss in the wrist, are the most difficult handicaps for the patient. In cases where the effect of nerve reconstructions implies worse functional results, a tendon transfer - which eliminates the potential negative results of nerve restoration - should be carried out as part of these proce- dures.
- MeSH
- časná diagnóza MeSH
- lidé MeSH
- nervový transfer metody využití MeSH
- nervus radialis chirurgie patofyziologie patologie MeSH
- obnova funkce fyziologie MeSH
- paréza etiologie chirurgie terapie MeSH
- pohyb fyziologie MeSH
- poranění ruky chirurgie terapie MeSH
- přenos šlachy klasifikace metody využití MeSH
- Check Tag
- lidé MeSH
Práce popisuje případ parézy radiálního nervu, vzniklé v souvislosti s tvorbou pakloubu po zlomenině humeru. Vývoj hypertrofického pakloubu byl zapříčiněn nekvalitně provedenou osteosyntézou a biomechanickými podmínkami neumožňujícími zhojení kosti. Současným operačním řešením pakloubu s deliberací radiálního nervu bylo dosaženo vynikajícího funkčního výsledku. Přestože parézy radiálního nervu vzniklé při úrazu nebo při manipulaci s úlomky jsou známou komplikací zlomenin pažní kosti, případy paréz pozdních patří mezi případy raritní.
This is a case of late-onset radial nerve palsy associated with the nonunion of the humeral shaft. Nonunion formation was caused by insufficient osteosynthesis and lack of proper biomechanical conditions for fracture healing. A good final outcome was achieved by simultaneous surgical treatment both nonunion of the humerus and radial nerve palsy. Radial nerve palsy presenting without delay after trauma or after reduction is well known complication of the humeral fracture. Case of late-onset palsy is very rare.
- Klíčová slova
- pakloub, zlomenina,
- MeSH
- fraktury humeru chirurgie komplikace radiografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nervus radialis MeSH
- neuropatie nervus radialis etiologie MeSH
- nezhojené fraktury chirurgie komplikace radiografie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
INTRODUCTION: The superficial branch of the radial nerve (SBRN) and the lateral antebrachial cutaneous nerve (LACN) are sensory nerves coursing within the forearm in a close relationship. This high degree of overlap and eventual communication between the nerves is of great surgical importance. The aim of our study is to identify the communication pattern and overlap of the nerves, to localize the position of this communication in relation to a bony landmark, and to specify the most common communication patterns. MATERIALS AND METHODS: One hundred and two adult formalin-fixed cadaveric forearms from 51 cadavers of Central European origin were meticulously dissected. The SBRN, as well as the LACN, were identified. The morphometric parameters concerning these nerves, as well as their branches and connections, were measured with a digital caliper. RESULTS: We have described the primary (PCB) and secondary communications (SCB) between the SBRN and the LACN and their overlap patterns. One hundred and nine PCBs were found in 75 (73.53%) forearms of 44 (86.27%) cadavers and fourteen SCBs in eleven hands (10.78%) of eight cadavers (15.69%). Anatomical and surgical classifications were created. Anatomically, the PCBs were classified in three different ways concerning: (1) the role of the branch of the SBRN within the connection; (2) the position of the communicating branch to the SBRN; and (3) the position of the LACN branch involved in the communication to the cephalic vein (CV). The mean length and width of the PCBs were 17.12 mm (ranged from 2.33 to 82.96 mm) and 0.73 mm (ranged from 0.14 to 2.01 mm), respectively. The PCB was located proximally to the styloid process of the radius at an average distance of 29.91 mm (ranged from 4.15 to 97.61 mm). Surgical classification is based on the localization of the PCBs to a triangular zone of the SBRN branching. The most frequent branch of the SBRN involved in the communication was the third (66.97%). Due to the frequency and position of the PCB with the third branch of the SBRN, the danger zone was predicted. According to the overlap between the SBRN and the LACN, we have divided 102 forearms into four types: (1) no overlap; (2) present overlap; (3) pseudo-overlap; and (4) both present and pseudo-overlap. Type 4 was the most common. CONCLUSION: The patterns of communicating branch arrangements appeared to be not just a rare phenomenon or variation, but rather a common situation highlighting clinical importance. Due to the close relationship and connection of these nerves, there is a high probability of simultaneous lesion.
We report the case of a 55-year-old woman with a 6-month history of progressive paresis of the right radial nerve. Perioperative imaging detected a spindle-shaped expansion of the radial nerve caused by an isolated local deposit of amyloid (amyloidoma). The deposit was resected in 2 phases and the resulting defect was bridged by a sural nerve autograft. Overall internal and hematological examination did not reveal systemic amyloidosis or lymphoproliferative disorder. The reason for our report is that localized forms of amyloid neuropathy are very rare.
Transection of the radial nerve is frequently associated with humeral shaft fractures that are part of a very complex upper extremity injury. In the presented case, a 19-year-old man with a 10-cm radial nerve defect with a need for nerve grafting to recover complete sensory and motor deficit of the radial nerve. In our case, at the same time we provided the tendon transfer of musculus (m.) pronator teres to m. extensor carpi radialis brevis, m. flexor carpi ulnaris to m. extensor digitorum communis, m. palmaris longus to m. extensor pollicis longus, and long sural nerve graft because of an extensive zone of the injury. The assumption was that if these two procedures are performed in one surgery, it will accelerate overall recovery, restore the functionality of the upper limb more quickly, and thus enable a faster recovery.
- MeSH
- autologní transplantace metody MeSH
- fraktury humeru chirurgie terapie MeSH
- horní končetina chirurgie diagnostické zobrazování patologie zranění MeSH
- kosterní svaly chirurgie transplantace MeSH
- lidé MeSH
- mladý dospělý MeSH
- nervus radialis * chirurgie patologie transplantace MeSH
- nervus suralis chirurgie transplantace MeSH
- neurochirurgické výkony metody MeSH
- přenos šlachy metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
