Lateral intermuscular septum as cause of radial nerve compression: case report and review of the literature

Abstract

Multiple sites of compression of the radial nerve have been described, some more commonly than others. In this case report we describe a case of radial nerve compression at the lateral intermuscular septum in a patient with a history of open reduction and internal fixation of a mid-shaft humerus fracture 10 years prior. To our knowledge, only one previous case of chronic radial nerve compression by the lateral intermuscular septum associated with a humeral shaft fracture has been described. Our patient’s clinical presentation with specific electrodiagnostic abnormalities, operative findings and post-operative symptom relief point towards the rare diagnosis of compression of the radial nerve at the level of the lateral intermuscular septum as the cause of his symptoms.

Apraxia severa por atrapamiento del nervio radial en el brazo: “síndrome de Lotem”. Presentación de un caso

“…En este caso, la ubicación y el tipo de dolor neurítico deberían guiar el diagnóstico. Adolfsson y Nettelblad, 12 en 1999, y Bowman y cols., 13 en 2018, publicaron series de casos sin antecedentes de traumatismo, con sensibilidad local aumentada, sensación de hormigueo y dolor que se incrementaba a la percusión del nervio radial (signo de Tinel) en el extremo lateral distal del brazo, pero sin clínica o signos subjetivos de debilidad muscular. Finalmente, fueron tratados mediante descompresión quirúrgica del nervio radial en el canal proximal al tabique intermuscular lateral, con resultados exitosos.…”

Radial nerve compression: anatomical perspective and clinical consequences

“…It separates the arm into anterior and posterior compartments. Because the RN is in direct contact with the LIMS as it descends along the arm, the LIMS can be considered a potential source of entrapment [31]. Compression caused by the LIMS can be either atraumatic or can follow a history of trauma.…”

“…In such situations, the onset of symptoms can be either immediate or delayed by months or even years after the incident. Bowman et al described patients who suffered mid-shaft humerus fractures that resulted several years later in chronic anterolateral pain in the arm [31]. There were no motor deficits or pathological sensations.…”

Transient Exertional Compressive Radial Neuropathy in a Collegiate Baseball Pitcher

“…The radial nerve passes through the lateral intermuscular septum approximately 10 cm from the lateral epicondyle of the elbow 9 . There have previously been 2 reported cases of chronic compressive neuropathy of the radial nerve at the lateral intermuscular septum secondary to previous trauma 10,11 . In addition, previously documented reports of atraumatic compression at this site showed improvement after surgical decompression 12 .…”

“…We report an unusual case of a collegiate baseball pitcher with pain and wrist extension weakness after short periods of pitching, consistent with an exertional compressive neuropathy of the radial nerve where it pierces the lateral intermuscular septum. Compressive neuropathy of the radial nerve can result as a consequence of trauma, such as a diaphyseal humerus fracture [10][11][12] , but can also occur without trauma, as a result of repetitive elbow extension and triceps contraction, in particular the lateral head, leading to pain and weakness 13,14 . In this case, symptoms of pain and weakness occurred only transiently with overhead pitching activities.…”