Neurolysis of the Distal Superficial Radial Nerve for Dysaesthesia Due to Nerve Tethering

Abstract

The subcutaneous course of the superficial radial nerve over the radial border of the wrist and hand renders it very susceptible to injury. Both traumatic and iatrogenic injury can produce tethering of this nerve, presenting as dysaesthesia. This study was designed to evaluate the efficacy of neurolysis of the distal superficial radial nerve for this condition. Twenty-five cases of tethered superficial radial nerves underwent neurolysis. At final follow-up (mean 3.5 years), fourteen cases reported symptomatic resolution while eleven continued to experience dysaesthesia. Intra-operatively, evidence of external abnormality, scarring, or compression was identified in only six cases, and its presence did not correlate with symptomatic outcome. Although the majority of patients were improved postoperatively, the success rate was lower than anticipated. Therefore, while neurolysis of the superficial radial nerve offers the opportunity for pain relief, it does not reliably produce success.

Adult Scaphoid Fracture

“…12 Deep palpation in the uninjured wrist can elicit pain, so the examiner should compare responses to bilateral examination, but radial sensory nerve findings can usually be distinguished from scaphoid pain. 13 The anatomical snuffbox is the groove between the tendons of the extensor pollicis longus on the ulnar side and the extensor pollicis brevis and abductor pollicis longus on the radial side. Alternatively, pain with digital pressure over the scaphoid tubercle may indicate scaphoid fracture.…”

Application of free temporoparietal fascial flap for recurrent neural adhesion of superficial radial nerve—A case report

“…The superficial radial nerve is susceptible to neural disorder due to its anatomical location . While it is well known that neuroma formation causes symptoms such as radiating pain, neural adhesion against surrounding scar tissue can elicit pain as well . The pathophysiology of neural adhesion is characterized by not only mechanical stress due to scar tissue and the ischemic condition of the nerves, but also by nerve traction caused by loss of smooth gliding during neighboring joint motion.…”

“…Definitive diagnostic criteria for neural adhesion have not yet been established and thus diagnosis might be difficult clinically. Some surgeons have reported that recurrent adhesion after neurolysis is not uncommon, but great care should be taken in operations for neurolysis because of the unreliable outcomes …”

“…The superficial radial nerve is vulnerable to trauma as well as injury during various surgical procedures such as those for de Quervain's disease and distal radius fracture because the nerve runs subcutaneously. [1][2][3][4][5][6][7] Neural adhesion of superficial radial nerve sometimes occurs when scar tissue adheres to the damaged nerve. This condition is characterized by dysesthesia and pain radiating to the nerve-innervated area during wrist and thumb motion.…”

“…Some surgeons have reported that recurrent adhesion after neurolysis is not uncommon, but great care should be taken in operations for neurolysis because of the unreliable outcomes. 1,12 We describe our experience performing neurolysis followed by nerve coverage using a free temporoparietal fascial (TPF) flap for recurrent neural adhesion of the superficial radial nerve in a patient who had had multiple reconstructive operations on the left forearm.…”