Radial nerve palsy in an elite bodybuilder

Abstract

A case is reported of high radial nerve palsy in an elite bodybuilder caused by an extrinsic mass effect of muscular hypertrophy. Surgical decompression resulted in complete clinical resolution. P eripheral compressive neuropathies of the arm are common, and a thorough understanding of the anatomy, pathophysiology, and clinical correlation are required for diagnosis and prognosis. Nerve compressions may be acute or chronic, and may remain mild or result in considerable disability, depending on the mechanism of the injury and the extent of the insult to the nerve. The latter also dictates the prognosis of nerve recovery.We report a unique case of high radial nerve palsy in an elite bodybuilder caused by an extrinsic mass effect of muscular hypertrophy, with complete clinical resolution after surgical decompression. We believe that this is the first report of such an injury in a bodybuilder. CASE REPORTA 45 year old, right handed, elite, male bodybuilder presented with a two week history of gradual onset of spontaneous right wrist drop. There was no evidence of recent trauma to the brachial plexus, upper arm, or forearm to account for the condition. Past medical history included left sided carpal tunnel syndrome, which resolved spontaneously in six months. Physical examination showed considerable wasting of the brachioradialis muscle, loss of the extensor carpi radialis and extensor carpi ulnaris, loss of digital extensors, and loss of the extensor pollicis longus and abductor pollicis longus. The triceps were preserved clinically. Plain radiography did not show any sinister bony and soft tissue lesion. A nerve conduction study showed severe acute motor denervation of muscles innervated by the right radial nerve, suggesting a lesion around the spiral groove. In view of spontaneous recovery of a previous compressive neuropathy without surgical intervention, a similar approach of conservative treatment was started with non-steroid anti-inflammatory drugs and physiotherapy. He was reviewed again after three months; no improvement was found. Magnetic resonance imaging of the right arm did not show any abnormal soft tissue mass, with a normal appearance of the humeral cortex and marrow signal. As no recovery was noted after four months, exploration of the right radial nerve was planned. The patient was placed in the lateral decubitus position, and a posterior longitudinal incision ( fig 1) was made. The radial nerve was identified after entering the interval between the long and lateral heads of the triceps. The raphe was incised in the usual manner to expose the nerve. The course of the nerve was traced proximally. There was a notable extensive venous engorgement of the comitantes vessels. The nerve was dissected proximally to the inferior edge of the teres major, which appeared to be constricting the underlying nerve. The aponeurotic edge of the muscle was incised 1.5 cm proximally allowing free passage of the examining digit into the triangular space until no extrinsic compression

Ultrasonographic Appearance of Idiopathic Radial Nerve Constriction Proximal to the Elbow

“…In fact, radial nerve compression can occur secondary to muscular overexertion through a fibrous arch coming from the lateral head of the triceps. 2,4,5 ; however, the manifestations are progressive and become more pronounced with the duration of muscle effort. The prognosis is usually good, with complete spontaneous recovery.…”

“…In addition, radial nerve palsy has also been reported after muscular overexertion as a result of compression by a fibrous arch coming from the long head of the triceps or from compression of the triceps in the absence of any defined fibrous arch. 5 During military rifle training, because of kneeling, radial nerve palsy has also been reported at the lateral border of the humerus, where the radial nerve pierces the lateral intermuscular septum. 3 Nerve compression is moderate when histopathologic studies report local demyelination with an intact axon.…”

Nerve entrapment as a cause of shoulder pain in the spinal cord injured patient

“…7,8 The etiology of compression is thought to be a combination of scarring from previous trauma/ and/or hypertrophy of the muscles bordering the space. 9 Therefore, it may be that SCI patients with their intense demands on their upper limbs develop hypertrophy and injuries similar to those of overhead throwing athletes.…”

Electrodiagnosis of Medial Pectoral Nerve Mononeuropathy

“…Anatomic studies have documented pectoralis minor insertions at sites including the coracoacromial ligament, superior glenoid margin, supraspinatus tendon, glenohumeral joint capsule, and humeral tuberosities [3][4][5] . Anomalous insertion of the Several cases of mononeuropathies in weightlifters and bodybuilders have been reported in the medical literature, including more commonly observed cases such as carpal tunnel syndrome 6 and suprascapular neuropathy, as well as unusual presentations such as thoracodorsal, dorsal scapular 1 , and proximal radial mononeorupathies 7 . Use of anabolic steroids and growth hormone may also predispose to the development of such problems and the evaluating clinician should inquire regarding the use of any such agents.…”