Treatment of Refractory Radial Sensory Neuroma With Function-Sparing Targeted Muscle Reinnervation to the Extensor Carpi Radialis Brevis

Cox, Hatcher G.; Gary, Cyril; Kleiber, Grant M.

doi:10.1016/j.jhsg.2022.01.006

Cited by 5 publications

(10 citation statements)

References 20 publications

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“…7 One case report discusses the successful use of TMR of the SRN in an end-to-side fashion into a motor branch of the PIN, 6 and a recent case series reports the management of painful neuroma of the SRN with TMR into a distal motor branch of the ECRB with compelling early improvement in the pain scores in all patients. 5 The technique described in this study uses TMR of the SRN into the nerve to supinator branches. The supinator motor branches are near the proximal SRN and deep in the forearm away from surface stimulation.…”

Section: Discussionmentioning

confidence: 99%

“…However, emerging evidence supports the potential use of TMR in the treatment of SRN neuromas. 5,6 Several recent studies have investigated possible TMR targets for SRN neuromas, with cadaver studies demonstrating the technical feasibility of performing TMR of the SRN into the terminal anterior interosseous nerve, 3,7 and into motor branches to the ECRL, ECRB, and BR. 7 One case report discusses the successful use of TMR of the SRN in an end-to-side fashion into a motor branch of the PIN, 6 and a recent case series reports the management of painful neuroma of the SRN with TMR into a distal motor branch of the ECRB with compelling early improvement in the pain scores in all patients.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…3 Although reports have demonstrated effectiveness of TMR in the management of a variety of upper extremity nerve injuries, few studies have reported the use of TMR for management of painful neuromas of the SRN. 3,4 Recent reports demonstrate promising early outcomes of TMR of the SRN to motor branches of the extensor carpi radialis brevis (ECRB) 5 and posterior interosseous nerve (PIN), 6 with cadaveric studies demonstrating technical feasibility of TMR of the SRN to the extensor carpi radialis longus and brevis (ECRL/ ECRB), brachioradialis (BR), and anterior interosseous nerve. 3,7 Although motor targets such as the BR, ECRL, or ECRB can be used, exposure of these motor targets can require surgery at or proximal to the elbow.…”

Section: Introductionmentioning

confidence: 99%

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Use of Supinator Motor Branches in Targeted Muscle Reinnervation of the Superficial Radial Nerve

Ferrin,

Hathaway,

Russo

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Summary: Symptomatic neuromas of the superficial radial nerve (SRN) can cause debilitating pain. Traditional surgical management options have demonstrated inconsistent outcomes prompting a search for alternatives. Recent reports have emerged on the use of targeted muscle reinnervation (TMR) for neuromas of the SRN using donors that are well established in hand surgery, such as the brachioradialis (BR) or extensor capri radialis longus or brevis. Use of the brachioradialis or extensor capri radialis longus motor targets can require surgery at or above the level of the antecubital fossa, and denervation of these muscle groups may be undesirable in cases of complex upper extremity injury where these donors may be needed for tendon or nerve transfer. The supinator is an expendable and often overlooked donor nerve that has not been assessed as a target for TMR of the SRN. In this case series, three patients with SRN neuromas whose conservative management failed and who did not have an SRN lesion amenable to reconstruction were managed with TMR to the nerves to supinator. At latest follow-up (9–22 months), no patients had deficits in supination or evident donor site morbidity. Two patients reported complete resolution of their SRN neuroma pain, and one patient reported partial improvement. This case series reports early results of TMR of the SRN using nerves to supinator in cases of SRN neuromas not amenable to reconstruction, demonstrating technical feasibility, improvements in neuroma pain, and no discernible donor morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Use of Supinator Motor Branches in Targeted Muscle Reinnervation of the Superficial Radial Nerve

Ferrin,

Hathaway,

Russo

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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“…When a single nerve branch is present to innervate an entire muscle, the function of the muscle is sacrificed when it is used as donor target for TMR. It is possible to use the secondary nerve branches as the target for TMR, as was done in a study by Gox et al 20 They performed TMR of the SRN to the ERCB by using the most distal secondary branch to the ERCB muscle in six patients. Patients’ preoperative visual analogue scale pain scores ranged from 7 to 10, and their postoperative scores ranged from 0 to 4.…”

Section: Discussionmentioning

confidence: 99%

“Anatomy of the superficial radial nerve and its target nerves for targeted muscle reinnervation: an anatomical cadaver study”

Langeveld

Bruin

Hundepool

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Targeted muscle reinnervation (TMR) is a surgical procedure for treating symptomatic neuroma, in which the neuroma is removed and the proximal nerve stump is coapted to a donor motor branch innervating a nearby muscle. This study aimed to identify optimal motor targets for TMR of the superficial radial nerve (SRN). Methods: Seven cadaveric upper limbs were dissected to describe the course of the SRN in the forearm and motor nerve supply—number, length, diameter, and entry points in muscle of motor branches—for potential recipient muscles. Results: The radial nerve provided three (three of six) motor branches, two (two of six) motor branches, or one (one of six) motor branch to the brachioradialis muscle, entering the muscle 21.7 ± 17.9 to 10.8 ± 15 mm proximal to the lateral epicondyle. One (one of seven), two (three of seven), three (two of seven), or four (one of seven) motor branches innervated the extensor carpi radialis longus muscle, with entry points 13.9 ± 16.2 to 26.3 ± 14.9 mm distal from the lateral epicondyle. In all specimens, the posterior interosseous nerve gave off one motor branch to the extensor carpi radialis brevis, which divided into two or three secondary branches. The distal anterior interosseus nerve was assessed as a potential recipient for TMR coaptation and had a freely transferable length of 56.4 ± 12.7 mm. Conclusions: When considering TMR for neuromas of the SRN in the distal third of the forearm and hand, the distal anterior interosseus nerve is a suitable donor target. For neuromas of the SRN in the proximal two-thirds of the forearm, the motor branches to the extensor carpi radialis longus, extensor carpi radialis brevis, and brachioradialis are potential donor targets.

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Neuromas cause severe residual problems at long-term despite surgery

Dahlin,

Gudinge,

Dahlin

et al. 2023

Sci Rep

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Pain, and disabilities after neuroma surgery, using patient reported outcome measurements (PROMs), were evaluated by QuickDASH and a specific Hand Questionnaire (HQ-8). The 69 responding individuals (response rate 61%; 59% women; 41% men; median follow up 51 months) reported high QuickDASH score, pain on load, cold sensitivity, ability to perform daily activities and sleeping difficulties. Individuals reporting impaired ability to perform daily activities and sleeping problems had higher scores for pain, stiffness, weakness, numbness/tingling, cold sensitivity and QuickDASH. Only 17% of individuals reported no limitations at all. No differences were observed between sexes. Surgical methods did not influence outcome. Symptoms and disabilities correlated moderately-strongly to each other and to ability to perform regular daily activities as well as to sleeping difficulties. Pain, cold sensitivity, sleeping difficulties and limitation to perform daily activities were associated to higher QuickDASH. A weak association was found between follow up time and QuickDASH score as well as pain on load, but not cold sensitivity. A major nerve injury was frequent among those with limitations during work/performing other regular daily activities. Despite surgical treatment, neuromas cause residual problems, which affect the capacity to perform daily activities and ability to sleep with limited improvement in long-term.

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Treatment of Refractory Radial Sensory Neuroma With Function-Sparing Targeted Muscle Reinnervation to the Extensor Carpi Radialis Brevis

Cited by 5 publications

References 20 publications

Use of Supinator Motor Branches in Targeted Muscle Reinnervation of the Superficial Radial Nerve

Use of Supinator Motor Branches in Targeted Muscle Reinnervation of the Superficial Radial Nerve

“Anatomy of the superficial radial nerve and its target nerves for targeted muscle reinnervation: an anatomical cadaver study”

Neuromas cause severe residual problems at long-term despite surgery

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