Ultrasound-guided needle release plus corticosteroid injection of superficial radial nerve:A case report

BACKGROUND The radial nerve(RN)splits into two main branches at the elbow:The superficial branch of RN(SBRN)and the deep branch of RN.The SBRN can be easily damaged in acute trauma due to its superficial feature.CASE SUMMARY A 55-year-old male patient injured his right wrist 10 mo ago.Debridement,suturing and bandaging were performed in the emergency room.Six months after the scar had healed,he felt numbness and tingling in the dorsal surface of the thumb of the right hand.So the surgery of resection and SBRN anastomosis were performed.The pathological findings showed it as traumatic neuroma.Four months after surgery,the patient felt numbness and tingling in the right dorsal surface of the thumb again.The tenderness was marked in the operated area.Ultrasound indicated that the SBRN was adhered to the surrounding tissue.The patient refused further surgical treatment and underwent ultrasound-guided needle release plus corticosteroid injection of the SBRN.Four weeks later,the tenderness in the surgical area was reduced by 70%,the numbness in the dorsal surface of the thumb of the right hand was reduced by 40%and the nerve swelling evaluated by ultrasound was reduced.Four months passed,he did not feel any numbness or tingling sensation of his right wrist.This is the first report of ultrasound-guided needle release plus corticosteroid injection of the SBRN.CONCLUSION Ultrasound can evaluate the condition of the RN,and the relationship with surrounding tissues.Ultrasound-guided needle release plus corticosteroid injection is an effective and safe treatment for SBRN adhesion.

Fifty two cases of entrapment syndrome of superficial radial nerve treated with short thrust needling at Shànglián(上廉LI 9)

Objective: To observe the clinical therapeutic effects on entrapment syndrome of superficial radial nerve treated with the short thrust needling at Shànglián(上廉LI 9).Methods: A total of 52 patients of entrapment syndrome of superficial radial nerve were treated with the short thrust needling at LI 9. Firstly, the needle was inserted gradually and deeply until the needle tip touched the radial periosterum. Secondly, the needle body was tilted to form an angle about 30° with the skin surface. Thirdly, the needle handle was lifted and trusted shortly and swiftly to induce the gentle rubbing of the needle tip on the periosterum. The stimulation intensity of this needling technique was determined by the obvious soreness and distention in the local area or the needling sensation radiated to the radial sides of the thumb, the index figure and the middle figure of the affected limb. Afterward, the needle was retained for 20 min. The treatment was given once a day, five treatments made one course and a total of 2 courses of treatment were required.Results: Of 52 cases, 50 cases were cured, accounting for 96.2% and 2 cases remarkably effective, accounting for 3.8%. The mean conduction velocity of the superficial radial nerve was(49.38 ±2.97) m/s after treatment, faster than(29.31 ±5.94) m/s before treatment, indicating the significant difference(P< 0.05).Conclusion: The short thrust needling at LI 9 achieves the satisfactory clinical therapeutic effects on entrapment syndrome of superficial radial nerve. This therapeutic method is feasible to be promoted in clinical practice because of its less point selection and short treatment course.

Anatomic location of the first dorsal extensor compartment for surgical De-Quervain’s tenosynovitis release:A cadaveric study

BACKGROUND De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidates for surgical release.However,risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection.Currently,there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy.Thus,this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications.AIM To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions.METHODS Six cadaveric forearms,including four left and two right forearm specimens were dissected.Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon.Distance of the first dorsal compartment from landmarks such as Lister’s tubercle,the wrist crease,and the radial styloid were calculated.Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment,additional compartment subsheaths,number of abductor pollicis longus(APL)tendon slips,and the presence of a pseudo-retinaculum.RESULTS Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm±0.80 mm.The distance from Lister’s tubercle to the distal aspect of the extensor retinaculum was 13.37 mm±2.94 mm.Lister’s tubercle to the start of the first dorsal compartment was 18.43 mm±2.01 mm.The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm±0.99 mm.The retinaculum length longitudinally on average was 26.82 mm±3.34 mm.Four cadaveric forearms had separate extensor pollicis brevis compartments.The average number of APL tendon slips was three.A pseudo-retinaculum was present in four cadavers.Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally(7.03 mm and 13.36 mm).CONCLUSION An incision that measures 3 mm proximal from the radial styloid,2 cm radial from Lister’s tubercle,and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.