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PIN vs. Radial Nerve Palsy

Catherine Curtin Associate Professor Plastic Surgery

Radial Nerve Anatomy

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Arm

Forearm

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Radial Nerve Palsy

! Loss of wrist and finger extension

! Loss of suppinator

! Triceps intact

Etiology

! Saturday night palsy ! After humeral fracture ! Other misadventure

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Humeral Fracture

! Fracture itself ! Retractors ! Intra-operative laceration ! Nerve caught in fracture or plate

Closed Humeral Fracture

! Many improve with time (60-90%) ! Watch for clinical improvement ! Serial Nerve Studies ! Operative exploration if no sign of

recovery 3-6 months

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Open Humeral Fracture

! Early exploration of the nerve ! Nerve grafting often required ! Outcomes poor for high energy injuries

PIN Palsy

! Motor palsy ! Loss of finger

extension ! Sensation, wrist

extension intact, suppinator

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PIN Pathology

! Elbow arthroscopy ! Distal biceps repair ! Elbow pathology

– Cyst – Lipoma

www.ejradiology.com376 × 500

Supportive Care

! Wrist splints – Simple – Elaborate – Both

! Prevention of contractures

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Surgical Treatment Acute

! Fix the nerve ! Nerve

transfers

Nerve transfers from branches to the flexor carpi radialis and pronator teres to reconstruct the radial nerve. García-López A, Navarro R, Martinez F, Rojas A. J Hand Surg Am. 2014 Jan;39(1):50-6

Tendon Transfers

! Re-route what is expendable to what you need

! PT-ECRB ! FCR or FCU to EDC ! PL or FDS to EPL

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Tendon Transfers

http://img.medscape.com/pi/emed/ckb/plastic_surgery/1271089-1288130-1838.jpg

Post-operative course

! Splint/Cast 3-4 weeks ! Protect repairs for six weeks ! Then advance activity

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Pearls

! Pronator Teres transfer often the weakest ! Some people starting early active motion ! Relies on brain plasticity

Nerve Compression Radial tunnel

! Quick Things I learned in Sweden – Point tenderness – +Scratch Collapse test – Weakness of ECU

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Thank You