Peripheral nerve palsy by torsional nerve injury

Peripheral nerve palsy caused by torsional nerve injury is rare. Only a few patients have been reported in the literature. The etiology of this type of nerve lesion is poorly understood.

To report on 5 patients presenting with peripheral nerve palsy caused by a torsional nerve injury.

Five patients presented with 6 upper peripheral nerve palsy involving the axillary nerve (n = 2), musculocutaneous nerve (n = 2), radial nerve (n = 1), and suprascapular nerve (n = 1). There was no history of trauma in 3 patients, but in the other 2 patients, nerve palsy occurred after a traumatic event. Because of a lack of spontaneous recovery, surgical exploration was performed. Torsion of the whole nerve (n = 5) or only 1 fascicle (n = 1) was found. Epifascicular epineurectomy and detorsion, as well as resection of the torsion site with subsequent primary nerve suture, were performed in 3 lesions.

Good to excellent recovery of motor function was achieved in all 5 patients. In the last patient who presented with 2 nerve torsions, the follow-up period after the last surgery is too short to allow evaluation.

Although not a frequent event, torsional nerve injury should be taken into consideration when dealing with peripheral nerve injuries. Surgical exploration with detorsion or suture results in good recovery.