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Nerve Ultrasound Protocol to Detect Dysimmune Neuropathies

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An Unusual Radial Neuropathy.

Greg Ernst, Mark Bagg

The Journal of Orthopaedic and Sports Physical Therapy

|July 2, 2019

Summary

A young woman experienced forearm pain and wrist drop due to radial neuropathy. Further testing revealed nerve compression between the triceps muscle heads, impacting wrist extension.

Area of Science:

Orthopaedic Surgery
Neurology
Sports Medicine

Background:

Radial neuropathy can present with insidious onset forearm pain, wrist drop, and sensory deficits.
Accurate diagnosis is crucial for effective management and recovery.

Observation:

A 23-year-old woman presented with left forearm pain, inability to extend the wrist, and dorsal hand numbness.
Initial electromyography (EMG) and nerve conduction studies (NCS) indicated radial neuropathy.
Magnetic resonance imaging (MRI) showed wrist extensor muscle edema and atrophy without a clear compressive lesion.

Findings:

A second, detailed EMG/NCS identified severe radial motor and sensory neuropathy.
Nerve compression was localized between the lateral and long heads of the triceps muscle.

Keywords:

EMG arm electromyogram magnetic resonance imaging nerve conduction study radial neuropathy

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Implications:

This case highlights the importance of comprehensive electrodiagnostic testing for diagnosing radial neuropathy.
Identifying specific compression sites, like within the triceps, is vital for targeted orthopaedic and surgical interventions.
Early and accurate diagnosis can prevent long-term functional deficits associated with radial nerve damage.