Supinator entrance

Patient, woman 40 years old veterinarian, presenting with decreased strength at extension of dig 4+5. Problems controlling finger movement, lifting a cup etc. No sensory symptoms. Some pain in hypothenar region and forearm. Standard electroneurography of median and ulnar nerve shows normal findings and excludes ulnar nerve entrapment. First electromyography shows findings of demyelinating changes in radial nerve innervated muscles with no clearly identifiable level of impact.

According to the patient she had done an MR scan wich did not show any findings of radial nerve entrapment.

Patient is referred for the third time for a neurophysiological examination. Referring handsurgeon wants to decompress the nerve relatively quickly if the symptoms remain. He is wondering where exactly is the radial nerve inflected. If there is any other neurophysiological exam that can be done. He considers the possibility that the patient might get better from antiinflammatory treatment so that surgery can be avoided.

Electroneurography of the radial nerve shows normal sensory conduction velocity and reduced motor conduction velocity of 38 m/s. Electromyography confirms as seen before an injury to the radial nerve. The location is described to be below triceps innervating nerve branches. The suggestion is made to do echoneurography, wich you can see below.

Short axis view. Radial nerve entrapment at proximal radial tunnel, passing through arcade of Frohse, supinator entrance. Images show increased density in the area and a hypoechogenic structure that crosses the radial nerve at the supinator entrance. Possibly a ganglion of the radiocapitallar joint. Exam 4-5 months after symptom debut.

Short to long axis in plane rotation.

Normal passage through arcade of Frohse, supinator entrance. Same patient, opposite arm. Short axis view.

Supinator entrance

Patient, woman 40 years old veterinarian, presenting with decreased strength at extension of dig 4+5. Problems controlling finger movement, lifting a cup etc. No sensory symptoms. Some pain in hypothenar region and forearm. Standard electroneurography of median and ulnar nerve shows normal findings and excludes ulnar nerve entrapment. First electromyography shows findings of demyelinating changes in radial nerve innervated muscles with no clearly identifiable level of impact.

According to the patient she had done an MR scan wich did not show any findings of radial nerve entrapment.

Patient is referred for the third time for a neurophysiological examination. Referring handsurgeon wants to decompress the nerve relatively quick if the symptoms remain. He is wondering where exactly is the radial nerve inflected. If there is any other neurophysiological exam that can be done. He considers the possibility that the patient might get better from antiinflammatory treatment so that surgery can be avoided.

Electroneurography of the radial nerve shows normal sensory conduction velocity and reduced motor conduction velocity of 38 m/s. Electromyography confirms as seen before an injury to the radial nerve. The location is described to be below triceps innervating nerve branches. The suggestion is made to do echoneurography, wich you can see below.

Short axis view. Radial nerve entrapment at proximal radial tunnel, passing through arcade of Frohse, supinator entrance. Images show increased density in the area and a hypoechogenic structure that crosses the radial nerve at the supinator entrance. Possibly a ganglion of the radiocapitallar joint. Exam 4-5 months after symptom debut.

Short to long axis in plane rotation.

Normal passage through arcade of Frohse, supinator entrance. Same patient, opposite arm. Short axis view.

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