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PIN vs. Radial Nerve Palsy
Catherine Curtin Associate Professor Plastic Surgery
Radial Nerve Anatomy
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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