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radial nerve exploration and decompression at the radial tunnel

  1. #1
    Default radial nerve exploration and decompression at the radial tunnel
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    any suggestions on this?

    Radial nerve compression, right elbow (radial tunnel syndrome).

    POSTOPERATIVE DIAGNOSIS: Radial nerve compression, right elbow (radial tunnel syndrome).

    PROCEDURE: Radial nerve exploration and decompression at radial tunnel, right elbow.

    ANESTHESIA: General.

    INDICATIONS: This young woman has a history of radial tunnel symptomatology. She has undergo two previous injections into the radial tunnel with excellent short-term relief. Her EMG was negative for gross nerve damage. She presents now for surgical management after failed conservative treatment.

    DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed on the operating table in the supine position. After installation of successful general anesthesia, a high right brachial tourniquet was placed. The right arm was sterilely prepped and draped. The extremity was exsanguinated, and the brachial tourniquet was inflated to 275 mmHg.

    An anterolateral incision was made over the elbow, extending from the elbow flexion crease distally about 2-1/2 inches in length. This was carried through the skin only. The fascia overlying the extensor mass was then incised longitudinally. With the elbow in 30 degrees of flexion and nearly full supination, the extensor musculature was bluntly split heading directly posteriorly toward the radial neck region. Gentle blunt dissection was carried out until the radial nerve was identified. The sensory branch was carefully isolated and reflected. The underlying motor branches were then identified. Some vascular leashes crossing the nerve were carefully dissected and ligated. The nerve was gently mobilized from the area of the elbow joint, into the supinator region. The supinator muscle was split over the radial nerve and directly over the radial shaft where it appeared that the most compression was taking place.

    The tourniquet was deflated. Hemostasis was obtained, and the incision site was thoroughly irrigated. The subcutaneous tissue was closed with 3-0 Vicryl, and the skin closed with 4-0 Monocryl and Steri-Strips. The area was injected with about 10 mL of 0.25% plain Marcaine to assist with postoperative pain relief. A light compressive dressing was applied followed by a sling. The patient was then awakened from general anesthesia after tolerating the procedure well with no apparent complications. Estimated blood loss was zero. No drains were left.

  2. #2
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