Adjunctive Complete Brachioradialis Tenotomy with Nerve Release for Decompression of the Superficial Branch of the Radial Nerve in the Forearm
Elspeth J R Hill, MD PhD MRes1, William M Padovano, MPHS2, Hasak Jessica, RN2 and Susan E Mackinnon, MD2, (1)Washington University School of Medicine, St Louis, MO, (2)Washington University School of Medicine, Saint Louis, MO
Introduction: Wartenberg first described compression of the superficial branch of the radial nerve at the interval between the extensor carpi radialis longus and brachioradialis tendons in 1932. Surgical management of resistant symptoms has traditionally involved release of the nerve with or without neurolysis. In this case series, we describe our experience with complete tenotomy of the brachioradialis tendon for decompression of the radial sensory nerve.
Materials & Methods: A retrospective review was performed of consecutive patients who underwent radial sensory nerve decompression with complete tenotomy of the brachioradialis tendon between August 2008 and December 2018. Presence of Tinel's sign, positive pain provocation testing, and/or positive scratch-collapse testing over the entrapment point of the radial sensory nerve in the forearm were considered indicative of nerve compression. Demographic information, mechanism of injury, and history of de Quervain disease were documented. Pain evaluations were administered at each pre- and post-operative clinic visit, and patients reported pain severity and impact on quality of life using a 10-point visual analogue scale (VAS). Changes in VAS scores were evaluated by Wilcoxon signed-rank test, and factors associated with improvements in VAS scores were assessed by linear regression.
Results: A total of 30 patients were included in this series. Of these, 4 underwent decompression of the radial sensory nerve only, 8 additionally underwent decompression of the posterior interosseus nerve and/or radial nerve in the arm. The remainder required concomitant surgery on additional upper extremity nerves. Median follow-up after nerve decompression was 78 days (IQR 41 to 180 days). Among patients only receiving radial nerve procedures, median pre-operative pain was 6 out 10 (IQR 3 to 8) and impact on quality of life was 8 out 10 (IQR 5 to 10). By the final post-operative visit, 83% of patients experienced improvements in pain, and VAS scores for pain and quality of life each improved by 2 points (p = 0.025 and p=0.0049, respectively). Younger patients had larger improvements in VAS scores for both pain (b = -0.21, 95% CI -0.31 to -0.10, p= 0.0013) and quality of life (b = -0.23, 95% CI -0.36 to -0.10, p = 0.0027).
Conclusions: Complete tenotomy of the brachioradialis tendon with release of the nerve is our preferred method for decompressing the superficial branch of the radial nerve in the forearm. Most patients in this series, particularly younger patients, experienced substantial improvements in pain and quality of life.
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