Display options
Cite
Papadopoulou M, Spengos K, Papapostolou A, et al. Intraoperative radial nerve injury during coronary artery surgery--report of two cases. J Brachial Plex Peripher Nerve Inj. 2006;1:7doi: 10.1186/1749-7221-1-7.
Papadopoulou, M., Spengos, K., Papapostolou, A., Tsivgoulis, G., & Karandreas, N. (2006). Intraoperative radial nerve injury during coronary artery surgery--report of two cases. Journal of brachial plexus and peripheral nerve injury, 17. https://doi.org/10.1186/1749-7221-1-7
Papadopoulou, Marianna, et al. "Intraoperative radial nerve injury during coronary artery surgery--report of two cases." Journal of brachial plexus and peripheral nerve injury vol. 1 (2006): 7. doi: https://doi.org/10.1186/1749-7221-1-7
Papadopoulou M, Spengos K, Papapostolou A, Tsivgoulis G, Karandreas N. Intraoperative radial nerve injury during coronary artery surgery--report of two cases. J Brachial Plex Peripher Nerve Inj. 2006 Dec 05;1:7. doi: 10.1186/1749-7221-1-7. PMID: 17147818; PMCID: PMC1697803.
Copy Download .nbib Format: NLM
Share it on

J Brachial Plex Peripher Nerve Inj. 2006 Dec 05;1:7. doi: 10.1186/1749-7221-1-7.

Intraoperative radial nerve injury during coronary artery surgery--report of two cases.

Journal of brachial plexus and peripheral nerve injury

Marianna Papadopoulou, Konstantinos Spengos, Apostolos Papapostolou, Georgios Tsivgoulis, Nikolaos Karandreas

Affiliations

  1. University of Athens School of Medicine, Department of Neurology, Eginition Hospital, Athens, Greece. [email protected]

PMID: 17147818 PMCID: PMC1697803 DOI: 10.1186/1749-7221-1-7

Abstract

BACKGROUND: Peripheral nerve injury and brachial plexopathy are known, though rare complications of coronary artery surgery. The ulnar nerve is most frequently affected, whereas radial nerve lesions are much less common accounting for only 3% of such intraoperative injuries.

CASE PRESENTATIONS: Two 52- and 50-year-old men underwent coronary artery surgery. On the first postoperative day they both complained of wrist drop on the left. Neurological examination revealed a paresis of the wrist and finger extensor muscles (0/5), and the brachioradialis (4/5) with hypoaesthesia on the radial aspect of the dorsum of the left hand. Both biceps and triceps reflexes were normoactive, whereas the brachioradialis reflex was diminished on the left. Muscles innervated from the median and ulnar nerve, as well as all muscles above the elbow were unaffected. Electrophysiological studies were performed 3 weeks later, when muscle power of the affected muscles had already begun to improve. Nerve conduction studies and needle electromyography revealed a partial conduction block of the radial nerve along the spiral groove, motor axonal loss distal to the site of the lesion and moderate impairment in recruitment with fibrillation potentials in radial innervated muscles below the elbow and normal findings in triceps and deltoid. Electrophysiology data pointed towards a radial nerve injury in the spiral groove. We assume external compression as the causative factor. The only apparatus attached to the patients' left upper arm was the sternal retractor, used for dissection of the internal mammary artery. Both patients were overweight and lying on the operating table for a considerable time might have caused the compression of their left upper arm on the self retractor's supporting column which was fixed to the table rail 5 cm above the left elbow joint, in the site where the radial nerve is directly apposed to the humerus.

CONCLUSION: Although very uncommon, external compression due to the use of a self retractor during coronary artery surgery can affect--especially in obese subjects--the radial nerve within the spiral groove leading to paresis and should therefore be included in the list of possible mechanisms of radial nerve injury.

References

  1. Rev Esp Anestesiol Reanim. 1992 Nov-Dec;39(6):371-3 - PubMed
  2. Anaesthesia. 2005 Jun;60(6):602-4 - PubMed
  3. Arch Neurol. 1989 Dec;46(12):1355-60 - PubMed
  4. Anesthesiology. 1990 Aug;73(2):202-7 - PubMed
  5. Ann Thorac Surg. 1992 Jun;53(6):1149-50 - PubMed
  6. Yonsei Med J. 2003 Dec 30;44(6):1106-9 - PubMed
  7. J Cardiovasc Surg (Torino). 1989 Nov-Dec;30(6):1015-6 - PubMed
  8. Anaesthesia. 2000 Oct;55(10):980-91 - PubMed
  9. J Clin Anesth. 2001 Jun;13(4):306-8 - PubMed
  10. J Neurol Neurosurg Psychiatry. 1972 Oct;35(5):638-47 - PubMed
  11. Anesthesiology. 1999 Apr;90(4):1062-9 - PubMed

Publication Types