Ann Rehabil Med.  2014 Jun;38(3):421-426. 10.5535/arm.2014.38.3.421.

Compressive Radial Neuropathy Developed Under a Fibrotic Band Associated With Rhabdomyolysis and Successfully Treated With Surgery

• Kim JY
• Lee JW
• Cha SO
• Park J

• KMID: 2165764
• DOI: http://doi.org/10.5535/arm.2014.38.3.421

Abstract

A 34-year-old male patient visited the emergency room with complaint of right wrist drop and foot drop. The day before, he was intoxicated and fell asleep in a room containing barbeque briquettes; After waking up, he noticed that his right wrist and foot were dropped. Upon physical examination, his right wrist extensor, thumb extensor, ankle dorsiflexor, and big toe extensor showed Medical Research Council (MRC) grade 1 power. The initial laboratory tests suggested rhabdomyolysis induced by unrelieved pressure on the right side during sleep. Right foot drop was improved after conservative care and elevated muscle enzyme became normalized with hydration therapy with no resultant acute renal failure. However, the wrist drop did not show improvement and a hard mass was palpated on the follow-up physical examination. Ultrasonography and magnetic resonance imaging studies were conducted and an abnormal mass in the lateral head of the tricep was detected. Axonopathy was suggested by the electrodiagnostic examination. A surgical decompression was done and a fibrotic cord lesion compressing the radial nerve was detected. After adhesiolysis, his wrist extensor power improved to MRC grade 4. Herein, we describe a compressive radial neuropathy associated with rhabdomyolysis successfully treated with surgery and provide a brief review of the related literature.

Keyword

Radial neuropathy; Rhabdomyolysis; Fibrosis

MeSH Terms

Acute Kidney Injury
Adult
Ankle
Decompression, Surgical
Emergency Service, Hospital
Fibrosis
Follow-Up Studies
Foot
Head
Humans
Magnetic Resonance Imaging
Male
Physical Examination
Radial Nerve
Radial Neuropathy*
Rhabdomyolysis*
Thumb
Toes
Ultrasonography
Wrist

Figure

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  Fig. 1 Right humerus magnetic resonance imaging (2 months after onset). A high signal intensity lesion in the lateral head of the tricep muscle with peripheral enhancement pattern in the enhanced image (white arrow).

• 

  Fig. 2 Operation findings. (A) A fibrotic cord (FC) is seen. (B) After adhesiolysis, the radial nerve (RN) become visible. RA, radial artery; RV, radial vein.

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