Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil.
Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil.
Microsurgery. 2018 Feb;38(2):151-156. doi: 10.1002/micr.30161. Epub 2017 Feb 16.
The aim of our study was to objectively test sensibility on the dorsal side of the hand in patients with radial nerve injury, to document deficits and to detect if surgery for sensory reconstruction is needed.
Nineteen patients of mean age 31 ± 10 years were examined at a mean of 26.4 ± 27.8 months post radial nerve injury. Sensory mechanical thresholds on the dorsal surface of the hand were evaluated using Semmes-Weinstein monofilaments. Sensation was considered significantly impaired when there was no perception of a 2.0 gr. Semmes-Weinstein filament. Nociception was evaluated using Adson forceps.
Five patients had normal 2.0 monofilament perception. Two of these five also had normal perception of the lighter 0.05 monofilament. In nine patients, zones of impaired sensibility were restricted to the first web space. In combined radial and musculocutaneous nerve lesions, the zone of impaired sensibility extended to the dorsum of the third metacarpus and occasionally to the dorsal aspect of the thumb. This zone averaged being five times the size as in isolated radial nerve injuries. On average, the zone of decreased 0.05 monofilament perception was six times the size detected for the 2.0 monofilament. No patient had complete anesthesia over the dorsum of the hand. No patient complained about pain or numbness. Only one patient among four with a combined radial and musculocutaneous nerve injury required sensory reconstruction.
Minimal sensory abnormalities should be expected after a radial nerve injury. Patients likely neither warrant nor request sensory reconstruction.
本研究旨在客观测试桡神经损伤患者手部背侧的感觉敏感性，记录缺陷，并检测是否需要进行感觉重建手术。
19 名平均年龄为 31±10 岁的患者在桡神经损伤后平均 26.4±27.8 个月接受检查。使用 Semmes-Weinstein 单丝评估手部背侧的感觉机械阈值。当无法感知 2.0 gr Semmes-Weinstein 单丝时，认为感觉明显受损。使用 Adson 夹评估痛觉。
5 名患者可正常感知 2.0 单丝。这 5 名患者中有 2 名也可正常感知更细的 0.05 单丝。在 9 名患者中，感觉受损区域仅限于第一指间间隙。在合并桡神经和肌皮神经损伤的患者中，感觉受损区域延伸至第三掌骨背侧，偶尔延伸至拇指背侧。该区域的平均大小是单纯桡神经损伤的 5 倍。平均而言，0.05 单丝感觉降低的区域是 2.0 单丝检测到的区域的 6 倍。没有患者在手背出现完全麻醉。没有患者抱怨疼痛或麻木。在 4 名合并桡神经和肌皮神经损伤的患者中，仅有 1 名需要感觉重建。
桡神经损伤后应预期出现最小的感觉异常。患者既不需要也不要求进行感觉重建。
