title: Surgical management and outcome of iatrogenic radial nerve injection injuries.
abstract: OBJECTIVE
  Iatrogenic injury to the radial nerve can occur following intramuscular or intravenous injections of the upper extremity. In this study, we review the injury mechanism, operative techniques, and outcomes of patients evaluated for radial nerve injection injuries.
  
  
  METHODS
  Data from 33 patients evaluated by the senior authors (DGK and DHK) from 1970-2011 with radial nerve injection injuries were reviewed retrospectively. All patients had injury of the nerve during injection. All corrective operations involved the use of direct intraoperative nerve action potential (NAP) recordings and either neurolysis, neurectomy, or suture/graft repair. The Louisiana State University Health Science (LSUHS) grading system was used for clinical assessment.
  
  
  RESULTS
  Of the 33 patients, 23 underwent surgical intervention for persistent neurological deficit and/or pain. Of the 24 patients evaluated for injuries at the arm level, 17 required surgical exploration and repair for persistent symptoms. Nine patients required external neurolysis because the lesions were in continuity and positive NAP recording was across the lesion. All of these patients achieved a Grade 4 or better in functional recovery. Eight patients with lesions in continuity but in which NAP could not be recorded underwent either end-to-end suture (7) or graft repair (1) following resection of a 3.0 cm non-recordable segment. All patients achieved Grade 3 or 4 functional recovery. Six patients with forearm injuries involving the superficial sensory branch of radial nerve underwent either neurolysis (3) or neurectomy (3).
  
  
  CONCLUSIONS
  Surgical exploration may be indicated when pain or disabling motor deficits persist. Early diagnosis and operative intervention can achieve favorable outcomes through exploration and radial nerve repair.
authors.affiliation: Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, United States. Electronic address: yoshuaesquenazi@gmail.com.
authors.forename: Yoshua
authors.initials: Y
authors.lastname: Esquenazi
authors.affiliation: Department of Anesthesiology and Pain Medicine, Jeju National University Medical School, Jeju, Republic of Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, LA, United States.
authors.forename: David G
authors.initials: DG
authors.lastname: Kline
authors.affiliation: Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, United States. Electronic address: daniel.kim.1@uth.tmc.edu.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010524:Peripheral Nervous System Neoplasms / Q000601:surgery*; D011826:Radial Nerve / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D055815:Young Adult
keywords: Graft repair; Iatrogenic injury; Injection injury; Neurectomy; Neurolysis; Radial nerve injection injury; Suture repair