Excision of a Schwannoma from the proximal radial nerve, using posterior approach to proximal humerus surgical technique
Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.
Learn the Excision of a Schwannoma from the proximal radial nerve, using posterior approach to proximal humerus surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Excision of a Schwannoma from the proximal radial nerve, using posterior approach to proximal humerus surgical procedure.
Schwannomas are benign peripheral nerve sheath tumours. They are rare, but the true incidence is unknown because they frequently present as incidental findings on magnetic resonance imaging (MRI). When superficially located they may present as painful lumps with electrical sensory symptoms of pins and needles, tingling and pain when knocked. When they occur in deeply located nerves they may present with symptoms associated with nerve compression especially if the tumour is sited at anatomically tight space.
Schwannomas grow slowly and the nerve accommodates the growing tumour, with neurological symptoms developing when compression is critical or the tumour reaches a size that distorts and compresses otherwise normal fascicles within a peripheral nerve. The symptoms experienced are dependent on the type of nerve and its anatomical location. Most tumours fall into the benign category and are either Schwannoma or Neurofibroma subtypes. Most are solitary but both can present as multiple tumours in neurofibromatosis. Multiple Schwannomas are also a feature of the separate genetic condition Schwannomatosis in which strings of multiple tumours may arise from a single nerve trunk.
Excision is recommended when they cause neuropathic pain or when there is developing neurological deficit. Following excision superficial nerves may remain sensitive or tethered in scar tissue. There is also a small risk of permanent neurological deficit following excision. The risk is greater after previous biopsy, in large tumours and with recurrent tumours. The decision to operate is usually based on symptom profile, careful clinical examination and MRI features. Atypical tumours with indeterminate imaging should be referred to a specialist unit where there is a soft tissue sarcoma MDT and biopsy planned with review of histopathology prior to excision. Malignant nerve sheath tumours are extremely rare but require specialist management for excision and reconstruction where indicated. The margins for excision are greater for proven or suspected malignant tumours and the focus in such cases is on tumour clearance rather than functional preservation, the opposite objective to that for benign tumours.
The case presented is a large Schwannoma in the radial nerve as it leaves the posterior axilla and extends into the spiral groove. The tumour was removed using a posterior approach to the humerus because of increasing size, pain, sensory symptoms and motor weakness. Prior to surgery the tumour had a biopsy and following this there was more pain, an increased tumour size and transient complete motor loss. Repeated imaging with MRI after the biopsy demonstrated a fluid level and suspected vascular malformation within the tumour.
Author: Dominic Power FRCS Tr & Orth, Consultant Hand and Peripheral Nerve Surgeon
Institution: Peripheral Nerve Injury Service, Birmingham Hand Centre, UK
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.