12:45

Exploration of radial nerve and lateral cutaneous nerve of forearm and DCP implant removal surgical technique

Overview

Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.

SUBSCRIBE


Learn the Exploration of radial nerve and lateral cutaneous nerve of forearm and DCP implant removal surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Exploration of radial nerve and lateral cutaneous nerve of forearm and DCP implant removal surgical procedure.

Any surgical procedure puts peripheral nerves at risk of injury. This may occur during the surgical approach, or by retractors and other instrumentation used during the procedure. Nerves may become entrapped or tethered around implants or in the surgical scar.

Patients typically present with signs and symptoms of nerve injury. Involvement of a sensory nerve, as in the following case, may be associated with pain, parasthaesia and reduced sensation. Left untreated, signs of chronicity may develop with central sensitisation and upregulation of pain pathways including psychological sequelae.

Early diagnosis and appropriate intervention in these patients can be rewarding.

The following technique describes my approach to the diagnosis and surgical management of a patient who was referred following injuries to the radial nerve and lateral cutaneous nerve of forearm during open reduction and internal fixation of the radius and ulna.

The decision about whether to proceed to surgical exploration should be made by a surgeon with experience in treating peripheral nerve disorders. It is largely based upon the history and clinical findings but may be aided by neurophysiology, radiology and physiotherapy. The use of targeted peripheral nerve blocks can be invaluable.

When exploring peripheral nerves in such a scenario, the peripheral nerve surgeon should be prepared for all eventualities, including the potential need to excise and graft a neuroma and in the use of adjuncts including nerve allograft and nerve wraps.

Readers will also find of interest the following published techniques on OrthOracle, which explain some of the additional techniques referred to in this section.

These include:

1. The use of a nerve wrap
2. The use of processed nerve allograft
3. Reconstruction with autologous nerve graft

Author: Tahseen Chaudhry, FRCS Orth, Consultant in hand and peripheral nerve surgery

Institution: University Hospital Birmingham, Birmingham, UK.

Feedback

  • 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 .

CPD Points:

  • 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

COURSE

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.

COURSE PROGRESS

Lessons Status

Accreditations

Logo Logo Logo Logo Logo

Associates & Partners

Logo Logo Logo Logo Logo