Surgical Treatment Strategies for Injuries of the "Unforgiving" Superficial Branch of the Radial Nerve

Background: Neuropathic pain caused by adhesions or neuroma formation of the superficial branch of the radial nerve (SBRN) is difficult to treat. The authors evaluated the effectiveness of different routinely used surgical techniques for SBRN neuralgia to provide a basis for future studies on SBRN neuralgia and explored the prognostic value of a preoperative diagnostic nerve block. Methods: The authors performed a retrospective cohort study by reviewing surgical records for procedures to treat SBRN neuralgia. Patient satisfaction was scored as satisfied or unsatisfied, and pain intensity was scored with a numeric rating scale. Results: The authors included 71 patients who had 105 surgeries on the SBRN. Patients with a neuroma (n = 43) were most satisfied after proximal denervation with burying into the brachioradialis muscle compared with burying elsewhere (53 versus 0 percent; p < 0.001). Adhesions of the SBRN (n = 28) were treated with neurolysis (39 percent satisfied). If neurolysis or denervation did not suffice, an additional denervation of the lateral antebrachial cutaneous nerve or posterior interosseous nerve led to satisfaction in 38 percent. A decrease of less than 3.5 points on the numeric rating scale score after diagnostic nerve block led to higher postoperative pain scores (4.0 versus 7.5; p = 0.014). The authors found that the outcome of the diagnostic nerve block can predict the outcome of SBRN denervation and burying into brachioradialis muscle. Conclusions: The most effective burying technique is burying the SBRN into the brachioradialis muscle. Future studies on the treatment of SBRN neuralgia should therefore compare newer techniques, with burying the SBRN into the brachioradialis muscle as the control group.