gms | German Medical Science

Objectives/Interrogation: Nerve torsion is a rare cause of peripheral nerve palsy and their etiologies are not well known. They are sometimes misdiagnosed as compressive neuropathies and the treatment and clinical results are different with compressive neuropathies. The purposes of this study are to describe the clinical differences between peripheral nerve torsion and common compressive neuropathy and to present the stages and possible pathomechanism for peripheral nerve torsion with three cases of peripheral nerve torsion which had the different degree and symptoms severity of nerve torsion each other.

Methods: We described the history, neurological symptom and physical examinations, findings of ultrasonographic images and electrodiagnostic studies, and the surgical appearances and degree of the torsion with three cases of peripheral nerve torsion. Also, the possible pathomechanism of nerve torsion was presented and the final clinical results were evaluated with the neurological physical examination, ultrasonographic images, and electrodiagnostic studies.

Results and Conclusions: One patient had radial nerve torsion and the others had median nerve torsion in the upper arm. At first, two of them were misdiagnosed as posterior interosseous nerve syndrome or anterior interosseous nerve syndrome though the lesions existed in the upper arm. All patients needed surgical treatment. The three patients had the different degree of nerve torsion each other. Also, all the nerve had the restriction of nerve gilding due to nerve adhesion and had its branch around nerve torsion site, which pulls the main nerve. It suggested important clues about the pathomechanism of peripheral nerve torsion. The symptoms were gotten better in two patients though it was not changed in one patient after surgery. Accurate localization and diagnosis with electrodiagnosis and ultrasonography are very important for the treatment of peripheral nerve torsion.