Abstract
Dear Editor,
Re: Shah HR, Cavalli E, Bertelli JA. Triceps paralysis with intact distal radial nerve function in partial brachial plexus injury: a unique presentation. J Hand Surg Eur. 2023, 48: 277–9
I read this case report by Shah et al. with interest. They report a case of suprascapular and axillary nerve injury with additional injury to the triceps branches of the radial nerve. Distal radial nerve function was intact. A 2.5-cm neuroma-in-continuity was found in the triceps motor branches. The triceps nerve and axillary nerves were reconstructed using nerve transfers. The outcome of the repairs is not reported.
The authors state, ‘An isolated stretch injury of triceps branches with normal function of the distal radial nerve has not been reported in the literature’. However, a similar case was reported by Wang et al. (2020) and managed with nerve transfers. In a series of infraclavicular injuries reported from my unit (Hems and Mahmood, 2012), there were five patients with axillary nerve injury with associated triceps paralysis but intact function of the distal radial nerve. This combination occurs in some of the group of infraclavicular injuries characterized by axillary nerve palsy without recorded shoulder dislocation. There is often additional injury to the suprascapular nerve. Further cases of triceps and axillary nerve injury have been managed in our brachial plexus service over the last 10 years. In all cases there has eventually been good spontaneous recovery of the triceps. We therefore do not think it is necessary to recommend exploration and repair of the triceps nerves. However, the associated axillary nerve injury is often severe requiring repair, usually with nerve grafts.