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DOI: 10.1055/s-0029-1245738
© Georg Thieme Verlag KG Stuttgart · New York
Unusual Functional Compression of the Deep Branch of the Radial Nerve by a Vascular Branch (Leash of Henry): Ultrasonographic Appearance
Seltene Funktionelle Kompression des tiefen Astes des Nervus radialis durch die ‘Leash of Henry’: ultrasonografische DarstellungPublication History
received: 22.7.2010
accepted: 2.9.2010
Publication Date:
11 October 2010 (online)
![](https://www.thieme-connect.de/media/roefo/201102/lookinside/thumbnails/10.1055-s-0029-1245738-1.jpg)
Zusammenfassung
Ziel: Die Kompression des tiefen Astes des Nervus radialis durch kreuzende Äste des Ramus recurrens der Arteria radialis – den sogenannten „Leashes of Henry” – repräsentiert eine seltene, aber wichtige Ursache einer Kompressionsneuropathie des Unterarms. Material und Methoden: Wir präsentieren 2 Patienten mit unklaren Symptomen einer Mononeuropathie des tiefen Astes des Nervus radialis (DBRN), die mittels hochauflösendem Ultraschall bezüglich einer neuralen Texturstörung auch zusätzlich unter Nutzung des Farb-/Power-Doppler-Modus untersucht wurden. Ergebnisse: In beiden Patienten wurde eine sog. „Leash of Henry”-Situation nachgewiesen: es zeigte sich eine lokale Texturstörung des DBRN mit einer korrespondierenden Nervenschwellung auf 2,7 bzw. 1,9 mm exakt im Überkreuzungsbereich durch einen pulsierenden Arterienast in typischer topografischer Position. Schlussfolgerung: Beide Patienten zeigten eine einzigartige topografische Übereinstimmung einer Texturstörung des DBRN mit der verursachenden kreuzende Arterie (LoH). Zusätzlich zur Texturstörung und Schwellung, die im B-Bild Ultraschall demonstriert werden, sollte bei jeder unklaren Neuropathie des Unterarms ein funktioneller Farb-/Power-Doppler-Ultraschall durchgeführt werden, um eine pulsierende hypertrophierte Arterie als Ursache der Nervenkompression auszuschließen.
Abstract
Purpose: Radial nerve compression caused by crossing branches of the recurrent radial artery – so called hypertrophic ”leash(es) of Henry” (LoH) – is rare. Nevertheless it is important to diagnose the type of compression neuropathy in the forearm. Materials and Methods: We report 2 subjects with unclear neuropathy of the deep branch of the radial nerve (DBRN) who showed compression by an LoH on high resolution ultrasound (HRUS) assessment. The shape and echotexture of the radial nerve were assessed with respect to the typical outer and inner texture of peripheral nerves in HRUS. Using color and/or power Doppler, an exact analysis of the surrounding soft tissues follows to search for possible atypical vessels compressing the nerve. Results: In both patients a hypertrophic leash of Henry was identified with color/power Doppler ultrasound and the direct vascular compression of the DBRN was readily demonstrated. The involved nerve segment was enlarged with a mean transverse diameter of 2.7 mm and 1.9 mm, with a hypoechoic change and partial masking of the inner fascicular texture of the nerve at the level of the LoH. Conclusion: In summary, both presented patients showed a unique topographic concordance of a textural change of the deep radial nerve (i. e., swelling and inner hypoechoic fascicular change) and the causative hypertrophic crossing artery. The use of power Doppler ultrasound in addition to caliber and texture changes shown on grayscale ultrasound and the functional visualization of pulsating vessels should be included in every sonographic examination of patients with chronic forearm pain symptoms.
Key words
elbow - nervous peripheral - leash of Henry - ultrasound
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Dr. Alexander Loizides
Department of Radiology, Innsbruck Medical University
Anichstrasse 35
6020 Innsbruck
Austria
Phone: ++ 43/5 12/5 04/2 27 61
Fax: ++ 43/5 12/5 04/2 27 58
Email: alexander.loizides@i-med.ac.at