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Spontaneous radial nerve palsy with hourglass-like constriction
  1. Fernanda Bretas1,
  2. Gabriel Costa Serrão de Araújo1,
  3. Odile Nogueira Ugarte2 and
  4. Marcus André Acioly3,4
  1. 1Division of Hand Surgery, Department of Surgery and Specialties, Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
  2. 2Division of Pathology, Fontes Diagnostic Medicine, Niteroi, Brazil
  3. 3Division of Neurosurgery, Department of Surgery and Specialties, Fluminense Federal University, Niterói - Rio de Janeiro, Brazil
  4. 4Division of Neurosurgery, Department of Surgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
  1. Correspondence to Professor Marcus André Acioly; marcusacioly{at}


Hourglass-like constriction (HLC) is an uncommon spontaneous mononeuropathy that is typically characterised by a sudden onset of pain followed by palsy, affecting branches of the radial (posterior interosseous nerve) and median nerves (anterior interosseous nerve). HLC of the radial nerve (RN) is rare, with only a few reported cases. Here, we report a case of a man who presented with acute wrist and finger drop due to the HLC of the RN. Surgery was recommended 5 months after clinical observation, when the lesion was resected and primarily repaired, resulting in satisfactory recovery. There is still much that remains unknown about HLC, especially for RN. The current understanding points out an inflammatory disease that should be treated conservatively for 3–7 months. The surgical technique depends mostly on the severity and extent of constriction; however, considering only RN constrictions, primary repair by neurorrhaphy or nerve grafts resulted in better functional outcomes.

  • Neurosurgery
  • Orthopaedics

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: FB, GCSdA, ONU and MAA. The following authors gave final approval of the manuscript: FB, GCSdA, ONU and MAA.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.