- Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Neurology, Cleveland Clinic, Cleveland, OH 44195, USA
- Department of Neurosurgery, Dayton Children Hospital, Dayton, Ohio
Department of Neurosurgery, Dayton Children Hospital, Dayton, Ohio
DOI:10.4103/2152-7806.178776Copyright: © 2016 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Sundar SJ, Healy AT, Shook SJ, Kamian K. Intraneural nodular fasciitis of the radial nerve with rapidly progressive motor symptoms. Surg Neurol Int 16-Mar-2016;7:28
How to cite this URL: Sundar SJ, Healy AT, Shook SJ, Kamian K. Intraneural nodular fasciitis of the radial nerve with rapidly progressive motor symptoms. Surg Neurol Int 16-Mar-2016;7:28. Available from: http://surgicalneurologyint.com/surgicalint_articles/intraneural-nodular-fasciitis-of-the-radial-nerve-with-rapidly-progressive-motor-symptoms/
Background:Nodular fasciitis is a benign mesenchymal tumor arising from fascia that typically presents as a rapidly growing, subcutaneous mass. Intraneural cases are very rare and can present with neurological symptoms, requiring surgical resection.
Case Description:A 31-year-old woman presented to us with painful paresthesias in her elbow and progressive motor deficits, for which she underwent surgery.
Conclusion:The authors report the first case of intraneural nodular fasciitis occurring in the radial nerve and highlight the possibility of rapidly progressive motor deficit in patients presenting with this rare clinical entity.
Keywords: Fasciitis/diagnosis, fasciitis/surgery, peripheral nervous system neoplasms, radial nerve, radial neuropathy
Nodular fasciitis is a rapidly growing, benign proliferation of myofibroblasts that arises from fascia, often presenting as a subcutaneous mass, and commonly found in the upper extremity.[
History and examination
A 31-year-old female with no history of trauma presented with a 6-month history of electrical, shooting pain and occasional numbness in her left elbow and hand. Prior treatment with nonsteroidal anti-inflammatories and a short course of corticosteroids did not help. Her painful paresthesias worsened, and electromyography revealed radial nerve sensory neuropathy; however, the motor examination was normal. Upon initial evaluation in July 2013, she noted new left-hand weakness. Examination revealed an irregular, tender, immobile lesion roughly 2 cm in diameter in the antecubital fossa, with severe paresthesias in a radial distribution. Motor examination was significant for left-sided wrist drop (2/5), and similar weakness in finger extension. Magnetic resonance imaging and ultrasound revealed a lesion measuring approximately 33 mm × 16 mm × 28 mm with ill-defined margins surrounding the radial neurovascular bundle at the distal humerus [Figures
Magnetic resonance imaging of a left antecubital lesion. (a) Axial T2-weighted; (b) coronal T2-weighted; (c) sagittal short T1 inversion recovery; and (d) postcontrast T2-weighted image. All depict an enhancing (d) mass with ill-defined borders involving the radial nerve and surrounding musculature
In surgery, a red, fragile mass encasing the radial nerve was observed medial to the brachioradialis [
Three months after surgery, the patient showed dramatic recovery and reported no pain. Her motor function showed improvement – wrist extension was 4+/5 and finger extension was 4−/5. Sensory examination revealed minor residual hypesthesia in the radial distribution. One year after the surgery the motor examination of the radial nerve was normal and the sensor exam was back to normal. There was no evidence of recurrence 20 months after the surgery.
Nodular fasciitis is a benign mesenchymal tumor that typically presents as a rapidly growing mass. The etiology of nodular fasciitis is not known, but the current theory is that local trauma or inflammatory processes can trigger proliferation of myofibroblasts.[
Our patient's initial complaints were sensory and only in the final month prior to surgery did motor symptoms appear and progress rapidly. There is only one other intraneural case to describe motor symptoms that progressively worsened, and it occurred in the median nerve of a 79-year-old female.[
Intraneural nodular fasciitis is an unusual lesion that can present as a rapidly growing mass with neurological symptoms. We report the first case occurring in the radial nerve and highlight the possibility of rapidly progressive motor deficit in patients presenting with this rare clinical entity.
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Conflicts of interest
There are no conflicts of interest.
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