Posterior Interosseous Nerve Syndrome Research Articles

Posterior interosseous nerve palsy due to lipoma: A rare case report

The posterior interosseous nerve is the terminal motor branch of the radial nerve without a sensory component. The nerve may be compressed for various reasons along the course of the forearm. Two different clinical pictures occur due to compression of the nerve in the forearm. In radial tunnel syndrome, entrapment of the nerve in the radial tunnel, pain in the elbow is at the forefront, while in the second clinical picture, posterior interosseous nerve syndrome, wrist and finger extension are affected. Posterior interosseous nerve syndrome is rare and develops due to many causes such as trauma, previous surgeries around the elbow, neurologic diseases and abnormal anatomical structures. A rare condition in the etiology of posterior interosseous nerve syndrome is mass lesions causing compression of the forearm.

A Case Report of Posterior Interrosseous Nerve Syndrome Due to Intermuscular Lipoma

Posterior interosseous nerve compressions are rare. The compression of the posterior interosseous nerve can happen either before, or through or after the course of the nerve in the supinator muscle. Tumors could rarely lead to secondary compression of the nerve by mass effect. We describe a case of a lady aged 73 years with a posterior interosseous nerve syndrome due to an intermuscular lipoma. The patient had appreciable recovery after surgery and physiotherapy. Keywords: Intermuscular lipoma, Posterior interosseous nerve, Compression.

Posterior Interosseous Nerve Syndrome due to Schwannoma - A Case Report.

Posterior interosseous nerve syndrome is the most frequent syndrome of radial nerve compression, with the arcade of Frohse being the main site of compression. Its symptoms include difficulties in finger and wrist extension with possible radial deviation. Herein, we present a case of posterior interosseous syndrome caused by a schwannoma, a type of neurological tumor.

Sonography and EMG Biofeedback’s Role in PIN Syndrome After Rehabilitation? A Case Report

The radial nerve divides into two terminal branches the superficial radial nerve and the posterior interosseous nerve. Posterior interosseous nerve entrapment is associated with weakness in the extension of fingers, atrophy of the forearm muscles, and localized pain in the lateral aspect of the elbow and proximal forearm without sensory deficits. A 37-year-old man complained of difficulty of right finger extension (MMT 2) and persistent pain (VAS 5) at the forearm after a fall from a motorcycle six months before admission. We treated the patient with a physical rehabilitation program for three months and a total of 12 visits. Sonography and electromyography (EMG) biofeedback were performed to evaluate improvement after the physical rehabilitation program. After three months, the pain was relieved, and forearm extensor muscle strength increased. This showed that sonography and EMG biofeedback play a role in the detection and evaluation of muscle and nerve abnormality due to posterior interosseous nerve (PIN) syndrome.

Demographics of Common Compressive Neuropathies in the Upper Extremity.

The purpose of this study was to compare the demographic differences of the most common peripheral nerve compressions in the upper extremity-carpal tunnel syndrome (CTS), ulnar nerve compression (UNC) at the elbow, combined CTS and UNC, radial tunnel syndrome (RTS), and posterior interosseous nerve syndrome (PINS)-as a means to better understand the etiologies of each. A retrospective chart review was performed of all patients over the age of 18 years seen at our institution in the 2018 calendar year. International Classification of Diseases, Tenth Revision codes were used to identify patients with diagnoses of upper extremity peripheral nerve compressions. Demographic details and relevant comorbidities were recorded for each patient and compared with controls, who were seen the same calendar year with no neuropathies. χ2 analyses, independent-samples t tests, and multivariate logistic regressions were performed (P < .05). A total of 7448 patients were identified. Those with CTS were mainly women, former smokers, and diabetic (all P < .001) and with a greater average body mass index (BMI) (P = .006) than controls. Patients with UNC were more often men and younger when compared with controls (both P < .001). A history of smoking, diabetes, and average BMI were similar between patients with UNC and controls (all P > .05). Those patients with combined CTS/UNC were mainly men, former smokers, and diabetic (all P < .001) when compared with controls. Patients with RTS/PINS were also mostly men (P = .007), diabetic (P = .042), and were more often current smokers (P < .001). The demographics of patients with various compressive neuropathies were not homogeneous, suggesting different etiologies.

P32-F Nerve ultrasound in the assessment of posterior interosseous nerve syndrome: a useful tool?

Background Nerve ultrasound (NUS) is a technique recently introduced in the routine assessment of neuromuscular diseases. In carpal tunnel syndrome adding a morphological test to the routine electrophysiological assessment does not increase neither cost nor excessive time to the exam. However, there is an ongoing debate if this kind of studies should be introduced in the neurophysiology laboratory and be performed by a neurophysiologist. Material and methods We present a case in which performing NUS at the same appointment as electromyography (EMG) and neurography implied a change in diagnosis and treatment. A 55-year-old male subject was scheduled for EMG and nerve conduction studies (NCS) due to an acute wrist drop following a 30 min nap. An acute compression of the radial nerve was suspected and EMG and NCS were performed to identify a possible radial mononeuropathy and exclude abnormalities in other nerves, plexus or roots. Results It was identified a pure motor lesion distal to triceps innervation, indicating a posterior interosseous nerve (PIN) syndrome. Additionally, a NUS exploration of the median, cubital and radial nerves was performed, and a hypo-anechoic mass was identified close to the supinator muscle and in contact with the PIN. A magnetic resonance imaging (MRI) was performed confirming previous findings. Conclusions This case is interesting because it depicts not only an infrequent entrapment neuropathy, namely posterior interosseous nerve syndrome, but also the added value that an easily available morphological study in a neurophysiology laboratory could have.

Posterıor Interosseous Nerve Syndrome Caused by Intramuscular Lipoma: A Rare Case of Radial Neuropathy

Lipomas are common benign soft tissue neoplasms that occur usually in subcutaneous tissue. In rare instances they can occu r in the deep soft tissue such as intramuscular and parosteal sites. When an intramuscular lipoma occurring in the proximal forearm or adjacent to the proximal radius they can compress the posterior interosseous branch of radial nerve and cause paralysis o f posterior interosseous nerve. In this report we describe an unusual case of a 55 - year - old man with posterior interosseous nerve syndrome caused by quite small intramuscular lipoma.

The utility of ultrasound in showing a unique cause of posterior interosseous nerve syndrome.

The utility of ultrasound in showing a unique cause of posterior interosseous nerve syndrome.

Anterior interosseous nerve and posterior interosseous nerve involvement in neuralgic amyotrophy

ObjectivesThe aim of this study was to gain a better understanding of anterior interosseous nerve and posterior interosseous nerve involvement in neuralgic amyotrophy. MethodsIn a retrospective chart review, 51 cases (49 patients) with anterior and posterior interosseous nerve syndrome were investigated in terms of their symptoms, course of disease, and prognosis. ResultsPatients first presented with pain in 52.9% of cases. The location of the pain was distal to the shoulder in most cases (85.1%). Sensory involvement was found in 27.5% of patients, and patients with pain before paresis had fewer sensory symptoms (p=0.006). Neurolysis significantly improved Hand20 scores, but conservative treatment did not (p=0.020 vs. 0.204). ConclusionsPatients with anterior interosseous nerve and posterior interosseous nerve affection in neuralgic amyotrophy had less pain. Neurolysis can be superior to conservative treatment in the patients with focal constrictions and no spontaneous recovery.

Ultrasound combined with electrodiagnosis improves lesion localization and outcome in posterior interosseous neuropathy.

Posterior interosseous nerve (PIN) syndrome is a rare compression neuropathy. Electrodiagnostic studies (EDx) combined with neuromuscular ultrasound (US) enable precise lesion localization and may improve patient outcome. In 4 patients with finger extension weakness, US was used to accurately localize concentric electromyographic (EMG) needle placement in PIN muscles and to visualize the lesion site. EMG with US guidance showed decreased recruitment with abnormal configuration in PIN muscles. Active denervation was not always observed. US scanning demonstrated larger PIN diameter in the affected arm. All patients had surgical intervention to confirm EDx and US findings and had improved outcome on follow-up. These cases demonstrate the benefits of augmenting EDx with US by guiding accurate electrode localization and providing diagnostic information about lesion location.

Ultrasound in dual nerve impairment after proximal radial nerve lesion.

IntroductionSonography in classical nerve entrapment syndromes is an established and validated method. In contrast, few publications highlight lesions of the radial nerve, particularly of the posterior interosseus nerve (PIN).MethodFive patients with a radial nerve lesion were investigated by electromyography, nerve conduction velocity and ultrasound. Further normative values of 26 healthy subjects were evaluated.ResultsFour patients presented a clinical and electrophysiological proximal axonal radial nerve lesion and one patient showed a typical posterior interosseous nerve syndrome (PINS). The patient with PINS presented an enlargement of the PIN anterior to the supinator muscle. However four patients with proximal lesions showed an unexpected significant enlargement of the PIN within the supinator muscle.ConclusionHigh-resolution sonography is a feasible method to demonstrate the radial nerve including its distal branches. At least in axonal radial nerve lesions, sonography might reveal abnormalities far distant from a primary proximal lesion site clearly distinct from the appearance in classical PINS.

Assessment of the utility of ultrasonography with high-frequency transducers in the diagnosis of entrapment neuropathies.

The primary aim of this paper was to assess the relevance of high-frequency ultra-sound examination in qualifying patients for either surgical or conservative treatment of peripheral entrapment neuropathies. The study was conducted in a group of 55 patients aged 7–83 (mean age 43.6), including 28 males and 27 females, who in 2009–2011 were referred to an ultrasound examination due to a clinical suspicion of entrapment neuropathies. For the purposes of the analysis, the patients were divided into four groups: carpal tunnel syndrome (1), ulnar nerve entrapment (2) (cubital tunnel syndrome and Guyon's canal syndrome), posterior interosseous nerve syndrome (3) and other entrapment neuropathies (4). The cases of isolated idiopathic carpal tunnel syndrome were excluded from the analysis. All patients underwent the interview, physical examination and ultrasound examination. Ultrasound examinations were performed with Esaote MyLab 50 and MyLab 60 systems using high-frequency broadband linear transducers: 6–18 MHz. Sixty-seven percent of patients (37 persons) underwent a neurophysiological test. Nerve echostructure, its hyperemia as well as nerve cross-sectional area or, in the case of small nerves, diameter were assessed in all patients. Furthermore, the following were assessed in individual groups: notch sign in group 1, nerve instability in a dynamic ultrasound examination in group 2, nerve angulation in a dynamic ultrasound examination and tenderness on nerve compression at the site of the visualized pathology in group 3. The analyses of the collected material were performed by means of descriptive statistics. The results of clinical and surgical verification were consistent with ultrasound findings in 96.4%. The results indicate that high-frequency ultrasonography is a valuable method in qualifying patients for various types of treatment of peripheral neuropathies resulting from compression.

Posterior Interosseous Nerve Syndrome from Thermal Injury

Background. Due to anatomical proximity to bone, the radial nerve is the most frequently injured major nerve of the upper extremity, frequently secondary to fractures (Li et al. (2013)). We describe an incidence when a branch of the radial nerve is injured as a result of a thermal injury. Observation. Radial nerve injury can occur anywhere along the anatomical course with varied etiologies, but commonly related to trauma. The most frequent site is in the proximal forearm involving the posterior interosseous branch. However, problems can occur at the junction of the middle and proximal thirds of the humerus and wrist radially. When the radial nerve is injured by a burn, a new rehabilitation dynamic arises. Not only does one agonize about the return of nerve function but also fret about the skin grafts that replaced the devitalized tissue housing that compartment. Discussion. Although posterior interosseous nerve syndrome has been described in the context of many different etiologies, it has not previously been discussed in relation to burn injuries. In this case, not only did the patient's rehabilitation involve aggressive therapy for return of sensation and function of the arm, but also prevention of contracture normally seen in replacement of full thickness burns.

측와위로 시행한 견관절 관절경 후에 동시에 발생한 전방 및 후방 골간 신경 증후군 - 증례보고 -

We report a case of simultaneous anterior and posterior interosseous nerve syndrome in association with shoulder arthroscopy. Shoulder arthroscopy was performed in a 45-year-old male patient with left shoulder instability. In the right lateral decubitus position, under general anesthesia, traction was applied with elbow extension for 2 hours. One week after surgery, the patient revisited the clinic for weakness of the flexor of the thumb, index finger, and extensor of the fingers. Recovery was not achieved after four months of observation. Therefore, nerve exploration was performed in the anterior and posterior interosseous nerve and hourglass-like fascicular constriction was detected in the posterior interosseous nerve. The area of constriction was removed and epineural neurorrhaphy was performed. Three months after exploration, the extension function of the fingers was recovered. Recovery was achieved gradually, and, five months after nerve exploration, the symptoms were completely recovered. Simultaneous anterior and posterior interosseous nerve syndrome following shoulder arthroscopy is rare. However, it could occur due to the traction and position of the patient. Thus, the operator should be careful of traction and position of the patient.

Posterior interosseous nerve syndrome due to radioulnar joint cyst

Posterior interosseous nerve syndrome due to radioulnar joint cyst

High resolution ultrasound in posterior interosseous nerve syndrome

Posterior interosseous nerve (PIN) syndrome is a rare compression neuropathy of the PIN in the region of the supinator muscle, most common by the arcade of Frohse. We aimed to specify ultrasonographic findings in patients with PIN syndrome in comparison to healthy volunteers. Ultrasound images and clinical data of 13 patients with PIN syndrome confirmed by neurological examination and electrophysiological testing were evaluated retrospectively. Anteroposterior nerve diameters measured at the arcade of Frohse were compared with those of 20 healthy volunteers. The echotexture and the presence of a caliber change of the PIN were additionally assessed. Enlargement of the PIN was seen in all patients with PIN syndrome, but not in volunteers (statistically significant difference in mean diameter P < 0.05). Furthermore, edema and caliber change of the PIN were present in all patients. High-resolution ultrasound allows for differentiation between patients with PIN syndrome and healthy volunteers.

Posterior interosseous nerve syndrome due to intramuscular lipoma

Lipomas are extremely common benign soft tissue tumors that are usually subcutaneous and asymptomatic. However, an intramuscular lipoma, occurring adjacent to the proximal radius, may easily cause paralysis of the posterior interosseous nerve because of a specific anatomical relationship of these structures in that area. In this report, we describe an unusual case of a 48-year-old-woman with a posterior interosseous nerve syndrome due to an intramuscular lipoma. The patient had good recovery after surgery and rehabilitation physiotherapy.

High Resolution Ultrasonography in Posterior Interosseous Nerve Syndrome

High Resolution Ultrasonography in Posterior Interosseous Nerve Syndrome

Sindrome compressiva del nervo radiale all’arcata di Frohse

Etiology, clinical symptoms, and surgical management of radial nerve entrapment in the cubital fossa are closely related to the underlying anatomy. The most important cause of posterior interosseous nerve syndrome is the fibrous arch of the supinator muscle (arcade of Frohse). Clinical symptoms range from weakness to frank paralysis of muscles innervated by the deep branch of the radial nerve. Pain from the elbow radiating the dorsum of the forearm to the radial side of the wrist and hand, without paralysis, can be the presentation of the radial tunnel syndrome.

Posterior interosseous nerve syndrome due to lipoma

Posterior interosseous nerve syndrome due to lipoma