Posterior Interosseous Nerve Syndrome Research Articles

Diagnosis and treatment of posterior interosseous nerve syndrome using soft tissue manipulation therapy: A case study

Peripheral nerve entrapments of the upper and lower extremity are commonly seen in practice. Chronically repetitive movement patterns lead to constriction of the nerve due to the development of local fibrosis within the soft tissues surrounding the nerve which also affects nerve traction, mobility, and function. A case is presented of a patient with motor weakness in the wrist and hand in order to illustrate the diagnosis and treatment of posterior interosseous nerve (PIN) syndrome. Using Active Release Techniques Soft Tissue Management and Peripheral Nerve Release Systems) the patient's symptomatology was resolved. Soft tissue-based management in conjunction with neural gliding may be beneficial in the conservative management of PIN syndrome. Further research into the pathophysiology of nerve entrapments will have immediate impact on the management of neuropathies and likely result in emphasizing conservative management and rehabilitation rather than surgical intervention particularly in cases not involving denervation or paralysis.

Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve

Peripheral compression neuropathies are familiar to the hand surgeon. Although compression neuropathies of the forearm are far less common than those of the wrist (namely, carpal tunnel syndrome), for the patient suffering from one of these neuropathies, a missed diagnosis has far-reaching consequences. In this 2-part review (I: Radial Nerve; II: Median Nerve), several compression neuropathies of the forearm are examined. We will first discuss compression neuropathies affecting the radial nerve: (1) posterior interosseous nerve syndrome, (2) radial tunnel syndrome, and (3) superficial radial nerve compression (Wartenberg's syndrome).

Diagnostic Utility of Ultrasound in Posterior Interosseous Nerve Syndrome

Diagnostic Utility of Ultrasound in Posterior Interosseous Nerve Syndrome

Posterior interosseous nerve dysfunction in the radial tunnel

Dysfunction of the Posterior Interosseous Nerve (PIN) has previously been classified into two different groups: Posterior Interosseous Nerve syndrome (PINS) if motor weakness manifests or Radial Tunnel Syndrome (RTS) if forearm pain is the main feature. Its main differential diagnosis is the common Tennis Elbow. There is little evidence or consensus on incidence or aetiology or treatment. The findings of this review suggests that both RTS and PINS have a common aetiology, that some investigative modalities may be useful in the diagnosis of PIN dysfunction but require further trials to support initial findings. Management options are difficult to evaluate due to a lack of controlled trials however surgical results appear to be good considered in the light of questionable diagnosis. Dysfunction of the Posterior Interosseous Nerve (PIN) has previously been classified into two different groups: Posterior Interosseous Nerve syndrome (PINS) if motor weakness manifests or Radial Tunnel Syndrome (RTS) if forearm pain is the main feature. Its main differential diagnosis is the common Tennis Elbow. There is little evidence or consensus on incidence or aetiology or treatment. The findings of this review suggests that both RTS and PINS have a common aetiology, that some investigative modalities may be useful in the diagnosis of PIN dysfunction but require further trials to support initial findings. Management options are difficult to evaluate due to a lack of controlled trials however surgical results appear to be good considered in the light of questionable diagnosis.

Cysticercosis of biceps brachii: A rare cause of posterior interosseous nerve syndrome

Objectives Cysticercosis, a parasitic disease caused by encysted larvae of the tapeworm Taenia solium, is commonly seen in developing countries and in immigrant population of developed countries. The most common presentation is as neuro cysticercosis, but rarely may have an extra cerebral muscular presentation. Methods A case of cysticercosis of the biceps brachii is presented in a 17 year old male, leading on to posterior interosseous nerve syndrome. Results The patient was completely cured by 6 months with medical management with albendazole. Conclusion Cysticercosis is not uncommon in developing countries and immigrant population of developed countries. The muscular presentation of cysticercosis may mimic a tumour leading to posterior interosseous nerve palsy. The management in such cases could be medical line of treatment or surgical excision.

Peripheral Neuropathies of the Median, Radial, and Ulnar Nerves: MR Imaging Features

The median, radial, and ulnar nerves of the upper limbs may be affected by various peripheral neuropathies, each of which may be categorized according to its cause, as either an entrapment or a nonentrapment neuropathy. Entrapment neuropathies, also referred to as nerve compression syndromes, include the supracondylar process syndrome, pronator syndrome, anterior interosseous nerve syndrome, carpal tunnel syndrome, posterior interosseous nerve syndrome, cubital tunnel syndrome, and Guyon canal syndrome. Nonentrapment neuropathies include traumatic nerve injuries, infectious and inflammatory conditions, polyneuropathies, and mass lesions at anatomic locations where entrapment syndromes typically do not occur. Although clinical examination and electrophysiologic testing are the cornerstone of the diagnostic work-up, in certain cases magnetic resonance (MR) imaging may provide key information about the exact anatomic location of a lesion or may help narrow the differential diagnosis. In patients with a diagnosis of peripheral neuropathy, MR imaging may help establish the cause of the condition and provide information crucial for conservative management or surgical planning. In addition, knowledge of the normal anatomy and of the possible causes, typical clinical findings, and MR imaging features of peripheral neuropathies that affect the median, radial, and ulnar nerves allows greater confidence in the diagnosis.

Investigation of two possible compression sites of the deep branch of the radial nerve and nerve supply of the extensor carpi radialis brevis muscle.

The posterior interosseous nerve arises from the deep branch of the radial nerve, and compression by adjacent structures results in posterior interosseous nerve syndrome. Sixty upper limbs from 30 Turkish subjects (18 males and 12 females) were dissected to reveal the course of the posterior interosseous nerve and to examine possible compression sites at the proximal and distal edges of the supinator muscle, and the exit of the nerve from the extensor carpi radialis brevis muscle. Posterior interosseous nerve syndrome is most probably caused by the tendinous part of the supinator muscle at the proximal edge.

Posterior interosseous nerve syndrome with hourglass-like fascicular constriction of the nerve

We describe a case of the posterior interosseous nerve (PIN) syndrome in a patient with gout. Exploration of the PIN revealed multiple hourglass-like constriction of the PIN, which did not correspond to any extrinsic compressing structures. Hourglass-like constrictions of the PIN is one of the causes of the painful PIN syndrome.

Sonography and MR Imaging of Posterior Interosseous Nerve Syndrome with Surgical Correlation

Sonography and MR Imaging of Posterior Interosseous Nerve Syndrome with Surgical CorrelationAlexander J. Chien1, David A. Jamadar1, Jon A. Jacobson1, Curtis W. Hayes1 and Dean S. Louis2Audio Available | Share

Dorsal wrist joint pain in tetraplegic patients during and after rehabilitation.

In a study of 42 tetraplegic patients, physiological, neurological, electrophysiological and radiological examinations were made in 11 patients with complete tetraplegia who had wrist pain after rehabilitation. Pain relief produced by a selective, posterior interosseous nerve lidocaine block indicated distal posterior interosseous nerve syndrome. This syndrome can sometimes be treated conservatively, but surgical excision was required after nerve scarification. Repetitive dorsiflexion, as in wheelchair handling, transfer and tenodesis-like movement, compresses the distal posterior interosseous nerve in some tetraplegic patients. Moreover, weakness of the wrist joint stabilizing muscles is likely to contribute to an increased weight load on the wrist joints. The aetiology of wrist pain in tetraplegia should be considered when there is carpal tunnel syndrome, Wartenberg syndrome, Kienböck syndrome or distal posterior interosseous nerve syndrome. The causes need to be adequately treated to reduce the negative impact of the resultant pain on carrying out the activities of daily life.

Outcome of Surgical Treatment in Posterior Interosseous Nerve Syndrome

Isolated paralysis of muscles innervated by the posterior interosseous nerve (PIN) is rare. Nine such cases of PIN palsy were reviewed over a period of seven years. Apart from one case with a traumatic etiology, the remaining cases did not have a significant clinical history identifying the cause of their neuropathy. Seven cases underwent surgical decompression, five of which improved dramatically. The remaining two patients required tendon transfers, resulting in a fully functional recovery.

Lipoma causing a posterior interosseous nerve syndrome

Posterior interosseous nerve syndrome is an entrapment neuropathy of the deep terminal branch of the radial nerve – the posterior interosseous nerve – at the radial tunnel. Radial neuropathy without prior injury or other obvious etiology occurs frequently. However, sometimes previous trauma, surgery, or tumors over the radial nerve contribute to chronic entrapment and can produce the classic syndrome. In this report we describe an unusual case of a 68-year-old-woman with a chronic posterior interosseous nerve syndrome due to a lipoma. The patient had poor recovery after surgery, despite splinting and rehabilitation physiotherapy, mainly because of the long duration (2 years) and severity of the compression neuropathy.

Outcome of surgical treatment in posterior interosseous nerve syndrome

Outcome of surgical treatment in posterior interosseous nerve syndrome

Occult scapholunate ganglion: a cause of dorsal radial wrist pain.

There are multiple causes for chronic dorsal wrist pain over the scapholunate ligament, including occult dorsal carpal ganglion cyst, scaphoid impaction syndrome, dorsal carpal capsulitis, distal posterior interosseous nerve syndrome, and dynamic scapholunate ligament instability. Patients with such pain often have normal x-rays. A retrospective study of 21 patients undergoing surgical exploration for chronic dorsal radial wrist pain who had no palpable cyst and normal x-rays revealed that 18 of the patients had occult scapholunate ganglion cysts or myxomatous degeneration within the scapholunate ligament. All had failed long-term conservative management. Surgery involved an approach through Langer's lines, resection of a large triangular portion of the capsule between the dorsal intercarpal and radiotriquetral ligaments, and tangential debridement of the area of myxoid degeneration proximal to the distal 2 to 3 mm of dorsal scapholunate interosseous ligament. None of the patients had scapholunate instability or scaphoid impacting syndrome. Of the 18 patients with histologically confirmed myxomatous changes in the scapholunate ligament, 16 had an excellent outcome as defined by rigorous criteria; 1 had a good outcome. There was 1 patient with a poor result. A compelling argument is made for surgical exploration of the scapholunate joint in patients with persistent dorsal radial wrist pain and scapholunate point tenderness.

Uncommon nerve compression syndromes of the upper extremity.

Nerve compression syndromes are a common cause of pain, sensory disturbance, and motor weakness in both the upper and the lower extremities. Although carpal tunnel syndrome is frequently diagnosed and treated surgically with success, other compression syndromes are less common and are often best treated nonsurgically. Understanding the anatomy of the major peripheral nerves with respect to intermuscular septa, fibrous bands, muscle margins, and internervous planes is crucial to understanding how and where peripheral nerve compression can occur. Some conditions, such as anterior interosseous nerve syndrome, respond well to nonoperative treatment; others, such as posterior interosseous nerve syndrome, are better treated by surgical intervention. The authors discuss the anatomic and pathologic causes for compression syndromes, as well as guidelines for treatment and outcomes.

Compression Neuropathies of the Wrist and Hand

In this review the authors cover compression neuropathies localized to the wrist and hand. Specifically, these include carpal tunnel syndrome, ulnar tunnel syndrome, Wartenberg's syndrome, distal posterior interosseous nerve syndrome, and bowler's thumb. For each of these neuropathies, the relevant anatomy, presentation, and treatment are discussed. Correlations to specific sport-related injuries are also discussed with relevant options of management.

Neurosurgery of the Peripheral Nervous System: The Posterior Interosseous Nerve Syndrome

Introduction The “posterior interosseous nerve syndrome” is caused by compression, in the upper third of the forearm, of the terminal motor branch of the radial nerve, called the deep radial nerve or posterior interosseous nerve (PIN). In most cases, this nerve is compressed at the arcade of Frohse. Proximally to this arcade, the main radial nerve and/or its branches, the sensory superficial radial nerve and the PIN, may be also compressed.

Posterior interosseous nerve syndrome: literature review and report of 14 cases

Posterior interosseous nerve syndrome: literature review and report of 14 cases

Nerve entrapment syndromes.

Peripheral nerve entrapment syndromes may be caused by inflammation, trauma, or congenital deficits. Some entrapment neuropathies are overdiagnosed, particularly carpal tunnel syndrome. Other nerve entrapment syndromes, such as the thoracic outlet syndrome, posterior interosseous nerve syndrome, and anterior interosseous nerve syndrome, are rare. In most cases of an entrapment neuropathy, the diagnosis and management are straightforward, but much remains to be learned about the natural history, course, and prevention of these clinical conditions.

SURGICAL TREATMENT OF POSTERIOR INTEROSSEOUS NERVE SYNDROME

Sixteen patients were operated on consecutively for palsy of the posterior interosseous nerve. The aetiologies were traumatic in 12 patients and non-traumatic in four. Operative neurolysis was done in six cases. Neurorrhaphy with sural nerve grafting was performed in two cases. Tendon transfer was done in eight cases. Relief of compression has the best result followed by nerve repair. Iatrogenic nerve injury after radial plating carried the worst prognosis. Although motor power was not normal after surgery, tendon transfer still provided a useful hand with residual extension lag of the fingers. The prognosis of operative treatment of posterior interosseous nerve syndrome depends mainly on its aetiology.