Spontaneous Posterior Interosseous Nerve Palsy Research Articles

Isolated spontaneous posterior interosseous nerve palsy: a review of aetiology and management.

Isolated posterior interosseous nerve palsy is an uncommon condition and its management is controversial. Existing literature is sparse and a treatment algorithm based on existing best evidence is absent. A comprehensive review was undertaken to elucidate the causes of spontaneous posterior interosseous nerve palsy and suggest a management strategy based on the current evidence. Posterior interosseous nerve palsy can be broadly categorized as compressive and non-compressive, and the existing evidence supports surgical intervention for compressive palsy. For posterior interosseous nerve pathology with no compressive lesion on imaging, conservative management should be tried first. Surgery is therefore reserved for compressive lesions and for failure of conservative management. The commonly performed operative procedures include decompression and neurolysis, neurorrhaphy and nerve grafting, and tendon transfers with or without nerve grafting performed as a salvage procedure. The prognosis is poorer in patients aged > 50 years, those with a delay to surgery, and those who have had long-standing compression with severe fascicular thinning.

Surgical and conservative treatments of complete spontaneous posterior interosseous nerve palsy with hourglass-like fascicular constrictions: a retrospective study of 41 cases.

The surgical treatment of spontaneous posterior interosseous nerve (PIN) palsy with hourglass-like fascicular constriction (HLFC) remains controversial. To review 41 patients with complete spontaneous PIN palsy with HLFC to clarify the necessity and choice of surgery. Interfascicular neurolysis (NY), neurorrhaphy, and autografting were performed on 10, 8, and 6 patients, respectively. The thinning extent of a nerve fasciculus ≤0.25, 0.25 to 0.75, and ≥0.75 was defined as mild, moderate, and severe constriction, respectively. Final British Medical Research Council muscle power grade ≥4 was defined as good recovery. Ultrasound showed the number, location, and thinning extent of HLFC of PIN well, with results that were highly consistent with intraoperative measurements. Of the 17 conservatively treated patients, 13 recovered well. Of the 24 surgically treated patients, 20 recovered well. For NY, 8 patients with mild to moderate PIN constriction recovered well, but 2 patients with severe PIN constriction recovered poorly. For 16 patients with severe HLFC, 12 of 14 patients who underwent neurorrhaphy or autografting recovered well; the surgical effects were much better than those of 2 patients who had undergone NY. Ultrasound is a helpful diagnostic technique for spontaneous PIN palsy with HLFC. Surgery is necessary for PIN constriction if conservative treatments fail. Surgical choices depend largely on the thinning extent of the PIN constriction and the age of the patients. The outcomes of patients aged ≥50 years were much worse. We suggest NY for mild to moderate, and neurorrhaphy or autografting for severe PIN constriction.

Surgical treatment of spontaneous posterior interosseous nerve palsy with hourglass-like constriction

Surgical treatment of spontaneous posterior interosseous nerve palsy with hourglass-like constriction

Non-traumatic Spontaneous Posterior Interosseous Nerve Palsy: Sonography and Magnetic Resonance Imaging with Electromyographic Correlation - A Case Report -

Non-traumatic Spontaneous Posterior Interosseous Nerve Palsy: Sonography and Magnetic Resonance Imaging with Electromyographic Correlation - A Case Report -

Fascicular constrictions in patients with spontaneous palsy of the anterior interosseous nerve and the posterior interosseous nerve

There is no definition for fascicular constrictions of the spontaneous anterior interosseous nerve palsy (sAINP) and spontaneous posterior interosseous nerve palsy (sPINP). One surgeon has evaluated his findings in our 32 patients of sAINP/sPINP using either photographs or video tapes and proposed a definition. All patients had interfascicular neurolysis, and 87 case reports of “fascicular constriction” were also evaluated. Fascicular constriction was defined as every instance of thinning in the fascicle regardless to its extent. Thinning as a result of extrinsic compression was excluded. The fascicular constrictions were divided into four types: recessed, recessed-bulging, rotation, and rotation-bulging constriction. Two independent surgeons went through our findings to verify their repeatability. The relation between the fascicular constrictions and age at the onset of palsy was evaluated using Student's t test. We found 54 fascicular constrictions, with many variations. However, they could all be categorised by our method. The repeatability among the independent authors was 96%. The age at the onset of palsy was significantly younger in rotation-bulging than in rotation constriction (p = 0.0003). Our definition of describing fascicular constrictions was accurate, and should help to provide consensus in describing these palsies.

Surgical treatment of spontaneous posterior interosseous nerve palsy

We have reviewed 38 surgically treated cases of spontaneous posterior interosseous nerve palsy in 38 patients with a mean age of 43 years (13 to 68) in order to identify clinical factors associated with its prognosis. Interfascicular neurolysis was performed at a mean of 13 months (1 to 187) after the onset of symptoms. The mean follow-up was 21 months (5.5 to 221). Medical Research Council muscle power of more than grade 4 was considered to be a good result. A further 12 cases in ten patients were treated conservatively and assessed similarly. Of the 30 cases treated surgically with available outcome data, the result of interfascicular neurolysis was significantly better in patients < 50 years old (younger group (18 nerves); good: 13 nerves (72%), poor: five nerves (28%)) than in cases > 50 years old (older group (12 nerves); good: one nerve (8%), poor: 11 nerves (92%)) (p < 0.001). A pre-operative period of less than seven months was also associated with a good result in the younger group (p = 0.01). The older group had a poor result regardless of the pre-operative delay. Our recommended therapeutic approach therefore is to perform interfascicular neurolysis if the patient is < 50 years of age, and the pre-operative delay is < seven months. If the patient is > 50 years of age with no sign of recovery for seven months, or in the younger group with a pre-operative delay of more than a year, we advise interfascicular neurolysis together with tendon transfer as the primary surgical procedure.

Acute posterior interosseous nerve palsy caused by a synovial haemangioma of the elbow joint

A case is described of spontaneous posterior interosseous nerve palsy of acute onset. The initial symptoms made it difficult to distinguish the condition from tendon rupture. The diagnosis was established using ultrasound, nerve conduction studies and MRI. The patient underwent surgery to decompress the posterior interosseous nerve and the histological examination identified the tumour as a synovial haemangioma. 12 months after the operation, the patient had made a complete recovery, confirmed by EMG.