Posterior interosseous nerve compression secondary to a parosteal lipoma: Case report and literature review

An unusual case of limited radial nerve palsy secondary to a parosteal lipoma is presented, along with a thorough review of the literature. Palsy of the posterior interosseous nerve secondary to compression by a lipoma is a rare occurrence. Most cases tend to occur in the fifth to eighth decades of life. The pattern of physical symptoms may be quite variable. A high degree of suspicion must be maintained in the setting of unexplained symptoms. The literature review revealed the presence of a diagnostic proximal forearm radiolucent mass in 13 of 15 patients. Although they are used as diagnostic aids, computed tomography and magnetic resonance imaging have not been shown to alter management. Though benign tumours constitute a minority of such cases, a plain radiograph is recommended in addition to electromyographic and nerve conduction studies.     

Posterior interosseous nerve palsy due to schwannoma: case report

This is a report of posterior interosseous nerve palsy caused by solitary and nerve-derived tumor. Magnetic resonance imaging is beneficial in the preoperative diagnosis and the localization of tumor.     

Posterior interosseous nerve compression syndrome following distal biceps brachii tendon rupture: an unusual sequel

We present an unusual case of a carpenter who had posterior interosseous nerve compression syndrome post-traumatic biceps brachii tendon rupture. The symptomatic presentation was confirmed by nerve conduction studies. Such a complication of biceps brachii tendon rupture has not been reported so far.     

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

The posterior interosseous nerve (PIN) paralysis is characterized by weakness of the innervated muscles: the supinator muscle, the extensor muscles to the wrist, fingers and thumb (except the extensor carpi radialis longus) and the abductor pollicis longus muscle. Exploration of the nerve is recommended if there are no signs of spontaneous recovery after a period of observation of three to nine months. Another form of posterior interosseous nerve syndrome (PINS), also called the radial tunnel syndrome, presents with proximal forearm pain only. It is recommended to treat these patients conservatively at first. Only if conservative therapy does not relieve the symptoms of pain the PIN should be explored. A retrospective follow-up study of 14 patients with PINS was carried out, of which 12 patients had paresis or paralysis and two patients a pain syndrome. All, but one, were operated on. The results at follow-up will be discussed. It is recommended that the period of observation should be six to eight months for patients with PIN paresis, however, for patients with a full paralysis it is not possible to make any recommendation from this series. In contrast to the results reported in the literature, both our patients with pain as the only symptom obtained poor results at follow-up. For this group of patients the importance of the conservative treatment is emphasized. Received: 20 February 1997 / Accepted: 7 October 1997     

旋后肌肌支移位术的解剖学研究

目的 通过对桡神经旋后肌肌支和骨间后神经的显微解剖,为旋后肌肌支移位术提供解剖学依据,并设计旋后肌肌支移位术的最佳手术入路.方法 选择13侧甲醛固定成人上肢标本,解剖肘以远桡神经及各肌支,记录旋后肌肌支及骨间后神经的形态特征、分布情况和直径.结果 旋后肌肌支一般有3支,旋后肌Frohse弓近端2支,旋后肌肌管内1支,管外肌支恒定,可直接与骨间后神经缝合,且口径匹配.结论 旋后肌肌支可用来移位修复骨间后神经,为臂丛神经中下干损伤患者提供一种新的神经移位方式.     

Anterior interosseous nerve syndrome with atypical nerve course in relation to the pronator teres

Summary A case of anterior interosseous nerve palsy is demonstrated due to an anatomical variation not recorded before causing this syndrome. Main median-nerve trunk and anterior interosseous nerve passed differently in relation to the pronator teres muscle. Surgery led to a rapid recovery of nerve function.     

Posterior interosseous reverse flap

Losses of skin substance of the dorsal face of the hand occasionally justify resorting to cover flaps when the noble elements (bones, tendons) are whether damaged or exposed. Few flaps allow filling in these losses of substance. Among those, which do, posterior interosseous reverse flap is indicated in some cases. We will present the technique and the main indications for the posterior interosseous flap. It is an island flap receiving reverse-flow vascularisation by the posterior interosseous artery. This flap is harvested from the second proximal quarter of a line extending from the lateral epicondyle of humerus to the ulnar head. The antebrachial fascia is incised longitudinally on the ulnar extensor of wrist and digiti minimi. The cutaneous flap is raised from radial to ulnar while sectioning the different intermuscular septa. Only the septum dividing the digiti minimi and ulnar extensor of wrist is preserved because it contains the pedicle. Once the main pedicle is identified, the skin paddle can be raised from proximal to distal. Then the septum holding the pedicle is detached from the ulna through to the distal radio-ulnar articulation, level with the bone surface. This flap is appropriate for losses of skin substance of the dorsal face of the hand extending to the first phalanxes and the first commissure. It can also be used to cover the anterior face of the wrist and is perfectly suited for retraction of the first commissure. Contrarily to the Chinese and ulnar flaps, it does not cause any damage to any significant arterial axis. Its main drawback is the scar on the donor site, which is often unsightly, while in the child; direct closure is possible in most cases.     

Posterior interosseous nerve palsy associated with neglected pediatric Monteggia fracture-dislocation: A case report

IntroductionThe main goal of the treatment is the anatomical reduction of the ulna fracture and the radial head dislocation in acute and chronic Monteggia cases. Acute pediatric Monteggia lesions are generally treated non-surgically; however, the treatment of chronic Monteggia is challenging. The aim of this article is to share our experiences about treatment of neglected Monteggia lesion.Presentation of caseA 6-year-old girl who underwent a surgery in our clinic for a missed Bado type-III Monteggia fracture-dislocation of the right elbow with concomitant posterior interosseous nerve (PIN) palsy, which resolved spontaneously after the operation. The operation consisted of open reduction of the radial head, transverse ulnar osteotomy and fixation with an intramedullary Kirchner wire, and annular ligament repair without exploring PIN. The patient was seen in routine follow-up periods until the postoperative first year using plain radiographies. At 16th week follow-up, all functions of the PIN were returned. At first-year follow-up, full range of elbow motion was observed; plain radiographies showed radiocapitellar joint congruency, and Mayo Elbow Performance Index was one hundred.DiscussionTreatment planning for chronic, neglected or missed Monteggia fractures is challenging. There is no consensus about the definitive treatment in the literature.ConclusionWe recommend anatomic and stable restoration of radiocapitellar joint by correcting ulna deformity. Radiocapitellar fixation and PIN exploration may not be necessary in all neglected Monteggia lesions.     

骨间前神经卡压征的手术治疗

目的　通过对手术后骨间前神经卡压征患者的随访 ,总结该病的手术治疗效果。方法　对 5例骨间前神经卡压征患者 ,在保守治疗无效后行神经松解术 ,3例行卡压神经的异常纤维束带切断术及神经外膜松解术 ,2例行神经外膜松解术。结果　 5例患者均得到术后 1年的随访 ,以最后 1次的随访结果为准。 4例患者的拇长屈肌、示指指深屈肌、旋前方肌的肌力恢复到M4,但有 1例未见恢复。该例再行功能重建术 ,手部功能亦得到恢复。结论　前骨间神经卡压征是少见病 ,常易误诊 ,一旦确诊 ,经保守治疗无效 ,以神经松解术治疗为佳。     

骨间前神经卡压征的电生理研究

目的分析总结骨间前神经卡压征的神经电生理特点,探讨其对骨间前神经卡压征的诊断意义。方法对12例骨间前神经卡压征患者进行神经电生理检测：（1）惠侧及对侧骨间前神经运动潜伏期及复合肌肉动作电位波幅：（2）患侧正中神经运动、感觉传导速度及复合肌肉动作电位、感觉动作电位波幅：（3）患侧拇短展肌、指浅屈肌、旋前方肌、拇长屈肌肌电图。结果10例骨间前神经运动潜伏期延长;12例骨间前神经复合肌肉动作电位波幅降低;12例正中神经运动、感觉传导速度及复合肌肉动作电位、感觉动作电位波幅正常：12例旋前方肌、10例拇长屈肌肌电图示神经性损害;12例拇短展肌、指浅屈肌肌电图正常。结论骨间前神经卡压征的神经电生理表现特点为：骨间前神经运动传导潜伏期延长及复合肌肉动作电位波幅降低,其支配肌肉肌电图示神经性损害,而正中神经运动及感觉传导正常．其支配肌肉肌电图正常。骨间前神经卡压征的神经电生理表现可为该病提供客观、准确的诊断与鉴别诊断依据。     

Posterior interosseous artery flap in traumatic hand injuries

Introduction Nineteen cases of posterior interosseous artery (PIOA) flap were reviewed. The patients' mean age was 24 (range 14–53) years.Materials and methods Nine patients were operated on as emergencies, and 10 patients were treated electively. Mean time of delay after trauma was 7.8 h (range 2–20 h) in emergency cases. Nine of them were non-replantable amputations. Skin defects were between 1.9×2.4 cm and 5.0×12.0 cm. Mean hospitalization time was 2.2 (range 1–5) days.Results Mean flap sensation was evaluated as 2.83–6.65 with the Semmes-Weinstein evaluation scale (only 2 patients scored less than 3.61). Five patients presented with discoloration and coolness. Average subjective evaluation was 8.2/10. Mean web opening after first web reconstruction was 40°. One posterior interosseous neuropraxia ( recovered in 4 months), one distal flap necrosis, and one flap lost (due to infection) occurred as early complications. Mean follow-up was 12.8 months (range 15 days to 30 months).Conclusions PIOA flap applications have reduced the need for lateral arm and radial forearm flaps and also shortened hospitalization time in clinical practice.     

第三骨间掌侧肌及其肌支的解剖观察

目的观察第三骨间掌侧肌及其肌支的解剖学特点，探讨腕尺管综合征中小指内收恢复困难的解剖学基础。方法在2．5倍手术放大镜下对20具新鲜无外伤、无畸形成人手标本进行解剖，观察第三骨间掌侧肌及其肌支及邻近结构，测量了第三骨间掌侧肌的大小和第三骨间掌侧肌支的长度、宽度、厚度，并对所得数据进行统计学处理。结果第三骨间掌侧肌及第三骨间掌侧肌支分别是骨间掌侧肌和骨间掌侧肌支中最细小的，部分第三骨间掌侧肌浅层存在明显的腱束，对第三骨间掌侧肌支形成潜在的卡压。结论第三骨间掌侧肌及其肌支是骨间掌侧肌和肌支中最细小的，部分由第三骨间掌侧肌桡侧绕至尺侧入肌，而第三骨间掌侧肌掌侧存在明显的腱束，对第三骨间掌侧肌支形成潜在卡压，可以解释小指内收恢复困难的原因。     

Slow progression predicts poor prognoses in patients with spontaneous posterior interosseous nerve palsy

Abstract

There are still no factors that predict the prognoses of patients with spontaneous posterior interosseous nerve palsies who are in an early phase of the illness. This paper reviewed 39 patients with this type of palsy. Seventeen patients who requested surgery for possible earlier recovery underwent interfascicular neurolysis because no signs of recovery were seen more than 3 months after onset. A Medical Research Council muscle power grade over 4 at their final visit was considered a good result, while a power less than grade 4 was considered a poor result. The clinical outcomes were significantly worse for the patients who had palsies with slow progressions (for more than 1 month) compared with those who had palsies with rapid progressions (completed within 1 month), regardless of their treatment. No significant difference was seen between the prognoses of patients with complete and incomplete palsies. We, therefore, recommend that interfascicular neurolysis is performed together with tendon transfer as the primary surgical procedures for patients with palsies with slow progression.     

桡神经浅支卡压征的治疗体会

本文报告用局封治疗１１例桡神经浅支卡压征。随访６个月－１年，疗效满意。其症状主要表现为：手背及前臂远段桡侧疼痛；手背桡侧感觉减退；患手握力下降；Ｔｉｎｅｌ征阳性。桡神经浅支穿出点神经是固定的，进入浅部后有一定的滑动度，长期反复活动腕关节，使桡神经浅支反复牵拉、磨擦，以致水肿纤维化、结缔组织增生造成卡压是其发病的解剖因素。     

桡神经浅支卡压征的治疗体会

本文报告用局封治疗１１例桡神经浅支卡压征。随访６个月-１年，疗效满意。其症状主要表现为：手背及前臂远段桡侧疼痛；手背桡测感觉减退；患手握力下降;Ｔｉｎｅｌ征阳性。桡神经浅支穿出点神经是固定的，进入浅部后有一定的滑动度，长期反复活动腕关节，使桡神经浅支反复牵拉、磨擦，以致水肿纤维化、结缔组织增生造成卡压是其发病的解剖因素。     

Posterior interosseous nerve of the elbow at the arcade of Frohse: Ultrasound appearance in asymptomatic subjects

PurposeTo assess the normal values of the antero-posterior (AP) diameter of the posterior interosseous nerve (PIN) of the elbow as it passes beneath the arcade of Frohse and to search for PIN-diameter differences between the upstream, entry point and downstream of the arcade.Material and methodsThirty asymptomatic patients prospectively underwent bilateral B-mode ultrasound of the PIN of the elbow. There were 15 men and 15 women with a mean age of 30.2 ± 5.31 (SD) years (range: 26–43 years). Of these, 23 patients were right-handers (23/30; 77%) and 7 were left handers (7/30; 23%). AP diameter of the PIN was measured in long axis at three different locations including the entry point of the arcade, 5-mm upstream and 5-mm downstream the arcade. A comparison between the three measurements was performed using paired t-test.ResultsThe mean AP diameters of the PIN were 0.83 ± 0.21 (SD) mm (range: 0.43–1.31 mm), 0.6 ± 0.17 (SD) mm (range: 0.29–1.16 mm) and 0.49 ± 0.13 (SD) mm (range: 0.26–0.86 mm) at 5-mm upstream, entry point of the arcade and 5-mm downstream the arcade of Frohse, respectively. Significant drops in PIN diameter were found between upstream and the arcade (−0.23 mm; 27%; P < 0.001), between the arcade and downstream (−0.11 mm; 17%; P < 0.001), and between upstream and downstream the arcade (−0.34 mm; 40%; P < 0.001).ConclusionDisparity in AP diameter of the PIN of the elbow in the arcade of Frohse is a normal finding and should not be erroneously interpreted as entrapment when present alone.     

Intraneural lipoma of the posterior interosseous nerve

Lipomas arising in the peripheral nerves are rare tumors, with most arising in the forearm and wrist, and most have occurred within the median nerve. This report describes a case with large lipoma arising in the posterior interosseous nerve.     

渐进性骨间前神经卡压误诊1例

患者,女,49 岁,5 d前出现右示指末节屈曲不利,逐渐加重至屈曲不能,无法捏物,无局部疼痛及麻木,于2019 年5月3 日至我院就诊.查体:右示指末节屈曲肌力0级,近、中指间关节屈伸正常,无压痛及感觉异常,余指各指间关节、掌指关节及腕掌关节无压痛,活动及感觉正常,鱼际肌轻度萎缩,腕部无明显压痛,Tinel征阴性.患者...     

带蒂骨间后神经示指固有伸肌支移位修复尺神经深支及鱼际肌支的解剖学研究

目的探讨应用带蒂示指固有伸肌支移位修复尺神经深支及鱼际支术式的可行性,为临床应用提供解剖依据。方法在放大10倍手术显微镜视下,观测18侧成人新鲜上肢标本中正中神经鱼际肌支、尺神经深支和骨间后神经示指固有伸肌支、终末支的神经束数目、直径、有髓神经纤维数、神经束间无损伤分离和强行分离长度。以带血管蒂骨间后神经终末支为桥接神经,模拟带血管蒂示指固有伸肌支移位术。结果示指固有伸肌支横径为[(1．10±0．24)mm,x±s,下同],有髓神经纤维数为(618±76)根;尺神经深支直径为(2．04±0．42)mm,有髓神经纤维数为(1 342±120)根;鱼际肌支直径为(1．62±0．36)mm,有髓神经纤维数为(1 088±95)根。示指固有伸肌支走行恒定,具有一定的横径和一定数目的有髓神经纤维,可携带血管移位修复尺神经深支及正中神经鱼际肌支。结论应用带血管蒂的示指固有伸肌支移位修复尺神经深支及鱼际肌支术式可行,为临床尺、正中神经高位损伤后手内在肌功能修复提供了一种新方法及可靠的解剖学依据。     

Reconstruction of Posterior Interosseous Nerve Injury Following Biceps Tendon Repair: Case Report and Cadaveric Study

Surgical repair of distal biceps tendon rupture is a technically challenging procedure that has the potential for devastating and permanently disabling complications. We report two cases of posterior interosseous nerve (PIN) injury following successful biceps tendon repair utilizing both the single-incision and two-incision approaches. We also describe our technique of posterior interosseous nerve repair using a medial antebrachial cutaneous nerve graft (MABC) and a new approach to the terminal branches of the posterior interosseous nerve that makes this reconstruction possible. Finally, we advocate consideration for identification of the posterior interosseous nerve prior to reattachment of the biceps tendon to the radial tuberosity.