Posterior interosseous nerve palsies

One hundred seventy patients with radial nerve disorders were reviewed at the Louisiana State University Medical Center over a 15-year period. Of these, 32 had involvement of the posterior interosseous nerve exclusively. Findings included weak wrist extension with a radial drift, inability to extend the fingers, paralysis of thumb extension, and weak thumb abduction. Causes included entrapment at the arcade of Froshe (14 patients), laceration (6 patients), fracture (6 patients), compression or contusion (3 patients), and loss associated with tumor (3 patients). The ratio of men to women was 2:1, and the right arm was involved twice as often as the left. Preoperative evaluation included physical examination, electrophysiological testing (electromyogram/nerve conduction velocity), and roentgenograms of the elbow and forearm. Of the 30 patients (2 patients had bilateral lesions), 26 underwent operation. In the operative series, all 28 nerves had a function of Grade 3 or more of a possible 5 after 4 years of follow-up. Seventeen had achieved Grade 4/5, and 7 had obtained Grade 5/5. At operation, 23 nerves were found to be in continuity. Fourteen lesions of nerves in continuity were associated with entrapment and, not unexpectedly, transmitted a nerve action potential with slowed conduction and low amplitude across the lesion. Four nerves in continuity that had lesions caused by injury had nerve action potentials and were treated by neurolysis, and another 4 had no nerve action potentials and were treated by graft or suture repair. Five injured nerves were not in continuity. Two could be repaired by end-to-end suture, and 3 required graft repair. A large ganglion cyst involving the posterior interosseous nerve was also resected.     

Posterior interosseous nerve palsy

We report a case of radial palsy of the Frohse arcade type with complete motor deficit due to compression of the posterior interosseous nerve by a fibrous bands in the radial tunnel proximal to the arcade. Simple neurolysis of the posterior interosseous nerve with section of the compressing fibrous bands allowed complete recovery of the motor deficit. We discuss the surgical technique based on our experience with this case and earlier reports in the literature.     

Penetrating injury to the terminal branches of the posterior interosseous nerve with nerve grafting

We report two cases of penetrating injuries to the terminal branches of the posterior interosseous nerve in the forearm. Repair using nerve grafts in both cases were followed by complete recovery.     

Posterior interosseous nerve syndrome due to pseudogout

Posterior interosseous nerve palsy associated with pseudogout of the elbow joint in a 71-year-old woman is described. Local steroid injection and administration of a nonsteroidal anti-inflammatory drug was effective in treatment.     

Posterior interosseous nerve palsy in rheumatoid arthritis

Bilateral posterior interosseous nerve palsy in a rheumatoid patient is described. Six previous case reports and our experience indicate that steroid injection into the elbow may not produce lasting recovery and may lead to unacceptable delay before surgical decompression. An anterolateral approach for division of the arcade of Frohse is effective in cases with diffuse synovitis; where there is a local cystic swelling a posterolateral approach provides better access. Good recovery of nerve function can be expected after early operation.     

Posterior interosseous nerve palsy due to lipoma

A 45-year-old male patient presented with paralysis of slow onset in the right forearm and hand muscles. Electromyographic assessment revealed severe denervation in the muscles innerved by the posterior interosseous nerve. Magnetic resonance imaging demonstrated a tumoral mass compressing the nerve. The patient underwent surgical excision with an initial diagnosis of lipoma. Surgical exploration and a biopsy confirmed the diagnosis. Active wrist movements and digital extension were possible after three weeks and the patient resumed full strength six weeks after the operation.     

Posterior interosseous nerve palsy due to intermuscular lipoma

Lipomas are usually subcutaneous and asymptomatic. Rarely, they can occur in a deeper soft tissue plane exerting pressure on adjacent nerves. When adjacent to the neck of the radius, it can cause posterior interosseous nerve compression. In this case report, posterior interosseous nerve palsy due to an intermuscular lipoma is reported.     

Posterior interosseous nerve palsy due to parosteal lipoma

Lipomas are extremely common benign soft tissue tumours that are usually subcutaneous and asymptomatic. Occasionally, lipomas can occur in deeper soft tissue planes and when adjacent to the neck of the radius they can cause compression of the posterior interosseous nerve. Five such cases are described. An anterior approach to excision of the lipoma is recommended.     

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.     

Posterior interosseous nerve axonotmesis from compression by a ganglion

A complete posterior interosseous nerve palsy resulted from axonotmesis caused by pressure from a ganglion cyst. Excision of the neuroma and interpositional nerve grafting gave a most satisfactory outcome.     

Posterior interosseous nerve entrapment after Monteggia fracture-dislocation in children

Objective: Although most of nerve injuries associated with Monteggia fracture-dislocation in children are neurapraxias and will recover spontaneously after conservative treatment, surgical exploration of the involved nerve is always required in the cases with the entrapment of posterior interosseous nerve (PIN). However, the necessity and time frame for surgical intervention for specific patterns of nerve dysfunction remains controversial. The aim of the report is to observe and understand the pathology of PIN injury associated with Monteggia fracture-dislocation in children, and to propose the possible indication for the exploration of nerve. Methods: Eight cases, six boys and two girls, with Monteggia fracture-dislocation complicated by PIN injury, managed operatively at the authors’ Hospital from 2007 to 2008 were retrospectively reviewed. All the patients underwent the attempted closed reduction before they received exploration of PIN, with open reduction and internal fixation or successful closed reduction. Results: The PIN was found to be trapped acutely posterior to the radiocapitellar joint in 4 out of 5 Type III Bado’s Monteggia fractures. In the remaining cases, since there were longer time intervals from injury to operation, chronic compressive changes and epineural fibrosis of radial nerve were visualized. After a microsurgical neurolysis performed, the complete recovery in the nerve function was obtained in all the cases during the follow-up. Conclusion: The findings from this study suggest that every case of type III Monteggia fracture-dislocation with decreased or absent function of muscles innervated by PIN and an irreducible radial head in children should be viewed as an indication for immediate surgical exploration of the involved nerve to exclude a potential PIN entrapment.     

Posterior interosseous nerve entrapment after Monteggia fracture-dislocation in children

Although most of nerve injuries associated with Monteggia fracture-dislocation in children are neurapraxias and will recover spontaneously after conservative treatment,surgical exploration of the invol...     

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.