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Anterior Interosseous Nerve Syndrome
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(Redirected from Anterior Interosseus Nerve Syndrome)
Other Names
- Kiloh-Nevin Syndrome
- AIN Compressive Neuropathy
- AINS
- Anterior Interosseus Nerve Syndrome
Background
- This page refers to neuropathy of the Anterior Interosseus Nerve (AIN)
History
Epidemiology
- Represents <1% of upper extremity neuropathies[1]
Pathophysiology
- General
Etiology
- Pathoanatomy
- Most common site of compression is the tendinous edge of the deep head of the Pronator Teres
- Also must consider
- Proximal edge of the Flexor Digitorum Superficialis arch (the FDS arcade)
- Gantzer's muscle (accessory head of the FPL muscle)
- FDS or FDP accessory muscles
- Arterial thrombosis (radial or ulnar artery have been implicated)
- Lacertus fibrous
- Etiology of the disease is controversial[2]
- Traumatic etiologies:[3]
- Supracondylar fractures,
- Penetrating injuries and stab wounds
- Cast fixation
- Venipuncture
- Complication of open reduction and internal fixation of fractures
- Spontaneous etiologies:
- Brachial plexus neuritis
- Compartment syndrome
- Compression neuropathy
- Traumatic etiologies:[3]
- Martin-Gruber Anastomosis
- Anatomical variant in which AINM gives off branches to ulnar nerve, patients can then present with symptoms in ulnar nerve patterns
Pathoanatomy
- Anterior Interosseus Nerve (AIN)
- Terminal motor branch of the Median Nerve
- Innervates:
- Flexor Pollicus Longus
- Flexor Digitorum Profundus (index, long fingers)
- Pronator Quadratus
Associated Conditions
- Parsonage Turner Syndrome
- Be suspicious if patient has bilateral AIN symptoms, shoulder pain, viral prodrome
Risk Factors
- Needs to be updated
Differential Diagnosis
Differential Diagnosis Wrist Pain
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Differential Diagnosis Forearm Pain
- Fractures
- Pediatric Specific Fractures
- Dislocations & Instability
- Soft Tissue Trauma
- Tendinopathies
- Neuropathies
- Pediatric Considerations
Other Considerations
Clinical Features
- History
- Poorly localized pain from forearm to anticubital fossa
- The patient will not report any parasthesias
- Inability to make "OK" sign
- Physical Exam: Physical Exam Wrist
- This disease is characterized by motor deficits only, there are no sensory deficits
- Weakness of index and thumb pincer movement
- Special Tests
- Pinch Test: Patient unable to hold sheet of paper between thumb and index finger
Evaluation
Radiographs
- Standard Radiographs Wrist
- 3 View radiographs typically acquired to evaluate for other etiologies
- No role in diagnosis of atraumatic disease
EMG/NCS
- Sensory nerve conduction studies of median nerve should be normal
- Can help differentiate neuralgic amyotrophy verse a compression neuropathy
MRI
- Identifying compression of the AIN on MRI can be difficult[4]
- Entrapment may not be visualized
- Enhancement within the muscles affected by the nerve root entrapment
Classification
- N/A
Management
Nonoperative
- Most patients improve with 6-12 weeks of relative rest and conservative care
- Relative rest, especially from provocative activities
- Splint elbow at 90° flexion
- Physical Therapy
- Medications including NSAIDS
Operative
- Indications:
- Failure of conservative measures
- 75% of patients improve following surgery if clear space occupying lesion(need citation)
- Procedure:
- Surgical decompression of AIN
Return to Play
- Needs to be updated
Complications
- Motor weakness
- Chronic pain
See Also
- Hand and Wrist Anatomy (Main)
- Wrist Pain (Main)
- Forearm Pain (Main)
- Elbow Pain (Main)
- Physical Exam Wrist
- Neuropathies (Main)
External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ Berger RA. Hand Surgery. Lippincott Williams & Wilkins. (2004) ISBN:0781728746
- ↑ Tyszkiewicz T, Atroshi I. Bilateral anterior interosseous nerve syndrome with 6-year interval. SAGE Open Med Case Rep. 2018;6:2050313X18777416.
- ↑ Akhondi, Hossein, and Matthew Varacallo. "Anterior Interosseous Syndrome." StatPearls [Internet]. StatPearls Publishing, 2018.
- ↑ Aljawder, Abdulla, et al. “Anterior Interosseous Nerve Syndrome Diagnosis and Intraoperative Findings: A Case Report.” International Journal of Surgery Case Reports, vol. 21, 2016, pp. 44–47. PubMed, https://doi.org/10.1016/j.ijscr.2016.02.021.
Created by:
John Kiel on 14 October 2019 18:05:24
Authors:
Last edited:
27 April 2023 08:25:26
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