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Posterior Interosseus Nerve Syndrome

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Other Names

  • PIN Compression Syndrome
  • PIN Syndrome

Background


Pathophysiology

  • Three subcategories
    • Neuropraxia: Mildest form, demyelination from compression or traction
    • Axonotmesis: Moderate form, demyelination as well as axonal injury
    • Neurotmesis: Severe, nerve is transected
  • Anatomic areas of pathology
  • Etiology
    • Idiopathic
    • Microtrauma
    • Trauma
      • Monteggia fractures
      • Radial head fracture-dislocations
    • Space-occupying lesions
    • Brachial Neuritis
    • Spontaneous compression
    • Iatrogenic (surgery)

Risk Factors

  • Males > Female (2:1)
  • Right > Left arm [1]
  • Manual Laborers
  • Bodybuilders

Differential Diagnosis

Differential Diagnosis Wrist Pain

Differential Diagnosis Forearm Pain


Clinical Features

  • General: Physical Exam Wrist
  • Often goes undiagnosed
  • History
    • Etiology is frequently idiopathic, although history of trauma or injury may endorsed
    • Patients often endorse weakness in finger and thumb extension
    • Vague pain in forearm and wrist
  • Physical exam
    • Examiner may notice atrophy of extensor muscles
    • Wrist extension is preserved because ECRL is innervated by the radial nerve
    • There may be deviation to the radial side due to ECU weakness and intact ECRL
    • Tinel’s Test can be positive
    • Resisted supination can reproduce symptoms

Evaluation

Radiographs

MRI

  • Not commonly needed, helpful to evaluate for other pathology
  • Can identify some causes of PIN compression

EMG/NCS


Classification

  • N/A

Management

Nonoperative

Operative

  • Reserved for those who fail at least 3 months conservative therapy
  • Involves surgical decompression

Return to Play

  • Needs to be updated

Complications

  • Surgical complications
    • Incomplete decompression
    • Continuation of symptoms
    • Ininability to return to work

See Also


References


  1. Cravens G, Kline DG. Posterior interosseous nerve palsies. Neurosurgery. 1990 Sep;27(3):397-402.
Created by:
John Kiel on 27 August 2019 21:55:27
Authors:
Last edited:
27 October 2020 23:19:05
Categories:
Neurology | Finger | Wrist | Forearm | Upper Extremity | Neuropathies | Overuse