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Levidy MF, Lindell K, Taylor KF. Isolated Palsy of the Anterior Interosseous Nerve to Flexor Pollicis Longus, Magnetic Resonance Imaging and Clinical Correlation: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00024. [PMID: 38709910 DOI: 10.2106/jbjs.cc.24.00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
CASE Anterior interosseous nerve (AIN) palsy is an uncommon, though well-described, clinical entity. When isolated to the thumb, it can be confused with atraumatic rupture of the flexor pollicis longus (FPL) tendon. A 57-year-old man experienced atraumatic onset of difficulty flexing the distal interphalangeal thumb joint. Magnetic resonance imaging (MRI) demonstrated denervation edema of the FPL, suggesting atypical AIN palsy. Resolution of symptoms and MRI findings occurred concomitantly with nonoperative treatment. CONCLUSION Atypical AIN palsy limited to the FPL is a rare clinical entity whose diagnosis can be supported with MRI. Here, we report a successful case of nonoperative management.
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Affiliation(s)
- Michael F Levidy
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Kenneth Lindell
- Department of Radiology, Tripler Army Medical Center, Honolulu, Hawaii
| | - Kenneth F Taylor
- Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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2
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Colasanti CA, Boin M, Hacquebord J, Virk M. Anterior interosseous nerve palsy in the early postoperative period after open capsular release for elbow stiffness: a case report. Clin Shoulder Elb 2023; 26:462-466. [PMID: 37088884 DOI: 10.5397/cise.2022.00899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 09/21/2022] [Indexed: 11/22/2022] Open
Abstract
Surgical release of elbow contracture is associated with injury to structures traversing the elbow. To date, only one other case report has been published describing anterior interosseous nerve (AIN) palsy that developed immediately after open elbow contracture release and debridement. Here we describe the unique case of a patient that developed AIN palsy 1 week after operation, including magnetic resonance imaging and electrodiagnostic studies, to shed some light on the etiology of this rare complication.
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Affiliation(s)
| | - Michael Boin
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Jacques Hacquebord
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
| | - Mandeep Virk
- Department of Orthopedic Surgery, New York University Langone Health, New York, NY, USA
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Serhal A, Lee SK, Michalek J, Serhal M, Omar IM. Role of high-resolution ultrasound and magnetic resonance neurography in the evaluation of peripheral nerves in the upper extremity. J Ultrason 2023; 23:e313-e327. [PMID: 38020515 PMCID: PMC10668945 DOI: 10.15557/jou.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/30/2023] [Indexed: 12/01/2023] Open
Abstract
Upper extremity entrapment neuropathies are common conditions in which peripheral nerves are prone to injury at specific anatomical locations, particularly superficial regions or within fibro-osseous tunnels, resulting in pain and potential disability. Although neuropathy is primarily diagnosed clinically by physical examination and electrophysiology, imaging evaluation with ultrasound and magnetic resonance neurography are valuable complementary non-invasive and accurate tools for evaluation and can help define the site and cause of nerve dysfunction which ultimately leads to precise and timely treatment. Ultrasound, which has higher spatial resolution, can quickly and comfortably characterize the peripheral nerves in real time and can evaluate for denervation related muscle atrophy. Magnetic resonance imaging on the other hand provides excellent contrast resolution between the nerves and adjacent tissues, also between pathologic and normal segments of peripheral nerves. It can also assess the degree of muscle denervation and atrophy. As a prerequisite for nerve imaging, radiologists and sonographers should have a thorough knowledge of anatomy of the peripheral nerves and their superficial and deep branches, including variant anatomy, and the motor and sensory territories innervated by each nerve. The purpose of this illustrative article is to review the common neuropathy and nerve entrapment syndromes in the upper extremities focusing on ultrasound and magnetic resonance neurography imaging.
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Affiliation(s)
- Ali Serhal
- Department of Radiology, Northwestern University, Chicago, USA
| | | | - Julia Michalek
- Department of Radiology, Northwestern Memorial Hospital, Chicago, USA
| | - Muhamad Serhal
- Department of Radiology, Northwestern University, Chicago, USA
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Anterior interosseous nerve neuropathy in a patient with spinal cord injury: case report and literature review. Spinal Cord Ser Cases 2022; 8:61. [DOI: 10.1038/s41394-022-00527-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/09/2022] Open
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Gunio D, Babaa A, Bencardino JT. Imaging of Nerve Disorders in the Elbow. Semin Musculoskelet Radiol 2022; 26:123-139. [PMID: 35609574 DOI: 10.1055/s-0042-1743407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Neuropathies of the elbow represent a spectrum of disorders that involve more frequently the ulnar, radial, and median nerves. Reported multiple pathogenic factors include mechanical compression, trauma, inflammatory conditions, infections, as well as tumor-like and neoplastic processes. A thorough understanding of the anatomy of these peripheral nerves is crucial because clinical symptoms and imaging findings depend on which components of the affected nerve are involved. Correlating clinical history with the imaging manifestations of these disorders requires familiarity across all diagnostic modalities. This understanding allows for a targeted imaging work-up that can lead to a prompt and accurate diagnosis.
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Affiliation(s)
- Drew Gunio
- Division of Clinical Radiology, Department of Radiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York
| | - Ahmad Babaa
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Pérez-Bellmunt A, López-de-Celis C, Rodríguez-Sanz J, Hidalgo-García C, Donnelly JM, Cedeño-Bermúdez SA, Fernández-de-las-Peñas C. Dorsal dry needling to the pronator quadratus muscle is a safe and valid technique: A cadaveric study. Physiother Theory Pract 2022; 39:1033-1037. [PMID: 35098871 DOI: 10.1080/09593985.2022.2031365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The pronator quadratus (PQ) muscle is an important stabilizer of the distal radio-ulnar joint and its pain referral pattern can mimic median or ulnar neuropathy. Research on treatment safety and efficacy with dry needling is scarce. OBJECTIVE To determine if a solid filiform needle accurately and safely penetrates the PQ during simulated clinical application of dry needling. METHODS A cadaveric descriptive study was conducted. Needling insertion of PQ was performed in 10 cryopreserved forearms with a 30*0.32 mm solid filiform needle. With the forearm pronated, the needle was inserted 3 cm proximal to the ulnar styloid in an anterior direction toward the muscle. The needle was advanced into the PQ based upon clinician judgment. Safety was assessed by calculating the distance from the needle to the surrounding neurovascular bundles. RESULTS Accurate needle penetration of the PQ was observed in 90% of the cadavers (needle penetration: 19.8 ± 4.0 mm, 95%CI 17.0 to 22.6 mm). No neurovascular bundle was pierced during needling in any specimen forearms. The distance from the tip of the needle was 15.1 ± 4.8 mm (95%CI 11.7 to 18.5 mm) to the ulnar nerve, 15.6 ± 7.6 mm (95%CI 10.0 to 21 mm) to the ulnar artery, 11.2 ± 3.3 mm (95%CI 8.8 to 13.6 mm) to the median nerve, and 4.9 ± 1.4 mm (95%CI 3.9 to 5.9 mm) to the anterior interosseous neurovascular bundle. CONCLUSION The results from this cadaveric study support the assumption that needling of the PQ by the dorsal aspect of the forearm can be accurately and safely conducted by an experienced clinician. Studies investigating the clinical safety and effectiveness of this interventions are needed.
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Affiliation(s)
- Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (Uic-barcelona), Barcelona, Spain
- ACTIUM Functional Anatomy Group, Faculty of Medicine and Health Sciences, Barcelona, Spain
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (Uic-barcelona), Barcelona, Spain
- ACTIUM Functional Anatomy Group, Faculty of Medicine and Health Sciences, Barcelona, Spain
| | - Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (Uic-barcelona), Barcelona, Spain
- ACTIUM Functional Anatomy Group, Faculty of Medicine and Health Sciences, Barcelona, Spain
| | - César Hidalgo-García
- Unidad de Investigación en Fisioterapia, Universidad de Zaragoza, Zaragoza, Spain
| | - Joseph M. Donnelly
- University of Saint Augustine for Health Sciences- Miami Campus. Department of Physical Therapy, 1 University Blvd, St. Augustine, FL, USA
| | - Simón A Cedeño-Bermúdez
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (Uic-barcelona), Barcelona, Spain
- ACTIUM Functional Anatomy Group, Faculty of Medicine and Health Sciences, Barcelona, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (Urjc), Alcorcón, Madrid, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
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Husain R, Reddy A, Dayan E, Huang M, Corcuera-Solano I. MRI Evaluation of Various Elbow, Forearm, and Wrist Neuropathies: A Pictorial Review. Semin Musculoskelet Radiol 2021; 25:617-627. [PMID: 34706391 DOI: 10.1055/s-0041-1729961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Upper extremity entrapment neuropathies are common and can cause pain, sensory loss, and muscle weakness leading to functional disability. We conducted a retrospective review from January 2007 until March 2020 of the magnetic resonance imaging (MRI) features of intrinsic and extrinsic causes of wrist, forearm, and elbow neuropathies of 637 patients who received a diagnosis of neuropathy by means of clinical and electrodiagnostic testing. We discuss cases with varying intrinsic and extrinsic nerve pathologies, including postoperative examples, affecting the median, radial, and ulnar nerve.Our collection of cases demonstrates a diversity of intrinsic and extrinsic causative factors. Intrinsic pathologies include neuritis as well as tumors arising from the nerve. Extrinsic causes resulting in nerve entrapment include masses, acute and chronic posttraumatic cases, anatomical variants, inflammatory and crystal deposition, calcium pyrophosphate deposition disease, and dialysis-related amyloidosis. Finally, we review postsurgical cases, such as carpal tunnel release and ulnar nerve transposition.Although upper extremity neuropathies tend to have a typical clinical presentation, imaging, particularly MRI, plays a vital role in evaluating the etiology and severity of each neuropathy and ultimately helps guide clinical management.
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Affiliation(s)
- Rola Husain
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Arthi Reddy
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Etan Dayan
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Mingqian Huang
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Idoia Corcuera-Solano
- Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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8
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Stratchko L, Rosas H. Imaging of Elbow Injuries. Clin Sports Med 2021; 40:601-623. [PMID: 34509201 DOI: 10.1016/j.csm.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Familiarity with throwing mechanics during elbow range of motion allows accurate diagnosis of sports-related elbow injuries, which occur in predictable patterns. In addition, repetitive stress-related injuries are often clinically apparent; however, imaging plays an important role in determining severity as well as associated injuries that may affect clinical management. A detailed understanding of elbow imaging regarding anatomy and mechanism of injury results in prompt and precise treatment.
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Affiliation(s)
- Lindsay Stratchko
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
| | - Humberto Rosas
- University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
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Na KT, Jang DH, Lee YM, Park IJ, Lee HW, Lee SU. Anterior Interosseous Nerve Syndrome: Is it a Compressive Neuropathy? Indian J Orthop 2020; 54:193-198. [PMID: 32952930 PMCID: PMC7474031 DOI: 10.1007/s43465-020-00099-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anterior interosseous nerve (AIN) syndrome is a rare disease whose pathophysiology is controversial. Despite efforts to elucidate the pathophysiology of AIN syndrome, it has not yet been resolved. We reinterpret electrodiagnostic studies, magnetic resonance imaging (MRI), and surgical findings to clarify the pathophysiology of AIN syndrome. MATERIALS AND METHODS In this retrospective case series, we included surgically treated 20 cases of nontraumatic AIN syndrome. Surgery was performed after a minimum of 12 weeks of conservative treatment. The clinical data and operation records were extracted from the medical records for analysis. All electrodiagnostic tests were reinterpreted by physicians with an American Board Certification in electrodiagnostic medicine. Moreover, every contrast-enhanced MRI performed during the assessment was reviewed by a musculoskeletal radiologist. RESULTS Of the twenty re-analyzed cases, nine AIN syndromes (45%) showed abnormal electromyography in non-AIN innervated muscles. Sensory nerve conduction studies were normal in all cases. Five magnetic resonance images (46%) showed signal changes in non-AIN-innervated muscles. Only four cases (20%) revealed definitive compression of the AIN during surgery. CONCLUSIONS Electrodiagnostic study and MRI indicated that many patients with AIN syndrome exhibited a diffuse pathologic involvement of the motor component of the median nerve. We conclude that the main pathophysiology of AIN syndrome would be diffuse motor fascicle neuritis of the median nerve in the upper arm.
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Affiliation(s)
- Ki-tae Na
- Department of Orthopedic Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, 56 Dong-su ro, Bupyeong-gu, Incheon, 21431 South Korea
| | - Dae-hyun Jang
- Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Yoon-min Lee
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Il-jung Park
- Department of Orthopedic Surgery, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, South Korea
| | - Hyun-woo Lee
- Department of Orthopedic Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, 56 Dong-su ro, Bupyeong-gu, Incheon, 21431 South Korea
| | - Sang-uk Lee
- Department of Orthopedic Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, 56 Dong-su ro, Bupyeong-gu, Incheon, 21431 South Korea
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Murphy EP, Fenelon C, Alexander M, Quinlan J. Anterior interosseous nerve palsy as a result of prolonged shoulder immobilisation. BMJ Case Rep 2019; 12:12/5/e229010. [PMID: 31092495 DOI: 10.1136/bcr-2018-229010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is a rare case of an anterior interosseous nerve (AIN) palsy in a patient as a result of a prolonged period of shoulder immobilisation. The patient had an open reduction internal fixation of a midshaft clavicle fracture. They subsequently underwent removal of metal due to symptomatic prominence of the metal work. The patient was in a shoulder immobiliser for a period of 5 months in total. They developed progressive AIN palsy as a result of a positional compression due to prolonged wearing of a shoulder immobiliser. This resolved with conservative management and careful observation.
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Affiliation(s)
| | - Christopher Fenelon
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, Ireland
| | - Michael Alexander
- Department of Neurophysiology, Tallaght University Hospital, Dublin, Ireland
| | - John Quinlan
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, Ireland
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11
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Hongsmatip P, Smitaman E, Delgado G, Resnick DL. Flexor carpi radialis brevis: a rare accessory muscle presenting as an intersection syndrome of the wrist. Skeletal Radiol 2019; 48:457-460. [PMID: 30097668 DOI: 10.1007/s00256-018-3034-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/22/2018] [Accepted: 07/24/2018] [Indexed: 02/02/2023]
Abstract
The flexor carpi radialis brevis (FCRB) is a rare accessory muscle of the forearm and wrist. It is typically asymptomatic, but has been discovered either incidentally during cadaveric studies or at the time of surgery in patients with distal forearm injury. Rarely, the FCRB muscle is associated with pain. We report a patient with wrist pain related to intersection between the tendon of the FCRB muscle and the tendon of the flexor carpi radialis (FCR) muscle, with an associated longitudinal split tear of the FCR tendon, documented by magnetic resonance imaging (MRI). To our knowledge, this is only the second report in the English literature of this intersection syndrome.
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Affiliation(s)
- Patcharee Hongsmatip
- Queen Savang Vadhana Memorial Hospital, 290 Jermjomphol Road Sriracha, Chonburi, 20110, Thailand. .,Department of Radiology, University of California San Diego, 408 Dickinson Street, Mail code 8226, San Diego, CA, 92103, USA.
| | - Edward Smitaman
- Department of Radiology, University of California San Diego, 408 Dickinson Street, Mail code 8226, San Diego, CA, 92103, USA
| | - Gonzalo Delgado
- Clinica MEDS, Av Bernardo Larrain Cotapoz 12654 Lo Barnechea, 7701224, Santiago, Chile
| | - Donald L Resnick
- Department of Radiology, University of California San Diego, 408 Dickinson Street, Mail code 8226, San Diego, CA, 92103, USA
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Abstract
The median nerve (MN) may be affected by various peripheral neuropathies, each of which may be categorized according to its cause, as either an extrinsic (due to an entrapment or a nerve compression) or an intrinsic (including neurogenic tumors) neuropathy. Entrapment neuropathies are characterized by alterations of the nerve function that are caused by mechanical or dynamic compression. It occurs because of anatomic constraints at specific locations including sites where the nerve courses through fibro-osseous or fibromuscular tunnels or penetrates a muscle. For the diagnosis of peripheral neuropathies, physicians traditionally relied primarily on clinical findings and electrodiagnostic testing with electromyography. However, if further doubt exists, clinicians may ask for an additional imaging evaluation.
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Atypically localized glomus tumor causing anterior interosseous nerve syndrome: A case report. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:492-494. [PMID: 29056390 PMCID: PMC6197377 DOI: 10.1016/j.aott.2017.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/29/2015] [Accepted: 06/06/2015] [Indexed: 01/08/2023]
Abstract
This article presents a 48-year-old male patient who presented with pain in the left forearm and weakness and clumsiness in the left hand of 6 months' duration. Flexor motor strength loss of the thumb and the index finger was present and neurophysiologic tests showed findings compatible with axonal injury in the anterior interosseous nerve (AIN) innervated muscles. Magnetic resonance imaging revealed a space-occupying lesion in the proximal forearm resembling a glomus tumor. Excision of the mass and release of the AIN were performed. Histopathology confirmed a glomus tumor, and the patient remains asymptomatic at 1 year postoperatively. We stress the importance of imaging studies in patients when a suspected secondary nature of nerve entrapment is present.
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Créteur V, Madani A, Sattari A, Bianchi S. Sonography of the Pronator Teres: Normal and Pathologic Appearances. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2585-2597. [PMID: 28670713 DOI: 10.1002/jum.14306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/17/2017] [Accepted: 03/20/2017] [Indexed: 06/07/2023]
Abstract
The pronator teres muscle is rarely examined during a routine sonographic examination of the elbow joint. Nevertheless, it can be affected by a variety of conditions, including trauma and tumors, and can be implicated in compression of the median nerve. This pictorial essay first illustrates the anatomy and biomechanics of the pronator teres. Then we present the sonographic technique for examination, normal sonographic appearance, and anatomic variations of the pronator teres and adjacent structures as well as sonography of their main disorders. Normal and pathologic sonographic appearances are correlated with magnetic resonance imaging and radiographic results.
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Affiliation(s)
- Viviane Créteur
- Imagerie Médicale, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Afarine Madani
- Imagerie Médicale, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
| | - Azadeh Sattari
- Imagerie Médicale, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium
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15
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A Comparison of Magnetic Resonance Imaging and Electroneuromyography for Denervated Muscle Diagnosis. J Clin Neurophysiol 2017; 34:248-253. [DOI: 10.1097/wnp.0000000000000364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Ulnar Tunnel Syndrome, Radial Tunnel Syndrome, Anterior Interosseous Nerve Syndrome, and Pronator Syndrome. J Am Acad Orthop Surg 2017; 25:e1-e10. [PMID: 27902538 DOI: 10.5435/jaaos-d-16-00010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
In addition to the more common carpal tunnel and cubital tunnel syndromes, orthopaedic surgeons must recognize and manage other potential sites of peripheral nerve compression. The distal ulnar nerve may become compressed as it travels through the wrist, which is known as ulnar tunnel or Guyon canal syndrome. The posterior interosseous nerve may become entrapped in the proximal forearm as it travels through the radial tunnel, which results in a pain syndrome without motor weakness. The median nerve may become entrapped in the proximal forearm, which can result in a variety of symptoms. Spontaneous neuropathy of the anterior interosseous nerve of the median nerve can be observed without external compression. Electrodiagnostic and imaging studies may aid surgeons in the diagnosis of these syndromes; however, a thorough physical examination is paramount to localize compressed segments of these nerves. An understanding of the anatomy of each of these nerve areas allows practitioners to appreciate a patient's clinical findings and helps guide surgical decompression.
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Abstract
This article presents a personal overview of nerve transfers and emphasizes the various factors that contribute to outcome following these surgeries. There is no "one result" for all nerve transfers. The results will vary depending on factors relating to the donor nerve and the recipient nerve, the degree of the surgical difficulty of the specific procedure, and issues relating to preoperative and postoperative rehabilitation. The general issues that influence all nerve injury and recovery, such as age of the patient, comorbidities, and time since injury, pertain to nerve transfers as well.
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Affiliation(s)
- Susan E Mackinnon
- Division of Plastic & Reconstructive Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Aljawder A, Faqi MK, Mohamed A, Alkhalifa F. Anterior interosseous nerve syndrome diagnosis and intraoperative findings: A case report. Int J Surg Case Rep 2016; 21:44-7. [PMID: 26921536 PMCID: PMC4802332 DOI: 10.1016/j.ijscr.2016.02.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/13/2016] [Accepted: 02/14/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Anterior Interosseous Nerve (AIN) is a motor branch from the Median nerve and runs deep in the forearm along with the anterior interosseous artery. It innervates three muscles in the forearm; an isolated palsy of these muscles is known as AIN Syndrome. There are several documented causes of AIN syndrome but its pathophysiology remains unclear. PRESENTATION OF CASE A 48-year old male that presented with right elbow pain and inability to flex his right interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. MR images denoted mild atrophy of the radial half of the flexor digitorum profundus and the pronator quadratus. Although there were no compressing lesions identifiable on MRI, Electrodiagnostic studies suggested compression neuropathy affecting the AIN. During surgical decompression of the median nerve in the proximal forearm, the operative findings were several tendinous fasciae and a tight fibrous arch of the flexor digitorum superficialis compressing the median nerve at the level of the AIN branch. DISCUSSION Different treatment schemes with reasonable outcome have been reported. Both nonsurgical and surgical intervention have been described in most of these schemes but differed in the timing of intervention with variable outcome. CONCLUSION Clinical suspicion should arise in the presence of isolated paralysis of the AIN-supplied muscles. MRI and electrodiagnostic studies will confirm the diagnosis and identify the etiology. The optimal treatment of AIN syndrome has not been established. We recommend surgical intervention in confirmed AIN syndrome from compression neuropathy, refractive to conservative therapy.
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Affiliation(s)
- Abdulla Aljawder
- Department of Orthopaedic Surgery, Bahrain Defence Force Hospital-Royal Medical Services, P.O.Box 28743, Riffa, Bahrain.
| | - Mohammed Khalid Faqi
- Department of Orthopaedic Surgery, Bahrain Defence Force Hospital-Royal Medical Services, P.O.Box 28743, Riffa, Bahrain
| | - Abeer Mohamed
- Department of Orthopaedic Surgery, Bahrain Defence Force Hospital-Royal Medical Services, P.O.Box 28743, Riffa, Bahrain
| | - Fahad Alkhalifa
- Department of Orthopaedic Surgery, Bahrain Defence Force Hospital-Royal Medical Services, P.O.Box 28743, Riffa, Bahrain
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Abstract
The elbow is a complex joint. Magnetic resonance imaging (MRI) is often the imaging modality of choice in the workup of elbow pain, especially in sports injuries and younger patients who often have either a history of a chronic repetitive strain such as the throwing athlete or a distinct traumatic injury. Traumatic injuries and alternative musculoskeletal pathologies can affect the ligaments, musculotendinous, cartilaginous, and osseous structures of the elbow as well as the 3 main nerves to the upper limb, and these structures are best assessed with MRI.Knowledge of the complex anatomy of the elbow joint as well as patterns of injury and disease is important for the radiologist to make an accurate diagnosis in the setting of elbow pain. This chapter will outline elbow anatomy, basic imaging parameters, compartmental pathology, and finally applications of some novel MRI techniques.
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Abstract
The peripheral nervous system is susceptible to a diverse array of pathologic insults, broadly categorizable into those entities intrinsic to the nerves themselves, either primarily arising within the nerve(s) or direct involvement of the nerve(s) secondary to a systemic process, and those processes external to the nerve(s) proper but affecting them extrinsically via mass effect, such as entrapment neuropathies. The soft tissue contrast inherent to high-quality MR imaging allows for outstanding visualization of the peripheral nervous system and surrounding structures. This review focuses on the use of MR imaging in the diagnosis and management of peripheral nerve disorders of the upper extremity.
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Abstract
This review discusses key diagnostic points and treatment guidelines for compression neuropathies of the wrist, forearm, and elbow. Recent treatment progress is reviewed, controversies are highlighted, and consensus is summarized. Limited or mini-open releases and endoscopic carpal tunnel releases are considered equally safe and efficient. Both methods are currently mainstays of surgical treatment.
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Accuracy of MRI in diagnosing peripheral nerve disease: a systematic review of the literature. AJR Am J Roentgenol 2015; 203:1303-9. [PMID: 25415709 DOI: 10.2214/ajr.13.12403] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE MRI is increasingly being used to evaluate extracranial peripheral nerve disease in clinical practice. The objective of this study was to systematically review the accuracy of MRI in distinguishing normal from abnormal extracranial peripheral nerves. CONCLUSION There is significant heterogeneity between studies investigating the accuracy of MRI. Studies have shown that nerve T2-weighted or STIR hyperintensity, nerve enlargement, and nerve flattening are associated with peripheral nerve disease.
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Chalian M, Behzadi AH, Williams EH, Shores JT, Chhabra A. High-Resolution Magnetic Resonance Neurography in Upper Extremity Neuropathy. Neuroimaging Clin N Am 2014; 24:109-25. [DOI: 10.1016/j.nic.2013.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
Peripheral nerve entrapments are frequent. They usually appear in anatomical tunnels such as the carpal tunnel. Nerve compressions may be due to external pressure such as the fibular nerve at the fibular head. Malignant or benign tumors may also damage the nerve. For each nerve from the upper and lower limbs, detailed clinical, electrophysiological, imaging, and therapeutic aspects are described. In the upper limbs, carpal tunnel syndrome and ulnar neuropathy at the elbow are the most frequent manifestations; the radial nerve is less frequently involved. Other nerves may occasionally be damaged and these are described also. In the lower limbs, the fibular nerve is most frequently involved, usually at the fibular head by external compression. Other nerves may also be involved and are therefore described. The clinical and electrophysiological examination are very important for the diagnosis, but imaging is also of great use. Treatments available for each nerve disease are discussed.
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Affiliation(s)
- P Bouche
- Department of Clinical Neurophysiology Salpêtrière Hospital, Paris, France.
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Subhawong TK, Wang KC, Thawait SK, Williams EH, Hashemi SS, Machado AJ, Carrino JA, Chhabra A. High resolution imaging of tunnels by magnetic resonance neurography. Skeletal Radiol 2012; 41:15-31. [PMID: 21479520 PMCID: PMC3158963 DOI: 10.1007/s00256-011-1143-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 02/24/2011] [Accepted: 02/25/2011] [Indexed: 02/02/2023]
Abstract
Peripheral nerves often traverse confined fibro-osseous and fibro-muscular tunnels in the extremities, where they are particularly vulnerable to entrapment and compressive neuropathy. This gives rise to various tunnel syndromes, characterized by distinct patterns of muscular weakness and sensory deficits. This article focuses on several upper and lower extremity tunnels, in which direct visualization of the normal and abnormal nerve in question is possible with high resolution 3T MR neurography (MRN). MRN can also serve as a useful adjunct to clinical and electrophysiologic exams by discriminating adhesive lesions (perineural scar) from compressive lesions (such as tumor, ganglion, hypertrophic callous, or anomalous muscles) responsible for symptoms, thereby guiding appropriate treatment.
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Affiliation(s)
- Ty K Subhawong
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, 601 N. Caroline Street, Room 4214, Baltimore, MD 21287, USA.
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Kim SJ, Hong SH, Jun WS, Choi JY, Myung JS, Jacobson JA, Lee JW, Choi JA, Kang HS. MR imaging mapping of skeletal muscle denervation in entrapment and compressive neuropathies. Radiographics 2011; 31:319-32. [PMID: 21415181 DOI: 10.1148/rg.312105122] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The diagnoses of entrapment and compressive neuropathies have been based on the findings from clinical examinations and electrophysiologic tests, such as electromyography and nerve conduction studies. The use of magnetic resonance (MR) imaging for the diagnosis of entrapment or compressive neuropathies is increasing because MR imaging is particularly useful for discerning potential causes and for identifying associated muscle denervation. However, it is sometimes difficult to localize nerve entrapment or demonstrate nerve compression lesions with MR imaging. Nevertheless, even in these cases, MR imaging may show denervation-associated changes in specific muscles innervated by the affected nerves. The analysis of denervated muscle distributions by using MR imaging, with a knowledge of nerve innervation patterns, would be helpful for determining the nerves involved and the levels of nerve entrapment or compression. In this context, the mapping of skeletal muscle denervation with MR imaging has a supplementary or even a primary role in the diagnosis of entrapment and compressive neuropathies.
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Affiliation(s)
- Su-Jin Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Brennan TD, Cupler EJ. Anterior interosseous nerve syndrome following peripheral catheterization: Magnetic resonance imaging and electromyography correlation. Muscle Nerve 2011; 43:758-60. [DOI: 10.1002/mus.22022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Acute and chronic elbow pain is common, particularly in athletes. Although plain radiographs, ultrasound, and computed tomography all have a role to play in the investigation of elbow pain, magnetic resonance imaging (MRI) has emerged as the imaging modality of choice for diagnosis of soft tissue disease and osteochondral injury around the elbow. The high spatial resolution, excellent soft-tissue contrast, and multiplanar imaging capabilities of MRI make it ideal for evaluating the complex joint anatomy of the elbow. This article reviews imaging of common disease conditions occurring around the elbow in athletes, with an emphasis on MRI.
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Affiliation(s)
- Kathryn J Stevens
- Department of Radiology, Stanford University Medical Center, Stanford University School of Medicine, Room S-062A Grant Building, 300 Pasteur Drive, Stanford, CA 94305-5105, USA.
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Ulrich D, Piatkowski A, Pallua N. Anterior interosseous nerve syndrome: retrospective analysis of 14 patients. Arch Orthop Trauma Surg 2011; 131:1561-5. [PMID: 21611763 PMCID: PMC3195807 DOI: 10.1007/s00402-011-1322-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The anterior interosseous nerve (AIN) is a only motor nerve innervating the deep muscles of the forearm. Its compression is rare. We present a retrospective analysis of 14 patients with an AIN syndrome with a variety of clinical manifestations who underwent operative and conservative treatment. PATIENTS AND METHODS Fourteen patients (six female, eight male, mean age 48 ± 9 years) were included. In six patients, the right limb was affected, and in eight patients the left limb. Conservative treatment was started for every patient. If no signs of recovery appeared within 3 months, operative exploration was performed. Final assessment was performed between 2 and 9 years after the onset of paralysis (mean duration of follow-up 46 ± 11 months). Patients were examined clinically for return of power, range of motion, pinch and grip strengths. Also the disability of the arm, shoulder, and hand (DASH) score was calculated. RESULTS Seven of our 14 patients had incomplete AIN palsy with isolated total loss of function of flexor pollicis longus (FPL), five of FPL and flexor digitorum profundus (FDP)1 simultaneously, and two of FDP1. Weakness of FDP2 could be seen in four patients. Pronator teres was paralysed in two patients. Pain in the forearm was present in nine patients. Four patients had predisposing factors. Eight patients treated conservatively exhibited spontaneous recovery from their paralysis during 3-12 months after the onset. In six patients, the AIN was explored 12 weeks after the initial symptoms and released from compressing structures. Thirteen patients showed good limb function. In one patient with poor result a tendon transfer was necessary. The DASH score of patients treated conservatively and operatively presented no significant difference. CONCLUSION AIN syndrome can have different clinical manifestations. If no signs of spontaneous recovery appear within 12 weeks, operative treatment should be performed.
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Affiliation(s)
- Dietmar Ulrich
- Department of Plastic and Reconstructive Surgery, Erasmus University Hospital, 2040, 3000 CA Rotterdam, The Netherlands
| | - A. Piatkowski
- Department of Plastic and Reconstructive Surgery, Aachen University of Technology, Aachen, Germany
| | - Norbert Pallua
- Department of Plastic and Reconstructive Surgery, Aachen University of Technology, Aachen, Germany
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Chi Y, Harness NG. Anterior interosseous nerve syndrome. J Hand Surg Am 2010; 35:2078-80. [PMID: 20961706 DOI: 10.1016/j.jhsa.2010.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 08/22/2010] [Indexed: 02/02/2023]
Affiliation(s)
- Ying Chi
- Department of Orthopaedic Surgery, University of California Irvine, Orange, CA 92806, USA
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Linda DD, Harish S, Stewart BG, Finlay K, Parasu N, Rebello RP. Multimodality Imaging of Peripheral Neuropathies of the Upper Limb and Brachial Plexus. Radiographics 2010; 30:1373-400. [DOI: 10.1148/rg.305095169] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Dang AC, Rodner CM. Unusual compression neuropathies of the forearm, part II: median nerve. J Hand Surg Am 2009; 34:1915-20. [PMID: 19969200 DOI: 10.1016/j.jhsa.2009.10.017] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 10/17/2009] [Indexed: 02/02/2023]
Abstract
We have previously discussed compression neuropathies of the radial nerve in the forearm. In the second half of this 2-part review, we will now turn our attention to 2 compression neuropathies affecting the proximal median nerve, before its entry through the carpal tunnel: (1) pronator syndrome and (2) anterior interosseous nerve syndrome.
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Affiliation(s)
- Alan C Dang
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06034-4037, USA
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Furuta T, Okamoto Y, Tohno E, Minami M, Nishiura Y, Ohtomo K. Magnetic resonance microscopy imaging of posterior interosseous nerve palsy. Jpn J Radiol 2009; 27:41-4. [PMID: 19373531 DOI: 10.1007/s11604-008-0290-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 10/10/2008] [Indexed: 10/20/2022]
Abstract
Posterior interosseous nerve palsy, also called deep radial nerve syndrome, is a neuropathy caused by radial nerve entrapment or compression at the level of the supinator muscle. Although imaging studies are not necessary for diagnosing this syndrome because of its characteristic clinical manifestations, the causes of palsy, which include mass lesions, or precise anatomical findings can sometimes be demonstrated by imaging. Magnetic resonance (MR) findings of posterior interosseous nerve palsy have been described as involving atrophy of related muscles caused by denervation, a common secondary change of this nerve disorder. We present a case in which the swollen posterior interosseous nerve itself could be directly depicted by MR imaging using a 4.7-cm microscopy coil in a patient with neuropathy.
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Affiliation(s)
- Toshihiro Furuta
- Department of Radiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan.
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