Tendon Transfer for Correction of the Radial Deviation Deformity of the Wrist and Centralization in Posterior Interosseous Nerve Palsy

There are very few descriptions of tendon transfers designed specifically to address the reconstruction of posterior interosseous nerve palsy (PINP). Unlike a radial nerve palsy (RNP), a patient with a PINP is able to extend their wrist but in radial deviation, because of the preserved innervation of the extensor carpi radialis longus (ECRL). Tendon transfers to restore finger and thumb extension in PINP have been extrapolated from tendon transfers to restore these functions in RNP, specifically using flexor carpi radialis, not flexor carpi ulnaris, so as not to further exacerbate the distinctive radial deviation deformity of the wrist. However, the standard pronator teres to extensor carpi radialis brevis transfer for a RNP fails to address or correct the radial deviation deformity in PINP. We present a simple tendon transfer specifically to address this radial deviation deformity in a PINP, by performing a side-to-side tenorrhaphy of the ECRL tendon to the extensor carpi radialis brevis tendon, followed by transection of the ECRL insertion onto the base of the index finger metacarpal distal to the tenorrhaphy. This technique converts a functioning ECRL from a radially deforming force, transferring its vector of pull onto the base of the middle finger metacarpal and so producing centralization of wrist extension in axial alignment with the forearm.

A rare case of posterior interosseous nerve palsy due to ganglion cyst arising from supinator muscle

Here we present a rare case of ganglion cyst of the elbow joint arising from supinator muscle causing posterior interosseous nerve (PIN) palsy in a 40-year-old female who presented with weakness in finger extension and carrying out routine activities with right hand since 2 weeks. Patient had pain over the right forearm radiating to the right hand since 3 months. She also noted a swelling in the right forearm, which was gradually increasing in size since last 1 month. Atraumatic PIN compression is uncommon and is usually caused by compression of PIN in the arcade of Frohse, by radial recurrent artery, and fibrous band around the radiocapitellar joint. Reports of PIN palsy caused by ganglionic cyst in the elbow joint are rare and case reports regarding the same are sparingly reported. Here we report a case of PIN palsy secondary to ganglion cyst arising from supinator muscle, which recovered completely after excision of the ganglion cyst.

Posterior Interosseous Nerve Palsy Caused by a Ganglion of the Arcade of Frohse

A 51-year-old male who is right-handed visited the outpatient for right fingers-drop. The patient’s fingers, including thumb, were not extended on metacarpophalangeal joint. The active motion of the right wrist was available. The electromyography and nerve conduction velocity study were consistent with the posterior interosseous neuropathy. Further evaluation was done with the magnetic resonance imaging for finding the space-occupying lesion or any possible soft tissue lesion around the radial nerve pathway. On magnetic resonance imaging, the ganglion cyst, which was about 1.8 cm in diameter, was observed on the proximal part of the superficial layer of the supinator muscle (Arcade of Frohse). The surgical excision was done on the base of ganglion cyst at the base of stalk of cyst which looked to be connected with proximal radioulnar joint capsule. The palsy had completely resolved when the patient was observed on the outpatient department a month after the operation.

Posterior interosseous nerve palsy caused by synovial osteochondromatosis of the elbow analyzed by three-dimensional reconstruction: a case report

Background

Synovial osteochondromatosis, a benign tumor consisting of cartilage and bone, generally presents as multiple osteochondral or chondral nodules. Peripheral nerve palsy caused by synovial osteochondromatosis is rare. Three-dimensional reconstruction based on magnetic resonance imaging shows the specific shape and location of the tumor and its relation to the nerve.

Case presentation

We describe a case of posterior interosseous nerve palsy caused by synovial osteochondromatosis of the elbow in a 66-year-old Japanese man. A three-dimensional reconstructed image based on magnetic resonance imaging was used to determine the location and shape of the giant tumor, which was composed of bone and cartilage. After surgical resection of the giant tumor and neurolysis of the posterior interosseous nerve, he fully recovered from nerve palsy 9 months postoperatively. There was no recurrence of the lesion 1 year postoperatively.

Conclusion

Synovial osteochondromatosis that causes posterior interosseous nerve palsy has a characteristic morphology and location, that is, a giant tumor located anterior to the humeroradial joint, as revealed by three-dimensional magnetic resonance image reconstruction.

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

INTRODUCTION

The 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 CASE

A 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.

DISCUSSION

Treatment planning for chronic, neglected or missed Monteggia fractures is challenging. There is no consensus about the definitive treatment in the literature.

CONCLUSION

We 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.

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

INTRODUCTION

The 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 CASE

A 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.

DISCUSSION

Treatment planning for chronic, neglected or missed Monteggia fractures is challenging. There is no consensus about the definitive treatment in the literature.

CONCLUSION

We 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.

Interfascicular Neurolysis for Incomplete Spontaneous Posterior Interosseous Nerve Palsy with a Surgical Delay of 17 Years: Is It Still Effective?

A 55-year-old woman with incomplete spontaneous posterior interosseous nerve (PIN) palsy underwent interfascicular neurolysis and tendon transfer, 17 years after its onset. After one year, her nerve function partially recovered electrophysiologically. This case suggests that incomplete spontaneous PIN palsy may recover by interfascicular neurolysis, even with a long preoperative delay.

Simultaneous bilateral posterior interosseous nerve palsy caused by rheumatoid synovitis of the elbows

A 60-year-old woman with rheumatoid arthritis (RA) developed bilateral posterior interosseous nerve palsy. Her left side recovered after conservative treatment. However, her right side, which had been affected previously, did not recover and required surgery. Although conservative therapy, including administration of biologic agents, should be conducted for tight control of RA activity, we recommend surgical treatment when there is recurrence of the disease.

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 caused by lipoma: A case report

Lipomas are benign soft tissue neoplasms that occur commonly in subcutaneous tissue. In rare instances they can occur in deeper planes. When occurring in the proximal forearm they can compress the posterior interosseous branch of the radial nerve resulting in an insidious onset of weakness of digital extensor muscles. A case of posterior interosseous nerve palsy from lipoma in a 58-year-old man in presented.