POSTERIOR INTEROSSEOUS NERVE SYNDROME

POSTERIOR INTEROSSEOUS NERVE SYNDROME

• compression of the terminal motor br of radial N, PIN, while passing under supinator
  

  

Pathophysiology and Anatomy

• distal third humerus - radial nerve pierces lateral inter muscular septum – travels anteriorly and distally between brachialis and brachioradialis – just proximal to elbow – divides superficial ( sensory – travels between brachioradialis and supinator) and deep br.
• PIN(motor) passes between 2 heads of supinator – under the fibrous arch, Arcade of Frohse – continues beneath supinator – exiting at distal edge – innervate muscles of posterior forearm

Compression sites of PIN

•  fibrous bands on the anterior radiocapitellar joint capsule
• vascular leash of Henry ( radial recurrent vessels)
• proximal edge of ECRB
• 
  
  Arcade of Frohse ( proximal edge of supinator)
• distal edge of supinator
• space occupying lesions like lipomas, ganglion
• Radiocapitellar synovitis in RA
• # radial neck, dislocation
• Iatrogenic in ORIF

Clinical features

• insidious onset
• pain proximal and lateral forearm
• weakness or paralysis of PIN innervated muscles
• sensory examination : normal
• Motor examination : extension of wrist with radial deviation. Loss of extension of all fingers
• No provocative tests
• Diagnostic studies
  • EMG
  • MRI for mass lesions
  • X ray for #/ dislocation
• Conservative / surgical decompression

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