POSTERIOR INTEROSSEOUS NERVE SYNDROME
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
- 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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