Nervio interóseo posterior: origen, localización y trayecto nervioso: una revisión / Posterior interosseous nerve: origin, location and nerve path: a review

RESUMEN: El nervio interóseo posterior (NIP) ha sido utilizado como sinónimo ocontinuación inmediata del ramo profundo del nervio radial (RPNR) al emerger en el compartimiento posterior del antebrazo. Su origen tampoco es claro, describiéndose como nervio interóseo posterior a su trayecto proximal, intermedio o distal al músculo supinador. El objetivo de esta revisión es detallar la visión de diversos autores respecto al origen y trayecto del NIP, proponiendo una correcta terminología para estas estructuras. Se realizó una revisión bibliográfica de varios textos y de algunos artículos utilizados para la enseñanza de la anatomía humana, publicados entre los años 1800 y la actualidad. En la búsqueda, se determinaron criterios de inclusión que consideraban, anatomía humana, escritos en español, francés o inglés y que aludieran al NIP. Tras la exploración inicial se localizaron 18 libros, procedentes de Francia, Rusia, España, Argentina, Estados Unidos, Canadá, Reino Unido, Alemania, India y México. Una descripción del NIP más precisa, en cuanto al origen, trayecto y función, es aquella postulada por la vertiente francesa, correspondiendo a un origen terminal del ramo profundo del nervio radial, luego de emitir sus ramos musculares. Este delgado nervio transcurre adosado a la membrana interósea para luego avanzar por el cuarto compartimiento extensor, distribuyéndose en las articulaciones dorsales del carpo a quienes inerva sensitiva y propioceptivamente.

SUMMARY: The posterior interosseous nerve (PIN) has been used as a synonym or immediate continuation of the deep branch of the radial nerve as it emerges in the posterior compartment of the forearm. Its origin is not clear either, being described as a posterior interosseous nerve to its proximal, intermediate or distal path to the supinator muscle. The objective of this review is to detail the vision of various authors regarding the origin and path of the PIN, proposing a correct terminology for these structures. A bibliographic review of several texts and some articles used for the teaching of human anatomy, published between the 1800s and the present day, was carried out. In the search, inclusion criteria were determined that considered human anatomy, written in Spanish, French or English and that alluded to the PIN. After the initial exploration, 18 books were located, coming from France, Russia, Spain, Argentina, the United States, Canada, the United Kingdom, Germany, India and Mexico. A more precise description of the PIN, in terms of origin, path and function, is that postulated by the French literature, corresponding to a terminal origin of the deep branch of the radial nerve, after emitting its muscular branches. This thin nerve runs attached to the interosseous membrane to then advance through the fourth extensor compartment, distributing itself in the dorsal carpal joints to which it innervates sensitively and proprioceptively.

Lesión de la rama anterior del nervio interóseo posterior / Injury of the anterior branch of the posterior interosseous nerve

Resumen: Introducción: El síndrome del nervio interóseo posterior, rama del nervio radial a nivel del antebrazo se caracteriza por la pérdida de función motora de algunos o todos los músculos inervados distalmente. Caso clínico: Masculino de 26 años con antecedente de fractura de radio proximal manejado con osteosíntesis que cursó con lesión del nervio radial siete años antes con recuperación completa, acude con dolor intenso a 4 cm distal a cabeza radial, acompañado de parálisis del extensor largo y corto del pulgar y del abductor del pulgar, con paresia del extensor propio del índice, en el que se efectúa diagnóstico de síndrome de atrapamiento de la rama anterior descendente del nervio interóseo posterior (SNIP). Discusión: El manejo conservador del SNIP está indicado durante las primeras ocho a 12 semanas, de no mostrar mejoría la indicación de exploración quirúrgica está indicada, siendo el retiro de material de osteosíntesis controvertido.

Abstract: Introduction: Posterior interosseous nerve syndrome, a branch of the radial nerve at the level of the forearm, is characterized by the motor function loss of some or all of the muscles innervated distally. Clinical case: A 26-year-old male with a history of proximal radius fracture associated to radial nerve injury, treated with osteosynthesis 7 years earlier, with full recovery, who currently presented intense pain 4 cm distal to the radial head, accompanied by paralysis of Extensor pollicis longus , Extesnor pollicis brevis and Abductor pollicis longus, with paresis of the Extensor indicis propius , in which a diagnosis of entrapment syndrome of the anterior descending branch of the posterior interosseous nerve (SNIP) was performed. Discussion: The conservative management of SNIP is indicated during the first 8-12 weeks, if no improvement is found, the indication for surgical exploration is indicated, and the removal of osteosynthesis material is controversial.

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.

Neuropatía por atrapamiento del nervio interóseo posterior en un adulto con displasia ósea / Entrapment neuropathy of the posterior interosseous nerve in an adult with bone displasia

Resumen: La neuropatía por atrapamiento del nervio Interóseo Posterior, rama motora del nervio radial, puede ser causada por la compresión estructural, mecánica, o dinámica en lugares específicos que conducen a la lesión del nervio. La proximidad del nervio interóseo posterior a la cabeza del radio lo hace susceptible a lesiones por eventos traumáticos agudos o crónicos, como manifestación tardía secundaria a luxación de la cabeza del radio. Esta última es una entidad poco frecuente en el adulto y siempre plantea diversos diagnósticos diferenciales referidos a su origen y eventual asociación con Acondroplasia. La patología compresiva del nervio Interóseo Posterior puede generar dos síndromes diferentes: Síndrome del nervio interóseo posterior o Síndrome del túnel radial. En este artículo se describe el caso de un adulto con una neuropatía por atrapamiento del nervio Interóseo Posterior, con subluxación unilateral de cabeza del radio y antecedentes personales de Displasia Ósea. A través del análisis de los estudios de electrodiagnóstico e imagenología, se plantean los diagnósticos diferenciales, etiológicos y diagnóstico positivo de Síndrome del nervio interóseo posterior. Así como su posibilidad de tratamiento conservador y quirúrgico.

Abstract: Entrapment neuropathy of the posterior interosseous nerve, motor branch of the radial nerve can be caused by structural, mechanical, or dynamic compression in specific locations that lead to nerve injury. The proximity of the posterior interosseous nerve to the radial head makes it susceptible to injury from acute or chronic traumatic events, such as late manifestation secondary to dislocation of the radial head. The latter is a rare entity in adults and always raises several differential diagnoses related to their origin and possible association with Achondroplasia. The compressive pathology of the posterior interosseous nerve can generate two different syndromes: posterior interosseous nerve syndrome or radial tunnel syndrome. This article describes the case of an adult with a posterior interosseous nerve entrapment neuropathy with unilateral radial head dislocation and personal history of Bone Dysplasia. Through analysis of electrodiagnostic and imaging studies, differential diagnoses, etiological and positive diagnosis of posterior interosseous nerve syndrome arise. As well as the possibility of conservative and surgical treatment.

Ultrasonographic findings of posterior interosseous nerve syndrome

PURPOSE: The purpose of this study was to evaluate the ultrasonographic findings associated with posterior interosseous nerve (PIN) syndrome. METHODS: Approval from the Institutional Review Board was obtained. A retrospective review of 908 patients' sonographic images of the upper extremity from January 2001 to October 2010 revealed 10 patients suspicious for a PIN abnormality (7 male and 3 female patients; mean age of 51.8±13.1 years; age range, 32 to 79 years). The ultrasonographic findings of PIN syndrome, including changes in the PIN and adjacent secondary changes, were evaluated. The anteroposterior diameter of the pathologic PIN was measured in eight patients and the anteroposterior diameter of the contralateral asymptomatic PIN was measured in six patients, all at the level immediately proximal to the proximal supinator border. The size of the pathologic nerves and contralateral asymptomatic nerves was compared using the Mann-Whitney U test. RESULTS: Swelling of the PIN proximal to the supinator canal by compression at the arcade of Fröhse was observed in four cases. Swelling of the PIN distal to the supinator canal was observed in one case. Loss of the perineural fat plane in the supinator canal was observed in one case. Four soft tissue masses were noted. Secondary denervation atrophy of the supinator and extensor muscles was observed in two cases. The mean anteroposterior diameter of the pathologic nerves (n=8, 1.79±0.43 mm) was significantly larger than that of the contralateral asymptomatic nerves (n=6, 1.02±0.22 mm) (P=0.003). CONCLUSION: Ultrasonography provides high-resolution images of the PIN and helps to diagnose PIN syndrome through visualization of its various causes and adjacent secondary changes.

The relationship of the posterior interosseous nerve to the supinator muscle in the dorsal approach to the proximal radius: A descriptive and quantitative anatomic study of Filipino cadavers

@#<p style="text-align: justify;"><strong>BACKGROUND AND OBJECTIVE:</strong>The posterior interosseous nerve (PIN) is vulnerable to injury in the dorsal approach to the proximal radius. The goal of this study is to describe the quantitative relationship of the PIN to the supinator muscle in the context of anatomic landmarks. Knowledge of superficial landmarks related to the PIN would hopefully minimize iatrogenic injury to the posterior interosseous nerve.<br /><strong>METHODS:</strong> 12 cadavers (22 forearms) were dissected and analyzed. The length of the supinator muscle was determined. The oblique distances of the PIN entry and exit points to the proximal and distal borders of the supinator muscle as well as their perpendicular distances to the lateral epicondyle-Lister's tubercle (LE-LT) reference line were measured and recorded. The number of PIN branches inside the supinator substance was recorded. Mean and median values were determined and subjected to statistical analysis.<br /><strong>RESULTS:</strong> Mean supinator length was 5 centimeters. Ninety-one percent of the cadaveric forearms had PIN branches inside the supinator muscle substance. Twelve of the 22 forearms (55%) had 2 branches. The mean oblique distances of the PIN from the lateral epicondyle to the entry and exit points in the proximal and distal borders of the supinator muscle was 3.52 and 7.31 centimeters, respectively. The mean perpendicular distances of the PIN from LE-LT reference line to the entry and exit points in the proximal and distal borders of the supinator muscle was 1.13 and 1.26 centimeters, respectively. An imaginary danger-zone 4 centimeters wide overlying the LE-LT reference line depicts the possible area where the PIN and its branches may most likely be located.<br /><strong>CONCLUSION:</strong> The dorsal approach to the proximal radius may allow a safe exposure without causing iatrogenic injury to the posterior interosseous nerve through the use of superficial anatomic landmarks and reference lines in combination with mean measurements from our study.</p>

The relationship of the posterior interosseous nerve to the supinator muscle in the dorsal approach to the proximal radius: A descriptive and quantitative anatomic study of Filipino cadavers

BACKGROUND AND OBJECTIVE:The posterior interosseous nerve (PIN) is vulnerable to injury in the dorsal approach to the proximal radius. The goal of this study is to describe the quantitative relationship of the PIN to the supinator muscle in the context of anatomic landmarks. Knowledge of superficial landmarks related to the PIN would hopefully minimize iatrogenic injury to the posterior interosseous nerve.METHODS: 12 cadavers (22 forearms) were dissected and analyzed. The length of the supinator muscle was determined. The oblique distances of the PIN entry and exit points to the proximal and distal borders of the supinator muscle as well as their perpendicular distances to the lateral epicondyle-Lister's tubercle (LE-LT) reference line were measured and recorded. The number of PIN branches inside the supinator substance was recorded. Mean and median values were determined and subjected to statistical analysis.RESULTS: Mean supinator length was 5 centimeters. Ninety-one percent of the cadaveric forearms had PIN branches inside the supinator muscle substance. Twelve of the 22 forearms (55%) had 2 branches. The mean oblique distances of the PIN from the lateral epicondyle to the entry and exit points in the proximal and distal borders of the supinator muscle was 3.52 and 7.31 centimeters, respectively. The mean perpendicular distances of the PIN from LE-LT reference line to the entry and exit points in the proximal and distal borders of the supinator muscle was 1.13 and 1.26 centimeters, respectively. An imaginary danger-zone 4 centimeters wide overlying the LE-LT reference line depicts the possible area where the PIN and its branches may most likely be located.CONCLUSION: The dorsal approach to the proximal radius may allow a safe exposure without causing iatrogenic injury to the posterior interosseous nerve through the use of superficial anatomic landmarks and reference lines in combination with mean measurements from our study.

Síndrome del nervio interóseo posterior: presentación de 3 casos / Posterior interosseous nerve syndrome: report of 3 cases

La neuropatía compresiva del nervio interóseo posterior es poco frecuente. Clínicamente se expresa por una paresia (o plejia) de los músculos extensores del puño, los dedos y abductores del pulgar. El estudio eléctrico es fundamental para determinar la topografía de la lesión, y la ecografía o imagen por resonancia magnética ayudan a descartar causas secundarias de compresión, pero el diagnóstico sigue reposando en un correcto examen clínico. En los casos que no mejoran o que tienen un déficit severo, se debe indicar el tratamiento quirúrgico dado que tiene hasta un 95% de buenos resultados cuando se acompaña de una buena rehabilitación posterior. Se presentan tres casos de parálisis del nervio interóseo posterior por compresión en su recorrido por debajo del músculo supinador corto. De los mismos, uno tuvo mejoría espontánea y dos requirieron cirugía descompresiva.

Compressive neuropathy of the posterior interosseous nerve is rare. Clinically it is expressed by a paresis (or plegia) of the extensor muscles of the wrist, fingers and thumb abductors. The electrophysiologic studies are essential for the diagnosis, and ultrasound or magnetic resonance imaging help rule out secondary causes of compression, but the diagnosis is still based on a correct clinical examination. In cases that do not improve or who have a severe deficit, surgery is indicated as it has up to 95 % of good results when it is accompanied by a good subsequent rehabilitation. We present three cases of paralysis of posterior interosseous nerve, caused by compression on its way below the short supinator. Of these, one had spontaneous improvement and two required decompressive surgery.

Differential Diagnosis Using Two Electrophysiological Testing Methods for Radial Tunnel Syndrome / 昆明医科大学学报

Objective To compare the traditional electrophysiological testing with modified methods for differential diagnosis of Radial Tunnel Syndrome (RTS).Methods A total of 87 selected patients were initially diagnosed as Lateral Epicondylitis (LE) or Tennis Elbow (TE) by doctors from the Outpatient Department of Orthopedics and Rehabilitation.Medical history was asked.Patients received physical examination and examinations for the sensory nerve action potential (SNAP) of superficial radial nerve,the compound muscle action potential (CMAP) of radial nerve and needle electromyography (EMG) to record the muscle Motor Unit Action Potentials (MUAPs).Then,the modified methods for CMAP of radial nerve were conducted on the forearm in the neutral,pronation and supination positions.Three values of CMAP latency were compared.RTS was diagnosed when the difference value ≥0.3 ms.The x 2 test was used to compare the positive detectable rates of the two methods for the RTS diagnosis.Results Thirteen out of 87 patients were diagnosed as RTS,among which three had interosseous nerve lesion and one had superficial radial nerve lesion.The traditional EMG failed to diagnose the remaining 9 RTS cases.These patients were finally diagnosed due to their latency difference of radial nerve CMAP ≥0.3ms when their forearms were examined in three positions.Conclusion The modified electrophysiology method shows a higher positive rate for the diagnosis of RTS.(P＜0.05).

Neuralgic Amyotrophy Manifesting as Mimicking Posterior Interosseous Nerve Palsy

The upper trunk of the brachial plexus is the most common area affected by neuralgic amyotrophy (NA), and paresis of the shoulder girdle muscle is the most prevalent manifestation. Posterior interosseous nerve palsy is a rare presentation in patients with NA. It results in dropped finger on the affected side and may be misdiagnosed as entrapment syndrome or compressive neuropathy. We report an unusual case of NA manifested as PIN palsy and suggest that knowledge of clinical NA phenotypes is crucial for early diagnosis of peripheral nerve palsies.

Severe, Persistent, Painful Neuropathy Relieved Immediately After Surgical Release: Case of Neurostenalgia of the Radial Nerve

Neurostenalgia is a neuropathic pain that results from continuing irritation of an anatomically intact nerve by a noxious agent. The pain resolves promptly after surgical release of the nerve. The authors report a case of neurostenalgia of the radial nerve in which the posterior interosseous branch was compressed at the arcade of Frohse, presenting with severe arm and elbow pain. The pain was immediately relieved after surgical release of the nerve.

Double-Bellied Extensor Digitorum Brevis Manus: A Case Report.

Most of the anatomical variations are noted during the cadaveric dissections. A rare variation of the Extensor digitorum brevis manus was observed on the dorsal aspect of the right hand of a 69-year-old male cadaver. This atavistic muscle had two bellies which originated from the dorsal aspect of the lower end of radius and the capsule of the wrist joint respectively. The two bellies fused to form a single tendon which inserted into the ulnar side of the dorsal digital expansion of the middle finger. Posterior interosseous nerve innervated the two bellies. This muscle may be involved in the wrist pain or may be misinterpreted as a ganglion or a nodule upon radiological examination. This muscle may be used for reconstructive purposes.

Clinical Features of Wrist Drop Caused by Compressive Radial Neuropathy and Its Anatomical Considerations

OBJECTIVE: Posture-induced radial neuropathy, known as Saturday night palsy, occurs because of compression of the radial nerve. The clinical symptoms of radial neuropathy are similar to stroke or a herniated cervical disk, which makes it difficult to diagnose and sometimes leads to inappropriate evaluations. The purpose of our study was to establish the clinical characteristics and diagnostic assessment of compressive radial neuropathy. METHODS: Retrospectively, we reviewed neurophysiologic studies on 25 patients diagnosed with radial nerve palsy, who experienced wrist drop after maintaining a certain posture for an extended period. The neurologic presentations, clinical prognosis, and electrophysiology of the patients were obtained from medical records. RESULTS: Subjects were 19 males and 6 females. The median age at diagnosis was 46 years. The right arm was affected in 13 patients and the left arm in 12 patients. The condition was induced by sleeping with the arms hanging over the armrest of a chair because of drunkenness, sleeping while bending the arm under the pillow, during drinking, and unknown. The most common clinical presentation was a wrist drop and paresthesia on the dorsum of the 1st to 3rd fingers. Improvement began after a mean of 2.4 weeks. Electrophysiologic evaluation was performed after 2 weeks that revealed delayed nerve conduction velocity in all patients. CONCLUSION: Wrist drop is an entrapment syndrome that has a good prognosis within several weeks. Awareness of its clinical characteristics and diagnostic assessment methods may help clinicians make diagnosis of radial neuropathy and exclude irrelevant evaluations.

Evaluation on effectiveness of neurolysis and nerve grafts surgery in treatment of early spontaneous posterior interosseous nerve entrapment / 吉林大学学报(医学版)

Objective To investigate the surgery method for early spontaneous posterior interosseous nerve entrapment,to observe the postoperative efficacy in treatment,to evaluate the surgical outcomes,and to provide a foundation for clinical choice of reasonable operation scheme.Methods 21 cases of early spontaneous posterior interosseous nerve entrapment received operation. 1 3 cases (1 8 arms) were treated by neurolysis, and 8 cases (8 arms )were treated by nerve grafts with small vessels wrapping operation;all the patients were followed up for 10 to 20 months;the finger extensor muscle strength and metacarpophalangeal joint activity were evaluated. Results The lesion extensor muscles were part of the denervation changes.Neurolysis muscle strength:14 arms were excellent(82.35%),2 arms were good,1 arm was fair,1 case was lost;extensor function:15 arms were excellent(88.24%),1 arm was good,1 arm was fair,1 case was lost.Nerve graft muscle strength:6 arms were excellent(75.00%),1 arm was good,1 arm was fair;extensor function:7 arms were excellent(87.50%),0 arm was good,1 arm was fair.Conclusion Neurolysis can have a good efficacy in treatment of early spontaneous posterior interosseous nerve entrapment without obvious degeneration.When the severe degeneration of entrapment nerve happens,a nerve graft surgical treatment is needed.

Clinical Significance of Ultrasonography for the Diagnosis of Nontraumatic Posterior Interosseous Nerve Palsy / The Japanese Journal of Rehabilitation Medicine

Objective : Causes of nontraumatic posterior interosseous nerve (PIN) palsy include space-occupying lesions, constrictions of the PIN, and supinator syndrome. The purpose of this study was to identify these causes using Ultrasonography (US). Methods : We performed US in seven cases (seven elbows) with palsy and examined the PIN and surrounding structures. Results : We identified the three causes by the following US findings : 1) A space-occupying lesion in two elbows. Both were low-echoic and diagnosed as ganglion. In these two cases, the PIN was elevated by the lesion and compressed against the arcade of Frohse. 2) A diffusely swollen PIN with constrictions was found in three cases. 3) A PIN showing a reduction in caliber beneath and a swelling (pseudoneuroma) proximal to the arcade of Frohse, compatible with supinator syndrome was also identified. Conclusion : US is useful for the diagnosis of nontraumatic PIN palsy.

Partial Paralysis of the Posterior Interosseous Nerve: A Case Report / 대한정형외과학회잡지

Partial paralysis of the posterior interosseous nerve at the forearm region has been rarely reported. We report our patients. After closed crushing injury at the forearm region, the patients showed "Sign of horns" which means disability of extension at the third and fourth metacarpo-phalangeal joint because of partial paralysis of the posterior interosseous nerve. We treated the patients as conservative treatment and the patients was completely recovered. So the autors report this case.

Incomplete Compressive Neuropathy of Posterior Interosseous Nerve Caused by Ganglion : A Case Report

Ganglion is a common benign tumor and is likely to cause paralysis of posterior interosseous nerve by compressiononce occurred in proximal radial area. A 25- year old female patient, who was suffering from forearm pain and trouble with extending her fingers after intramuscular stimulation, visited this hospital. We diagnosed as the common extensor muscle rupture by physical examination. But, on the basis of preoperative MRI, she was diagnosed with incomplete posterior interosseous nerve paralysis caused by ganglion of the proximal radius. We performed the surgical excision and obtained a satisfactory result without any evidence of recurrence at the 1 year follow-up after surgery. Incomplete compressive neuropathy of posterior interosseous nerve sometimes confused with spontaneous rupture of the common extensor muscle, which can lead to inappropriate surgical treatment. Careful preoperative examination is essential to avoid misdiagnosis. We report this case with review of the relevant literature, because of rarity of incomplete compressive neuropathy of posterior interosseous nerve by ganglion.

Consideraciones anátomo-clínicas sobre el nervio radial en el codo / Anatomical and clinical considerations about the radial nerve in the elbow

El recorrido del nervio radial a través del codo constituye, para este elemento nervioso, un camino con riesgo de lesiones intrínsecas o extrínsecas. Cambios de la morfología de las estructuras osteomusculares que constituyen el desfiladero del nervio radial, tanto patológicos como traumáticos, pueden determinar el atrapamiento y compresión del mismo, determinando el daño del nervio y/o la inflamación localizada a nivel de las estructuras circundantes. Mediante la disección de 30 preparados, formolizados al 10 por ciento, y el análisis subsecuente de la disposición de las estructuras musculares e inserción de las mismas, se determinaron los posibles puntos de riesgo anatómico que pudiesen alterar al nervio radial o a sus ramos en la canal bicipital lateral o en su ingreso y distribución en el parte proximal del antebrazo (relación con el músculo supinador y los músculos extensores radial largo y corto). Definimos 4 zonas de posible atrapamiento y compresión del nervio radial y sus ramos: 1. Septo intermuscular lateral. 2. Músculo extensor radial corto. 3. Músculo supinator, a nivel de la Arcada de Frohse. 4. Músculo supinator, a la salida de la masa muscular, en el dorso del antebrazo. La compresión del nervio radial a nivel del codo es una de las neuropatías del miembro superior, más frecuentes. El objetivo de este trabajo fue analizar las implicancias anatómicas del recorrido del nervio radial en su pasaje desde el brazo al antebrazo, especialmente las relaciones con las estructuras osteomusculares, cuyas alteraciones pueden ser las responsables de patologías compresivas del nervio radial que puedan llevar a dolor, parestesias, con o sin pérdida sensorial y/o impotencia funcional.

The radial nerve route through elbow constitutes, for this nervous element, a way with risk of intrinsic or extrinsic injuries. Morphologic changes of the structures that constitute the denle of the radial nerve, pathological as much traumatic, can determine it atrapment and compression, determining the damage of the nerve and/or the inflammation located at level of the surrounding structures. 30 forearm-elbow, preserved with formol to 10 percent, were dissected, and the subsequent analysis of the disposition of the muscular structures and insertion of the same ones, will determine the possible points of anatomical risk that they will affect the radial nerve or its branches in the brachial track or in the proximal forearm (relation with the supinator muscle and extensor carpi radialis longus and brevis muscles).We defined 4 zones of atrapment and compression of the radial nerve and its branches: 1. External intermuscular setum; 2. Extensor carpi radialis brevis muscle; 3. Supinator muscle , atlevelof theFrohse's Arch;4. Supinator muscle, when coming out of the muscular mass, in the back of the forearm. The compression of the radial nerve at level of the elbow is one of the frequent neuropathies of the superior member. It is for that reason that the objective of this work consists of analyzing the anatomical aspects of the route of the radial nerve in its passage from the arm to the forearm, specially relations with morphological structures, whose alterations determines pathologies of the radial nerve which can take to pain, parestesies, with lost sensorial and functional impotence.

Posterior Interosseous Nerve(PIN) Syndrome Caused by Anomalous Vascular Leash

Posterior interosseous nerve(PIN) syndrome is an entrapment of the deep branch of the radial nerve just distal to the elbow joint. It is caused by acute trauma or masses compressing the nerve. We report an unusual case of PIN syndrome with wrist drop caused by compression of the nerve by anomalous vascular leash. The patient has recovered with the surgical decompression of the offending vessels and arcade of Frohse.

Treatment of Posterior Interosseous Nerve Palsy / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical features, results, and prognosis of posterior interosseous nerve injury related to fracture or dislocation of the proximal radius. MATERIALS AND METHODS: From patients with posterior interosseous nerve injury between January, 1985 to December 2002, fourteen patients were selected. There were 2 cases with fracture of the proximal radius alone, 6 cases with fracture of both bones of the forearm, 5 cases with Monteggia fracture, and 1 case of radius head fracture. Eight cases showed nerve injury at the time of trauma, 3 cases after open reduction, and 3 cases after hardware removal. The involved nerve was explored in patients without spontaneous recovery for further treatment. Final range of motion, motor function, and satisfaction were used to assess the results. RESULTS: Seven cases, all with closed fracture, showed spontaneous recovery. The average time of recovery was 6.2 weeks. The remaining 7 cases were treated by neurorraphy (1 case), neurolysis (1 case), sural nerve graft (2 cases), and tendon transfer (3 cases). All cases showed satisfactory results. CONCLUSION: Traumatic posterior interosseous nerve injury rarely happens. Injury after closed fracture usually shows spontaneous recovery. Injury can also take place during open reduction or hardware removal. In cases without spontaneous recovery, The prognosis is generally good after proper treatment.