Treatment of spontaneous anterior interosseous nerve palsy

Narihito Kodama MD, PhD, Kosei Ando MD, PhD, Yoshinori Takemura MD, PhD, and Shinji Imai MD, PhD
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  • Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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OBJECTIVE

The purpose of this study was to clarify the clinical outcomes of spontaneous anterior interosseous nerve palsy (AINP) treated nonsurgically or surgically.

METHODS

The authors retrospectively evaluated the clinical course of 27 patients affected with AINP, treated nonsurgically or surgically. Thirteen patients underwent surgical treatment (interfascicular neurolysis), and 14 patients underwent conservative nonsurgical treatment. The mean patient age at the onset of symptoms was 49 years (range 17–77 years). The mean follow-up duration from onset to the latest follow-up examination was 23 months (range 12–38 months).

RESULTS

In 12 of 14 patients receiving conservative treatment, signs of recovery from the palsy were obtained within 6 months. These patients showed a recovery of manual muscle test (MMT) grade ≥ 3. In contrast, 2 patients who took more than 12 months from symptom onset to initial recovery showed poor recovery (MMT grade ≤ 2). Surgical treatment was performed in 13 patients because of no sign of recovery from palsy. The mean period from symptom onset to the operation was 8.4 months (range 6–14 months). Ten of 13 patients who underwent surgical treatment within 8 months after symptom onset showed good recovery, with MMT grade ≥ 4. However, 3 patients who underwent surgical treatment more than 12 months after onset showed recovery with MMT grade ≤ 3.

CONCLUSIONS

Conservative treatment for AINP may be continued when patients show signs of recovery within 6 months after symptom onset. In contrast, surgical treatment may be performed within 8 months from the onset of symptoms when the patients show no recovery signs for 6 months.

ABBREVIATIONS

AIN = anterior interosseous nerve; AINP = anterior interosseous nerve palsy; FDP1 = flexor digitorum profundus of the index finger; FPL = flexor pollicis longus; MMT = manual muscle test; NSG = nonsurgical treatment group; SG = surgical treatment group.

Illustration from Duan et al. (pp 1174–1181).

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Contributor Notes

Correspondence Narihito Kodama: Shiga University of Medical Science, Shiga, Japan. koda62@belle.shiga-med.ac.jp.

INCLUDE WHEN CITING Published online March 8, 2019; DOI: 10.3171/2018.11.JNS181609.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Cohen BE, Cukier J: Simultaneous posterior and anterior interosseous nerve syndromes. J Hand Surg Am 7:398400, 1982

  • 2

    England JD, Sumner AJ: Neuralgic amyotrophy: an increasingly diverse entity. Muscle Nerve 10:6068, 1987

  • 3

    Futami T, Kobayashi A, Tadano I, Wakita R, Otsuka H: [Conservative management of anterior or posterior interosseous nerve syndrome.] J Jpn Soc Surg Hand 19:111114, 2002 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 4

    Hashizume H, Nishida K, Nanba Y, Shigeyama Y, Inoue H, Morito Y: Non-traumatic paralysis of the posterior interosseous nerve. J Bone Joint Surg Br 78:771776, 1996

    • Search Google Scholar
    • Export Citation
  • 5

    Haussmann P, Patel MR: Intraepineurial constriction of nerve fascicles in pronator syndrome and anterior interosseous nerve syndrome. Orthop Clin North Am 27:339344, 1996

    • Search Google Scholar
    • Export Citation
  • 6

    Hill NA, Howard FM, Huffer BR: The incomplete anterior interosseous nerve syndrome. J Hand Surg Am 10:416, 1985

  • 7

    Kim DH, Murovic JA, Kim YY, Kline DG: Surgical treatment and outcomes in 15 patients with anterior interosseous nerve entrapments and injuries. J Neurosurg 104:757765, 2006

    • Search Google Scholar
    • Export Citation
  • 8

    Lundborg G: Commentary: hourglass-like fascicular nerve compressions. J Hand Surg Am 28:212214, 2003

  • 9

    Miller-Breslow A, Terrono A, Millender LH: Nonoperative treatment of anterior interosseous nerve paralysis. J Hand Surg Am 15:493496, 1990

    • Search Google Scholar
    • Export Citation
  • 10

    Mumenthaler M, Schliack H (eds): Peripheral Nerve Lesions: Diagnosis and Therapy. New York: Thieme, 1991

  • 11

    Nagano A: Spontaneous anterior interosseous nerve palsy. J Bone Joint Surg Br 85:313318, 2003

  • 12

    Nigst H, Dick W: Syndromes of compression of the median nerve in the proximal forearm (pronator teres syndrome; anterior interosseous nerve syndrome). Arch Orthop Trauma Surg 93:307312, 1979

    • Search Google Scholar
    • Export Citation
  • 13

    Oberlin C, Shafi M, Diverres JP, Silberman O, Adle H, Belkheyar Z: Hourglass-like constriction of the axillary nerve: report of two patients. J Hand Surg Am 31:11001104, 2006

    • Search Google Scholar
    • Export Citation
  • 14

    Ochi K, Horiuchi Y, Tazaki K, Takayama S, Matsumura T: Fascicular constrictions in patients with spontaneous palsy of the anterior interosseous nerve and the posterior interosseous nerve. J Plast Surg Hand Surg 46:1924, 2012

    • Search Google Scholar
    • Export Citation
  • 15

    Ochi K, Horiuchi Y, Tazaki K, Takayama S, Matsumura T: Surgical treatment of spontaneous anterior interosseous nerve palsy: a comparison between minimal incision surgery and wide incision surgery. J Plast Surg Hand Surg 47:213218, 2013

    • Search Google Scholar
    • Export Citation
  • 16

    Ochi K, Horiuchi Y, Tazaki K, Takayama S, Nakamura T, Ikegami H, et al. : Surgical treatment of spontaneous posterior interosseous nerve palsy: a retrospective study of 50 cases. J Bone Joint Surg Br 93:217222, 2011

    • Search Google Scholar
    • Export Citation
  • 17

    Pan Y, Wang S, Zheng D, Tian W, Tian G, Ho PC, et al. : Hourglass-like constrictions of peripheral nerve in the upper extremity: a clinical review and pathological study. Neurosurgery 75:1022, 2014

    • Search Google Scholar
    • Export Citation
  • 18

    Pan YW, Wang S, Tian G, Li C, Tian W, Tian M: Typical brachial neuritis (Parsonage-Turner syndrome) with hourglass-like constrictions in the affected nerves. J Hand Surg Am 36:11971203, 2011

    • Search Google Scholar
    • Export Citation
  • 19

    Parsonage MJ, Turner JW: Neuralgic amyotrophy; the shoulder-girdle syndrome. Lancet 1:973978, 1948

  • 20

    Schantz K, Riegels-Nielsen P: The anterior interosseous nerve syndrome. J Hand Surg Br 17:510512, 1992

  • 21

    Sood MK, Burke FD: Anterior interosseous nerve palsy. A review of 16 cases. J Hand Surg Br 22:6468, 1997

  • 22

    Spinner M: The anterior interosseous-nerve syndrome, with special attention to its variations. J Bone Joint Surg Am 52:8494, 1970

  • 23

    Vigasio A, Marcoccio I: Homolateral hourglass-like constrictions of the axillary and suprascapular nerves: case report. J Hand Surg Am 34:18151820, 2009

    • Search Google Scholar
    • Export Citation
  • 24

    Yamamoto S, Nagano A, Mikami Y, Tajiri Y: Multiple constrictions of the radial nerve without external compression. J Hand Surg Am 25:134137, 2000

    • Search Google Scholar
    • Export Citation
  • 25

    Yamamoto S, Tajiri Y, Mikami Y, Okinaga S, Nagano A: [Surgical indication of spontaneous anterior interosseous nerve palsy.] J Jpn Soc Surg Hand 26:7678, 2010 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 26

    Yasunaga H, Shiroishi T, Ohta K, Matsunaga H, Ota Y: Fascicular torsion in the median nerve within the distal third of the upper arm: three cases of nontraumatic anterior interosseous nerve palsy. J Hand Surg Am 28:206211, 2003

    • Search Google Scholar
    • Export Citation

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