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Daniel H. Kim, Judith A. Murovic, Yong-Yeon Kim and David G. Kline

Object

The authors present data obtained in 15 surgically treated patients with anterior interosseous nerve (AIN) entrapments and injuries.

Methods

Fifteen patients with AIN entrapments and injuries underwent surgery between 1967 and 1997 at Louisiana State University Health Sciences Center (LSUHSC) or Stanford University Medical Center. Patient charts were reviewed retrospectively. The LSUHSC grading system was used to evaluate the function of muscles supplied by the AIN.

Nontraumatic injuries included seven AIN compressions by bone or soft tissue. Traumatic injury mechanisms consisted of stretch or contusion (six patients), injection (one patient), and burn scar (one patient). Presentations included weakness in the flexor digitorum profundus (FDP) muscle to the index finger, FDP muscle to the middle finger, pronator quadratus muscle, and flexion of the distal phalanx of the thumb. Preoperative evaluations included electromyography and nerve conduction studies as well as elbow and forearm plain radiographs.

On surgery, lesions in continuity involved seven compressions, four stretch or contusion injuries, and one injection injury, all of which demonstrated nerve action potentials (NAPs) and were treated with neurolysis. Among the seven compression and four stretch or contusion injury cases, six and three patients, respectively, had LSUHSC Grade 3 or better functional recoveries postoperatively. Two stretch or contusion injuries involved lesions in continuity but demonstrated negative NAPs at surgery. Thus, each was treated using a graft repair after resection of a neuroma. There was one burn scar injury, which was treated via an end-to-end suture anastomosis, leading to a functional recovery better than Grade 3.

Conclusions

Fifteen AIN entrapments or injuries responded favorably to nerve release and/or repair.

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Daniel H. Kim, Judith A. Murovic, Yong-Yeon Kim and David G. Kline

Object

The authors report data in 45 surgically treated posterior interosseous nerve (PIN) entrapments or injuries.

Methods

Forty-five PIN entrapments or injuries were managed surgically between 1967 and 2004 at Louisiana State University Health Sciences Center (LSUHSC) or Stanford University Medical Center. Patient charts were reviewed retrospectively. The LSUHSC grading system was used to assess PIN-innervated muscle function.

Injuries were caused by nontraumatic (21 PIN entrapments and four tumors) and traumatic (nine lacerations, eight fractures, and three contusions) mechanisms. Presentations included weakness in the extensor carpi ulnaris muscle, causing compromised wrist extension and radial drift; extensor digitorum, indicis, and digiti minimi muscles with paretic finger extension; extensor pollicis brevis and longus muscles with weak thumb extension; and abductor pollicis longus muscle with rare decreased thumb abduction due to substitutions of the median nerve–innervated abductor pollicis brevis muscle and, at 90°, the extensor pollicis brevis and longus muscles. Preoperative evaluations consisted of electromyography and nerve conduction studies, elbow and forearm plain x-ray films, and magnetic resonance imaging for tumor detection.

At surgery, in continuity lesions were found in 21 entrapments and three fracture-related and three contusion injuries; all transmitted nerve action potentials (NAPs) and were treated with neurolysis. Five fracture-related PIN injuries, one of which was a lacerating injury, were in continuity and transmitted no NAPs; graft repairs were performed in all of these cases. Among nine lacerations, three PINs appeared in continuity, although intraoperative NAPs were absent. Two of these nerves were treated with secondary end-to-end suture anastomosis repair and one with secondary graft repair. There were six transected lacerations: three were treated with primary suture anastomosis repair, two with secondary suture anastomosis, and one with graft repair. Four tumors involving the PIN were resected. Most muscles innervated by 45 PINs had LSUHSC Grade 3 or better functional outcomes.

Conclusions

Forty-five PIN entrapments or injuries responded well to PIN release and/or repair.