Sonography and MR Imaging of Posterior Interosseous Nerve Syndrome with Surgical Correlation

Chien, Alexander; Jamadar, David A.; Jacobson, Jon A.; Hayes, Curtis W.; Louis, Dean S.

doi:10.2214/ajr.181.1.1810219

Cited by 78 publications

(43 citation statements)

References 7 publications

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“…24 -32 Other sources of compression that have been described include ganglia arising from the anterior capsule of the proximal radioulnar joint and in the supinator muscle, 33-40 rheumatoid pannus, 41 septic arthritis of the elbow, 42 synovial chondromatosis, [43][44][45] and vasculitis. 46 One case report described the use of sonography to detect fibrous bands that compress the PIN, 47 although this imaging modality is not commonly employed in the workup of PIN syndrome.…”

Section: Posterior Interosseous Nerve (Pin) Syndromementioning

confidence: 99%

Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve

Dang¹,

Rodner²

2009

The Journal of Hand Surgery

132

114

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Peripheral compression neuropathies are familiar to the hand surgeon. Although compression neuropathies of the forearm are far less common than those of the wrist (namely, carpal tunnel syndrome), for the patient suffering from one of these neuropathies, a missed diagnosis has far-reaching consequences. In this 2-part review (I: Radial Nerve; II: Median Nerve), several compression neuropathies of the forearm are examined. We will first discuss compression neuropathies affecting the radial nerve: (1) posterior interosseous nerve syndrome, (2) radial tunnel syndrome, and (3) superficial radial nerve compression (Wartenberg's syndrome).

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Section: Posterior Interosseous Nerve (Pin) Syndromementioning

confidence: 99%

Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve

Dang¹,

Rodner²

2009

The Journal of Hand Surgery

132

114

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“…No motor weakness of the extensor muscles is present Axial fat-saturated fast spin-echo T2-weighted image (FSE T2WI) (a) and T1-weighted image (T1WI) (b) at the proximal forearm demonstrate a huge lipoma (arrows) between the radius and supinator muscle, possibly compressing the posterior interosseous nerve branching off from the radial nerve. c Axial fatsaturated FSE T2WI at the mid-forearm shows increased signal intensity and mild atrophy of the extensor muscles (arrows), anchors the radial nerve or its branches to the elbow joint; the tendinous edge of extensor carpi radialis brevis; the vessel group of the radial recurrent artery and its branches, which is called the leash of Henry; the arcade of Frohse, a fibrous band at the origin of the supinator muscle; and the fascial arcade at the distal end and lateral side of the supinator muscle [71][72][73][74].Although the terms radial tunnel syndrome and posterior interosseous nerve syndrome are somewhat confusing and occasionally coincide, owing to their similar causes and anatomic location, they are distinguished on the basis of different clinical presentations. Radial tunnel syndrome presents primarily with pain and occasional sensory disturbances, without significant weakness.…”

Section: Radial Nervementioning

confidence: 99%

Role of magnetic resonance imaging in entrapment and compressive neuropathy—what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity

et al. 2006

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The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions, but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the upper extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the upper extremity are as follows: the brachial plexus of the thoracic outlet; axillary nerve of the quadrilateral space; radial nerve of the radial tunnel; ulnar nerve of the cubital tunnel and Guyon's canal; median nerve of the pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging.

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“…9,10 A caliber change of the PIN as it passes through the arcade of Frohse may be considered a manifestation of nerve compression or entrapment. 7,11,12 In our study, the observation was made that the PIN became flattened as it pierced the proximal supinator muscle in the forearm (Figure 4). In all elbows, the PIN showed a decrease in the AP dimension once within the proximal supinator muscle at the level of the arcade of Frohse.…”

Section: Discussionmentioning

confidence: 55%

“…1,6 Among the upper extremity entrapment neuropathies, posterior interosseous nerve (PIN) syndrome (or supinator syndrome) has been described using magnetic resonance imaging and sonography. 7 In this condition, the PIN may be entrapped as it courses under the arcade of Frohse and enters the supinator muscle ( Figure 1). The hallmark of such nerve entrapment is abnormal swelling …”

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confidence: 99%

Posterior Interosseous Nerve of the Elbow

Dong

Jamadar

Robertson

et al. 2010

Journal of Ultrasound in Medicine

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Objective. In our clinical practice, we have noted a caliber change of the posterior interosseous nerve (PIN) at the elbow as seen in the long axis on sonography simulating nerve entrapment. The objective of this study was to characterize the PIN using sonography in asymptomatic individuals. Methods. Our study retrospectively characterized the PIN in 50 elbows of 47 asymptomatic patients with sonography. Measurements of the PIN in a short‐axis cross section using the circumferential trace technique and the anteroposterior (AP) dimension in the long axis were made proximal, at, and distal to the arcade of Frohse. Results. There was reduction of the AP dimension of the PIN distal to the arcade of Frohse when compared with the measurements at the arcade of Frohse and proximal to the arcade (P < .0001); however, there was no significant difference between the cross‐sectional area of the PIN at all 3 levels (P = .59). Conclusions. The PIN normally flattens as it enters into the supinator muscle without a notable change in the cross‐sectional area. This appearance should not be misinterpreted as nerve entrapment when imaged in the long axis.

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Sonography and MR Imaging of Posterior Interosseous Nerve Syndrome with Surgical Correlation

Cited by 78 publications

References 7 publications

Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve

Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve

Role of magnetic resonance imaging in entrapment and compressive neuropathy—what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity

Posterior Interosseous Nerve of the Elbow

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