Posterior interosseous neuropathy
Background
- Posterior interosseous nerve (C7-8) is a branch of the radial nerve that supplies motor innervation to the forearm extensor muscles
- Compression or injury can cause an isolated PIN palsy [1]
- More proximal pathologies can cause a combined palsy
- More common in body builders and laborers due to repetitive pronosupination
Causes
- Peripheral neuropathy
- Repetitive microtrauma
- Entrapment
- Trauma
- Space occupying lesions
- Ganglion cyst
- Lipoma
- Bone tumor
- Iatrogenic
Clinical Features
- Forearm and wrist pain
- Weakness on finger and wrist extension
Differential Diagnosis
Median Nerve Syndromes
- Carpal tunnel syndrome
- Pronator teres syndrome
- Anterior interosseous neuropathy
Ulnar Nerve Syndromes
- Ulnar neuropathy at the elbow and wrist
Radial Nerve Syndromes
- Radial neuropathy at the spiral groove (ie. "Saturday night palsy")
- Posterior interosseous neuropathy
Proximal Neuropathies
- Suprascapular neuropathy
- Long thoracic neuropathy
- Axillary neuropathy
- Spinal accessory neuropathy
- Musculocutaneous neuropathy
Evaluation
Workup
- Plain films
- EMG (as outpatient)
Diagnosis
- Usually a clinical diagnosis (in ED)
Management
- Nonoperative: rest, activity modification, NSAIDs, splinting
- Operative decompression: compressive masses
Disposition
- Discharge with orthopedic follow up
See Also
External Links
References
- Dang AC et al. Unusual Compression Neuropathies of the Forearm, Part I: Radial Nerve. JHS. 2009;34A:1906-1914.
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