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Compression Neuropathy
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Vijay A Malshikare, J Terrence Jose Jerome
USG is a valuable and increasingly used diagnostic tool for entrapment neuropathies. The authors have developed a neuromuscular ultrasound study to measure posterior interosseous nerve (PIN) diameter supination, mid prone and pronation of the forearm. This is called dynamic imaging, evaluating the nerve during movements. The normal diameter ranges between 1.30mm and 2.13mm at the antecubital fossa. The arcade of Frohse is the common site of the deep branch of radial nerve impingement followed by the fibrous medial border extensor carpi radialis and distal border of the supinator muscle. The nerve may be thickened (edematous, scarred) proximal to the arcade of Frohse and may become wrinkled proximal to the point of compression in the course of supination against resistance. A decrease in the diameter (anteroposterior) of the PIN confirms the nerve compression. This has to be compared with the same level of the contralateral nerve
Hands
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
There are three common constriction points (of the PIN) within the radial tunnel: Sharp tendinous medial border of the ECRB.Fan of vessels from the radial recurrent artery (‘leash of Henry’) that can compress various branches of the RN.Arcade of Frohse – the free aponeurotic margin of the supinator under which the PIN passes (thus the PIN syndrome). This is the most common site of RN compression.Fibrous bands around the radiohumeral joint may also cause constriction; some suggest that RTS may be a result of overuse.
Compression Neuropathies
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
This motor syndrome is variably the result of tendinous hypertrophy of the arcade of Frohse and the thickening of the radiocapitellar joint capsule. Vascular compression of the artery of Henry (from the recurrent radial artery) has been described. Repetitive supination motion injury from work activities or from crutches pressing on the supinator muscle may contribute to the condition. The symptoms include a progression of paresis of the extensors of the MCP joints, resulting variably in LOS of the finger extensors and of the thumb abductors. Pain may radiate to the neck and shoulder. Clinical testing for this syndrome may proceed as follows: (a) palpation over the PIN under the supinator muscle may elicit pain; (b) the Tinnel sign, tapping over the radial head immediately distal to the lateral epicondyle, may produce tingling along the radial nerve; (c) passive stretching of the third digit may reproduce pain. EMG studies did not show consistent results. Management of the condition is mainly protective and preventive. Rest and gentle exercise may speed recovery. Anesthetic/steroid injections may offer symptomatic relief. Surgery has been successful in fewer than 50% of cases (35,39).
Anatomic surface landmarks to guide injection for posterior interosseous nerve block
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Swapnil D. Kachare, Bradley J. Vivace, Luke T. Meredith, Milind D. Kachare, Christina N. Kapsalis, Michael Ablavsky, Rachel H. Safeek, Claude Muresan, Joshua H. Choo, Morton L. Kasdan, Bradon J. Wilhelmi
The PIN provides antebrachial extensor innervation and is the main contributor to the innervation of the dorsal wrist capsule [5,6]. Anatomically, the PIN originates from the bifurcation of the radial nerve and passes through the Arcade of Frohse to emerge dorsally at the distal edge of the supinator muscle [5]. Distally it continues within the 4th extensor compartment with a variable course and branching pattern differing even amongst opposite forearms of the same cadaver [7]. A fifth branch divides into a radial and ulnar branch at 12.8 ± 2.2 cm proximal to Lister’s tubercle where the radial branch supplies extensor pollicis longus (EPL) and extensor pollicis brevis (EPB) before passing deep to the interosseous membrane and an ulnar branch that supplies extensor indicis (EI) and EPL before giving off a terminal articular branch approximately 5–10 cm in length to the dorsal aspect of the wrist capsule [5,6].
Effect of dry needling on radial tunnel syndrome: A case report
Published in Physiotherapy Theory and Practice, 2019
The radial tunnel is an anatomical space extending from the radial head to the distal border of the supinator, bounded medially by the biceps tendon and brachialis and laterally by the brachioradialis, extensor carpi radialis longus, and extensor carpi radialis brevis (Portilla Molina et al., 1998). The radial nerve divides into a terminal superficial sensory and a deep branch (predominantly motor, also known as the PIN) at the level of the lateral epicondyle following which the deep branch enters the radial tunnel (Cha, York, and Tawfik, 2014; Lutz, 1991) (Figure 1). RTS describes the entrapment of the deep branch within the radial tunnel which can potentially occur at five different sites (Naam and Nemani, 2012). They include the fibrous bands anterior to the radial head, leash of Henry (anastomosing branches of the recurrent radial artery and its vein) at the radius neck, proximal edge of the supinator (also known as the arcade of Frohse), distal border of the supinator (which forms the distal edge of the radial tunnel), and the fibrous medial part of the extensor carpi radialis brevis (Moradi, Ebrahimzadeh, and Jupiter, 2015).
Management of posterior interosseous nerve (PIN) palsies after distal biceps tendon repair using a single incision technique- a conclusive approach to diagnostics and therapy
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Inga S. Besmens, Marco Guidi, Andreas Schiller, David Jann, Pietro Giovanoli, Maurizio Calcagni
Posterior interosseous nerve (PIN): The PIN arises from the radial nerve at the radiohumeral joint line. It passes under the supinator muscle at the arcade of Frohse. It then winds around the radial neck within the substance of the supinator muscle into the posterior compartment of the forearm