Anterior Interosseous Nerve Syndrome: Is it a Compressive Neuropathy?
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ORIGINAL ARTICLE
Anterior Interosseous Nerve Syndrome: Is it a Compressive Neuropathy? Ki‑tae Na1 · Dae‑hyun Jang2 · Yoon‑min Lee3 · Il‑jung Park4 · Hyun‑woo Lee1 · Sang‑uk Lee1 Received: 26 February 2020 / Accepted: 26 March 2020 / Published online: 6 April 2020 © Indian Orthopaedics Association 2020
Abstract Background Anterior interosseous nerve (AIN) syndrome is a rare disease whose pathophysiology is controversial. Despite efforts to elucidate the pathophysiology of AIN syndrome, it has not yet been resolved. We reinterpret electrodiagnostic studies, magnetic resonance imaging (MRI), and surgical findings to clarify the pathophysiology of AIN syndrome. Materials and Methods In this retrospective case series, we included surgically treated 20 cases of nontraumatic AIN syndrome. Surgery was performed after a minimum of 12 weeks of conservative treatment. The clinical data and operation records were extracted from the medical records for analysis. All electrodiagnostic tests were reinterpreted by physicians with an American Board Certification in electrodiagnostic medicine. Moreover, every contrast-enhanced MRI performed during the assessment was reviewed by a musculoskeletal radiologist. Results Of the twenty re-analyzed cases, nine AIN syndromes (45%) showed abnormal electromyography in non-AIN innervated muscles. Sensory nerve conduction studies were normal in all cases. Five magnetic resonance images (46%) showed signal changes in non-AIN-innervated muscles. Only four cases (20%) revealed definitive compression of the AIN during surgery. Conclusions Electrodiagnostic study and MRI indicated that many patients with AIN syndrome exhibited a diffuse pathologic involvement of the motor component of the median nerve. We conclude that the main pathophysiology of AIN syndrome would be diffuse motor fascicle neuritis of the median nerve in the upper arm. Keywords Anterior interosseous nerve syndrome · Peripheral nerve · Reinterpretation
Background
The current article was presented at “2016 korean microsurgical society conference” and win an excellence award. * Sang‑uk Lee self‑[email protected] Ki‑tae Na [email protected] Dae‑hyun Jang [email protected] Yoon‑min Lee [email protected] Il‑jung Park [email protected] Hyun‑woo Lee [email protected]
Anterior interosseous nerve (AIN) syndrome is a clinical condition characterized by weakness of the flexor pollicis longus (FPL) and the flexor digitorum profundus of the index finger (FDP1). Since Tinel described AIN syndrome as “dissociated 1
Department of Orthopedic Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, 56 Dong‑su ro, Bupyeong‑gu, Incheon 21431, South Korea
2
Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, South Korea
3
Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
4
Department of Orthopedic Surgery, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, South Ko
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