Xray arcade4/1/2023 ![]() ![]() Most nerve entrapments occurs due to an osseoligamentous tunnel narrowing. Also, because of the lack of extensor carpi ulnaris, there maybe some radial deviation of the wrist with extension with the remaining innervated ECRL and ECRB. Because the extensor carpi radialis longus and in some cases the extensor carpi radialis brevis are innervated before the radial nerve passes into the supinator, there is usually some sparing of wrist extension. In more severe cases, the patient may present with weakness in the wrist and finger extensors. Characteristics/Clinical Presentation Ī patient who presents with this diagnosis of posterior interosseous syndrome may have a history of vague proximal posterior forearm pain with no weakness in more mild cases. The causes of posterior interosseous nerve syndrome include intrinsic nerve abnormalities and extrinsic compression. ![]() Although less common, it can also follow surgical reinsertion of a ruptured distal biceps brachii tendon. Posterior interosseous nerve syndrome can be iatrogenic following reduction of radial fracture, transposition of the ulnar nerve or release of the extensor origin for lateral epicondylitis. This diagnosis may be associated with lateral epicondylitis. Compression of the posterior interosseous nerve is associated with repetitive activities that involve gripping, wrist supination and pronation, with a component of wrist extension. Impingement of the radial nerve results in posterior interosseous nerve syndrome. However, it can also occur following trauma, such as a blow to the proximal dorsal region of the forearm. It is the area where the nerve enters the supinator muscle and is the most common place for a compression of the nerve. Posterior interosseous nerve syndrome usually develops spontaneously and is caused by compression injuries to the upper extremity, mostly in the arcade of Frohse. With repeated pronation and supination a dynamic compression of the nerve in the proximal part of the forearm can be created. Posterior interosseous nerve syndrome can be caused by a traumatic injury, tumors, inflammation and an anatomic injury. Proximal forearm fractures can also result in posterior interosseous nerve palsy. With a humeral shaft fracture, there is a 12% chance of associated with radial nerve paralysis. Posterior interosseous nerve syndrome is more common in males, manual labourers and bodybuilders, with an incidence of 3 per 100 000. Supinator muscle with posterior interosseous nerve passing deep via the Arcade of Frohse The posterior interosseous nerve is a motor nerve and sequentially innervates supinator, extensor carpi radialis brevis, extensor digitorum communis, extensor digiti minimi, extensor carpi ulnaris, abductor pollicis, extensor pollicis brevis, extensor pollicis longus, and extensor indicis. The posterior interosseous nerve continues in the radial tunnel through the supinator, as it goes from the anterior to the posterior surface of the forearm. The arcade of Frohse, which is the most common point of compression, is a connection between the deep and superficial heads of the supinator and is fibrotendinous in 30% to more than 80% of the population. The posterior interosseous nerve is much longer and enters the radial tunnel underneath a musculotendinous arch, the arcade of Frohse. The superficial radial nerve ends proximal to the radial tunnel. Īt the level of the lateral epicondyle, between the brachioradialis and brachialis muscles, the radial nerve, which has its origin in the brachial plexus, divides into its 2 terminal branches: the superficial radial nerve and the posterior interosseous nerve. The floor is formed by the deep head of the supinator and the capsule of the radiocapitellar joint, while the roof is formed by the superficial head of the supinator and the radial recurrent vessels. This tunnel is attached laterally to the brachioradialis, extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB) and medially to the biceps tendon and brachialis. The radial tunnel is a space that extends 5cm from the radial head to the distal margin of the supinator. Damage to this branch of the radial nerve results in posterior interosseous nerve syndrome. The radial nerve supplies the majority of the forearm and hand extensors. ![]() Proximal to the supinator arch, the radial nerve is divided into a superficial branch and posterior interosseous branch. This nerve is the deep motor branch of the radial nerve. The posterior interosseous nerve is located close to shaft of the humerus and the elbow.
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