Slow progression predicts poor prognoses in patients with spontaneous posterior interosseous nerve palsy

Abstract

There are still no factors that predict the prognoses of patients with spontaneous posterior interosseous nerve palsies who are in an early phase of the illness. This paper reviewed 39 patients with this type of palsy. Seventeen patients who requested surgery for possible earlier recovery underwent interfascicular neurolysis because no signs of recovery were seen more than 3 months after onset. A Medical Research Council muscle power grade over 4 at their final visit was considered a good result, while a power less than grade 4 was considered a poor result. The clinical outcomes were significantly worse for the patients who had palsies with slow progressions (for more than 1 month) compared with those who had palsies with rapid progressions (completed within 1 month), regardless of their treatment. No significant difference was seen between the prognoses of patients with complete and incomplete palsies. We, therefore, recommend that interfascicular neurolysis is performed together with tendon transfer as the primary surgical procedures for patients with palsies with slow progression.

Possible guarded prognosis for childhood-onset spontaneous posterior interosseous nerve palsy: two case reports

“…Both those who believe the condition is due to neuralgic amyotrophy and those who believe it is caused by fascicular constriction favour conservative treatment in children. However, in adults, slow progression of the palsy for more than a month is one of the poor prognostic factors associated with conservative treatment (Ochi et al, 2013), which also was the case in our two paediatric cases. We therefore conclude that surgical treatment should be considered, not only in adult-onset spontaneous PIN palsy, but also in children if there is no spontaneous recovery or even slow worsening of the palsy during conservative treatment.…”

Interfascicular Neurolysis for Incomplete Spontaneous Posterior Interosseous Nerve Palsy with a Surgical Delay of 17 Years: Is It Still Effective?

“…Her palsy kept on proceeding for more than 3 months (slow progression) 2) with no apparent cause. Although she visited several hospitals, her palsy remained undiagnosed and untreated for 17 years.…”

“…Recent studies have demonstrated that age at onset, preoperative delay, complication of ulnar nerve or C8 palsy, surgical finding of fascicular constriction, and progression of palsy significantly correlate with its prognosis. 1,2) However, the therapeutic approach for incomplete spontaneous PIN palsy in which the onset occured more than a year before surgical treatment still remains controversial. Here, we present a case of spontaneous PIN palsy undergoing interfascicular neurolysis with a surgical delay of 17 years.…”