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

Ochi, Kensuke; Homma, Yukio; Arino, Hiroshi; Toyama, Yoshiaki

doi:10.1142/s0218810415720089

Cited by 3 publications

(4 citation statements)

References 5 publications

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“…The authors advocated intervening with tendon transfers if there has been no improvement in 7 months in patients aged > 50 years and within 12 months in patients aged < 50 years. More recently, the same author has reported a patient doing well with neurolysis performed 17 years after onset of symptoms (Ochi et al., 2015). There are other reports of patients improving after marked delays to treatment (Werner et al., 2007).…”

Section: Resultsmentioning

confidence: 99%

Isolated spontaneous posterior interosseous nerve palsy: a review of aetiology and management

McGraw

2018

J Hand Surg Eur Vol

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Isolated posterior interosseous nerve palsy is an uncommon condition and its management is controversial. Existing literature is sparse and a treatment algorithm based on existing best evidence is absent. A comprehensive review was undertaken to elucidate the causes of spontaneous posterior interosseous nerve palsy and suggest a management strategy based on the current evidence. Posterior interosseous nerve palsy can be broadly categorized as compressive and non-compressive, and the existing evidence supports surgical intervention for compressive palsy. For posterior interosseous nerve pathology with no compressive lesion on imaging, conservative management should be tried first. Surgery is therefore reserved for compressive lesions and for failure of conservative management. The commonly performed operative procedures include decompression and neurolysis, neurorrhaphy and nerve grafting, and tendon transfers with or without nerve grafting performed as a salvage procedure. The prognosis is poorer in patients aged > 50 years, those with a delay to surgery, and those who have had long-standing compression with severe fascicular thinning.

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Section: Resultsmentioning

confidence: 99%

Isolated spontaneous posterior interosseous nerve palsy: a review of aetiology and management

McGraw

2018

J Hand Surg Eur Vol

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“…Ochi et al . reported a patient doing well with neurolysis performed 17 years after the onset of symptoms ( 9 ) , and Werner et al . reported patients improving after marked delays to treatment ( 10 ) .…”

Section: Discussionmentioning

confidence: 99%

“…Currently, tendon transfer is recommended if there has been no improvement in 7 months in patients aged >50 years and within 12 months in patients aged <50 years (8) . Ochi et al reported a patient doing well with neurolysis performed 17 years after the onset of symptoms (9) , and Werner et al reported patients improving after marked delays to treatment (10) . Thus, PIN may recover nerve function even with a long surgical delay.…”

Section: Introductionmentioning

confidence: 99%

Palsy of the posterior interosseous nerve treated by targeted ultrasound-guided perineural hydrodissection

et al. 2021

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Perineural hydrodissection is a minimally invasive technique using an injection of fluid to dissect the perineural plane and tissue space. This report describes a case of palsy of the descending branch of the posterior interosseous nerve (PIN) which was recovered by targeted ultrasound-guided perineural hydrodissection. Ultrasonographic examination was performed, and multiple stenotic lesions interrupted by hyperechoic bands within the fascicles of the PIN were found. Using ultrasonography, perineural hydrodissection was performed four times every other week. Fifteen weeks after the first hydrodissection, there was no restriction in the patient’s thumb and fingers movement, and ultrasonography revealed that multiple stenotic lesions had improved. Today, surgical treatment is recommended for patients with complete nerve constriction. However, there is no standardized approach for patients with incomplete or without nerve constriction. Ultrasound-guided perineural hydrodissection is a noninvasive and easy method. This procedure could be a useful diagnostic and therapeutic modality for the management of the disease.

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“…Needle electromyography showed spontaneous fibrillation potentials and positive sharp waves in the extensor carpi ulnaris and no electrical activity in the other muscles innervated by the PIN. Considering that incomplete spontaneous PIN palsy may partially recover by simple interfascicular neurolysis even 17 years after the onset (Ochi et al., 2015), interfascicular neurolysis was performed. No pathological feature, such as compression of the nerve, entrapment, fascicular constriction or hourglass-like deformity, was seen (Figure 1).…”

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confidence: 99%

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

Ochi

Seki

2021

J Hand Surg Eur Vol

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incubation. Mantoux tuberculin test, CT-scan of the lungs and sputum smear microscopy were negative. Antituberculous therapy with Rifampicin, Isoniazid, Pyrazinamide and Ethambutol was given for 6 months. Four years after surgery, there was no evidence of recurrence. The patient was symptom free and could perform all daily living activities without discomfort. Grip and pinch strengths were 85% and 90% of the contralateral side, respectively.When facing a growing cystic mass containing multiple rice or melon-seed bodies in the hand, one should always suspect the possibility of extrapulmonary tuberculosis. Negative chest radiographs or a negative skin tuberculin test do not exclude the presence of tenosynovial tuberculosis (Weber et al., 2015). Intraoperative cultures for M. tuberculosis are mandatory (Panigrahi et al., 2021). Direct microscopic examination is rarely positive (Weber et al., 2015). Treatment includes radical resection of the lesion and prolonged antituberculous chemotherapy (Bayaram et al., 2016). Concurrent nerve compressions must be adequately addressed.

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

Cited by 3 publications

References 5 publications

Isolated spontaneous posterior interosseous nerve palsy: a review of aetiology and management

Isolated spontaneous posterior interosseous nerve palsy: a review of aetiology and management

Palsy of the posterior interosseous nerve treated by targeted ultrasound-guided perineural hydrodissection

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

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