Surgical treatment of spontaneous posterior interosseous nerve palsy

Abstract

We have reviewed 38 surgically treated cases of spontaneous posterior interosseous nerve palsy in 38 patients with a mean age of 43 years (13 to 68) in order to identify clinical factors associated with its prognosis. Interfascicular neurolysis was performed at a mean of 13 months (1 to 187) after the onset of symptoms. The mean follow-up was 21 months (5.5 to 221). Medical Research Council muscle power of more than grade 4 was considered to be a good result. A further 12 cases in ten patients were treated conservatively and assessed similarly. Of the 30 cases treated surgically with available outcome data, the result of interfascicular neurolysis was significantly better in patients < 50 years old (younger group (18 nerves); good: 13 nerves (72%), poor: five nerves (28%)) than in cases > 50 years old (older group (12 nerves); good: one nerve (8%), poor: 11 nerves (92%)) (p < 0.001). A pre-operative period of less than seven months was also associated with a good result in the younger group (p = 0.01). The older group had a poor result regardless of the pre-operative delay. Our recommended therapeutic approach therefore is to perform interfascicular neurolysis if the patient is < 50 years of age, and the pre-operative delay is < seven months. If the patient is > 50 years of age with no sign of recovery for seven months, or in the younger group with a pre-operative delay of more than a year, we advise interfascicular neurolysis together with tendon transfer as the primary surgical procedure.

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

“…Spontaneous posterior interosseous nerve (PIN) palsy is a nontraumatic PIN palsy that has an unknown aetiology, despite careful clinical and diagnostic evaluations [1]. Space-occupying lesions are excluded from this "spontaneous" PIN (sPIN) palsy because the space-occupying lesions that can result in PIN palsy can now be diagnosed with diagnostic imaging [1].…”

“…Space-occupying lesions are excluded from this "spontaneous" PIN (sPIN) palsy because the space-occupying lesions that can result in PIN palsy can now be diagnosed with diagnostic imaging [1]. Thus, sPIN palsies should be distinguished from palsies that have been historically described as non-traumatic paralysis of PIN because surgical explorations of this historical condition have shown that most of the causes involved space-occupying lesions [2][3][4][5][6].…”

“…The treatment guidelines for sPIN palsy are controversial [1,3,[7][8][9][10][11][12][13][14][15][16][17][18][19]; roughly 30% of the patients are suspected to have persistent functional deficits when treated with non-operative treatment alone [1,9,20], while roughly 10%-20% have been reported to have unsatisfactory results with treatment with simple neurolysis [1,14,19]. Thus, predictive variables at the early phase of palsy would be of great value in determining the therapeutic approach because immediate neurolysis with tendon transfers result in better functional outcomes in patients with poor prognoses.…”

Polyarthritis and posterior interosseous nerve palsy associated with gastric carcinoma

“…He had a severe pain in his right arm, 2 weeks before the onset of the palsy. Electrodiagnostic evaluations were made, and isolated posterior interosseous nerve palsy (PINP) was conWrmed [9]. Magnetic resonance imaging of his right elbow showed no evidence of space-occupying lesion (tumour or severe synovitis).…”

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

“…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.…”