The accuracy of distal posterior interosseous and anterior interosseous nerve injection

Grutter, Paul W.; DeSilva, Gregory L.; Meehan, Robert E.; DeSilva, Stephen P.

doi:10.1016/j.jhsa.2004.05.012

Cited by 19 publications

(21 citation statements)

References 14 publications

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“…[1][2][3]6,8 Multiple anatomic studies have elucidated the distal anatomy of the posterior interosseous nerve because of its importance as a pain mediator in dorsal wrist pain syndromes and its surgical relevance for wrist denervation procedures. [3][4][5][6]9 Shortly after exiting the distal supinator, the posterior interosseous nerve typically divides into 6 branches arranged ulnar to radial, which course in the dorsal forearm compartment.…”

Section: Original Researchmentioning

confidence: 99%

“…9 This terminal division of the nerve eventually enters the radial side of the fourth wrist dorsal extensor compartment, coursing deep to the extensor digitorum and extensor indicis proprious tendons before arborizing into multiple branches, which innervate the dorsal wrist capsuloligamentous structures ( Figure 1). 1,3,6,[9][10][11] Although the posterior interosseous nerve is generally 1 to 3 mm in diameter in the fourth dorsal compartment, it may enlarge by several millimeters as part of a distal swelling referred to as "Acrel's ganglion." 3,10 The etiology and function of Acrel's ganglion remain indeterminate, but recent histologic studies have shown that it does not contain nerve cell bodies and is therefore not a true ganglion.…”

Section: Original Researchmentioning

confidence: 99%

“…In 10 of the cadaveric specimens, the primary author also completed a sonographically guided injection into the presumed posterior interosseous nerve using diluted yellow latex. 1 The cadaveric hand was placed in a prone position, and the fourth dorsal extensor compartment tendons were visualized using an anatomic transverse view, short axis to the tendons. Injections were completed with a 25-gauge, 38-mm stainless steel needle using an in-plane (long-axis) approach.…”

Section: General Designmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Regardless of etiology, pain mediation via the terminal branches of the posterior interosseous nerve appears to play an important role in the clinical syndrome of dorsal wrist pain. 2,3,8 Consequently, complete or partial wrist denervation has been used as palliative treatment of chronic dorsal wrist pain when curative or reconstructive procedures are not feasible.…”

mentioning

confidence: 99%

“…In the latter case, sonographically guided percutaneous ablation of the nerve could be used in selected patients as an alternative to open surgical partial wrist denervation. [1][2][3] …”

mentioning

confidence: 99%

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Sonographic Appearance of the Posterior Interosseous Nerve at the Wrist

Smith

Rizzo

Finnoff

et al. 2011

Journal of Ultrasound in Medicine

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hronic dorsal wrist pain is a disabling clinical problem that may result from a variety of pathoetiologic processes, including arthritis, instability, capsular injury, dorsal wrist ganglia, and neuroma formation. [1][2][3][4][5][6][7] Regardless of etiology, pain mediation via the terminal branches of the posterior interosseous nerve appears to play an important role in the clinical syndrome of dorsal wrist pain. 2,3,8 Consequently, complete or partial wrist denervation has been used as palliative treatment of chronic dorsal wrist pain when curative or reconstructive procedures are not feasible. 2,3,6,8 Whereas complete wrist denervation requires multiple Jay Smith, MD, Marco Rizzo, MD, Jonathan T. Finnoff, DO, Yusef A. Sayeed, MD, MPH, MEng, Johan Michaud, MD, Carlo Martinoli, MD Received March 2, 2011, from ORIGINAL RESEARCHObjectives-The purpose of this study was to determine whether sonography can identify the distal posterior interosseous nerve at the wrist.Methods-On the basis of previous anatomic descriptions, high-resolution musculoskeletal sonography was used in an attempt to identify the distal posterior interosseous nerve in the wrists of 20 unembalmed cadaveric specimens (11 male and 9 female; ages 54-98 years). High-frequency scanning (17-5 MHz) of the fourth dorsal extensor compartment revealed a small (1-3 mm) hypoechoic structure located on the compartment floor, presumed to represent the posterior interosseous nerve. Electronic calipers measured the distance between Lister's tubercle and this structure, as well as the structure's radial-ulnar width and volar-dorsal height. The presumed posterior interosseous nerves of 10 specimens were then injected with diluted colored latex using sonographic guidance. Subsequent dissection definitively identified the sonographically visualized and injected structure.Results-Dissection revealed latex within the posterior interosseous nerve in all 10 injected specimens, thus confirming that the sonographically visualized structure represented the distal posterior interosseous nerve. The nerve was identified sonographically in all 20 examined specimens, was located an average of 4.88 mm (range, 2.10-10.0 mm) ulnar to Lister's tubercle, and had an average width and height of 2.35 mm (range, 1.20-3.50 mm) and 1.01 mm (range, 0.80-1.40 mm), respectively.Conclusions-High-resolution sonography can reliably identify the distal posterior interosseous nerve within the fourth dorsal extensor compartment. Clinicians should consider formal evaluation of the posterior interosseous nerve in patients presenting with dorsal wrist pain syndromes. Future investigations should explore the potential role of sonographically guided percutaneous procedures directed at the posterior interosseous nerve.

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Section: Original Researchmentioning

confidence: 99%

Section: Original Researchmentioning

confidence: 99%

Section: General Designmentioning

confidence: 99%

mentioning

confidence: 99%

“…In the latter case, sonographically guided percutaneous ablation of the nerve could be used in selected patients as an alternative to open surgical partial wrist denervation. [1][2][3] …”

mentioning

confidence: 99%

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Sonographic Appearance of the Posterior Interosseous Nerve at the Wrist

Smith

Rizzo

Finnoff

et al. 2011

Journal of Ultrasound in Medicine

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Central Wrist Denervation

Dellon

2019

Joint Denervation

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Comment on “The Diagnostic Utility of Midcarpal Anesthetic Injection in the Evaluation of Chronic Wrist Pain.”

Freeland

2007

Hand (New York, N,Y.)

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The authors have proposed midcarpal injection of lidocaine as a diagnostic test to determine the presence or absence of intracarpal pathology in patients with chronic wrist pain and normal routine wrist x-rays by evaluating grip strength and pain relief after injection. The reference standard (the essential lesion) was the presence of intracarpal pathology on arthroscopic evaluation of the wrist. A 6-kg (28%) improvement of grip strength had 73% sensitivity (the proportion of patients with the disorder in whom the test result was positive) and 70% specificity (the proportion of patients without the disorder in whom the test results were negative) in association with arthroscopic evidence of intracarpal pathology. Tests with high sensitivities are useful for ruling out disease. Tests with high specificities are useful for ruling in disease. Likelihood ratios might provide more effective interpretation of diagnostic clinical tests than sensitivity and specificity values. [2,3] Pain relief in this report did not correlate with intracarpal pathology and was therefore not considered a diagnostic discriminator.

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The accuracy of distal posterior interosseous and anterior interosseous nerve injection

Cited by 19 publications

References 14 publications

Sonographic Appearance of the Posterior Interosseous Nerve at the Wrist

Sonographic Appearance of the Posterior Interosseous Nerve at the Wrist

Central Wrist Denervation

Comment on “The Diagnostic Utility of Midcarpal Anesthetic Injection in the Evaluation of Chronic Wrist Pain.”

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