Posterior Interosseous Nerve Compression in the Forearm, AKA Radial Tunnel Syndrome: A Clinical Diagnosis

J. Megan M. Patterson, Manuel A. Medina, Alexander Yang, Susan E. Mackinnon

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Posterior interosseous nerve (PIN) compression in the forearm without motor paralysis is a challenging clinical diagnosis. This retrospective study evaluated the clinical assessment, diagnostic studies, and outcomes following surgical decompression of the PIN in the forearm. Methods: This study reviewed 182 patients’ medical charts following PIN decompression between 2000 and 2020 by a single surgeon. After exclusion of combined nerve entrapments, polyneuropathy, motor palsy, or lateral epicondylitis, the study included 14 patients. Data collected included: clinical presentation and pain drawings, provocative testing, functional outcomes, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Results: There were 15 PIN decompressions (14 patients, mean follow-up = 11.9 months). Clinical presentation included pain (n = 14) (proximal dorsal forearm, n = 14; distal forearm over radial sensory nerve, n = 3) and positive clinical tests (sensory collapse test over the radial tunnel, n = 8; pain with forearm pronation and compression over the radial tunnel, n = 10; Tinel sign, n = 5). Postoperatively, there were significant improvements in Visual Analog Scale pain scores (6.7 to 3.3, P =.0006), quality-of-life scores (74.7 to 32.7, P =.0001), and DASH scores (46.3 to 33.6, P =.02). Conclusions: The PIN compression in the forearm without motor paralysis is a clinical diagnosis supported by pain drawings, pain quality, and provocative tests. Patients with persistent, therapy-resistant dorsal forearm pain should be evaluated for PIN compression. Surgical decompression provides statistically significant quantifiable improvement in pain and quality of life.

Original languageEnglish
JournalHand
DOIs
StateAccepted/In press - 2022

Keywords

  • anatomy
  • diagnosis
  • forearm
  • nerve
  • nerve compression
  • peripheral neuropathies
  • posterior interosseous nerve
  • radial nerve
  • radial tunnel

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