Share This Article:

Potential Compressive Sites of the Anterior Interosseous Nerve in the Proximal Forearm: An Anatomic Study

Abstract Full-Text HTML Download Download as PDF (Size:166KB) PP. 166-171
DOI: 10.4236/ojo.2012.24031    3,079 Downloads   5,123 Views  

ABSTRACT

Background: The etiology and treatment of spontaneous paralysis variants of anterior interosseous nerve (AIN) syndrome remains controversial. Variation and multiple sites of potential compression complicate the successful performance of neurolysis. This anatomic study of the AIN and sites of potential compression in the proximal forearm facilitates critical steps involved in neurolytic procedures and management. Methods: Upper extremities of twelve cadavers were examined to evaluate potential sites of AIN compression in the proximal forearm. Potential sites of musculoaponeurotic compression were evaluated, including: lacertus fibrosus; inferior fibrous arch of the humeral head of the pronator teres (PT) muscle; inferior fibrous arch of the ulnar head of the PT muscle; fibrous arch in the flexor digitorum superficialis (FDS) muscle; Gantzers muscle; and vascular structures near the AIN and median nerve. Results: The AIN arose at a mean distance of 54.5 mm distal to the elbow from the posterior (n = 9) or ulnar side (n = 3) of the median nerve. Relative positions of AIN branches were variable. A fibrous arch was found between the lacertus fibrosus and the PT in two cases. Nine cadavers had two fibrous arches in the PT and FDS, and three cadavers had one arch. An accessory head in the FDS was found to be a risk of AIN compression. Gantzer’s muscle was present in six cases, crossing the AIN superficially. Two potentially compressive vascular arches were identified. Conclusions: Our observations confirm that multiple musculoaponeurotic and/or vascular structures can contribute to AIN compression in the proximal forearm. Understanding the complex anatomic relationships of this nerve is crucial to improving outcomes of neurolysis in cases of non-regressive AIN paralysis.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

L. Mathieu, E. Simms, F. Rongiéras, E. Voiglio and C. Oberlin, "Potential Compressive Sites of the Anterior Interosseous Nerve in the Proximal Forearm: An Anatomic Study," Open Journal of Orthopedics, Vol. 2 No. 4, 2012, pp. 166-171. doi: 10.4236/ojo.2012.24031.

References

[1] A. J. Arenas, F. J. Artazcoz, A. Tejero and C. Arias, “Anterior Interosseous Nerve Injury Associated with a Monteggia Fracture-Dislocation,” The Acta Orthopaedica Belgica, Vol. 67, No. 1, 2001, pp. 77-80.
[2] D. J. Bamford and D. Stanley, “Anterior Interosseous Nerve Paralysis: An underdiagnosed Complication of Supracondylar Fracture of the Humerus in Children,” Injury, Vol. 20, No. 5, 1989, pp. 294-312.
[3] Y. Mirovsky, D. Hendel and N. Halperin, “Anterior Interosseus Nerve Palsy Following Closed Fracture of the Proximal Ulna,” Archives of Orthopaedic and Traumatic Surgery, Vol. 107, No. 1, 1988, pp. 61-64. doi:10.1007/BF00463528
[4] P. Keogh, H. Khan, E. Cooke and G. McCoy, “Loss of Flexor Pollicis Longus Function after Plating of the Radius: Report of Six Cases,” The Journal of Hand Surgery, Vol. 22B, No. 3, 1997, pp. 375-376. doi:10.1016/S0266-7681(97)80405-6
[5] L. I. Katolik and M. S. Cohen, “Anterior Interosseous Nerve Palsy after Open Capsular Release for Elbow Stiffness: Report of Two Cases,” The Journal of Hand Surgery, Vol. 34, No. 2, 2009, pp. 288-291.
[6] E. W. Kelly, B. F. Morrey and S. W. O’Driscoll, “Complications of Elbow Arthroscopy,” Journal of Bone & Joint Surgery, Vol. 83, No. 1, 2001, pp. 25-34.
[7] M. Sisco and G. A. Dumanian, “Anterior Interosseous Nerve Syndrome Following Shoulder Arthroscopy,” Journal of Bone & Joint Surgery, Vol. 89, No. 2, 2007, pp. 392-395. doi:10.2106/JBJS.F.00445
[8] D. B. O’Neill, B. Zarins, R. H. Gelberman, T. M. Keating and D. Louis, “Compression of the Anterior Interosseous Nerve after Use of a Sling for Dislocation of the Acromioclavicular Joint: A Report of Two Cases,” Journal of Bone & Joint Surgery, Vol. 72, No. 7, 1990, pp. 1100-1102.
[9] M. E. Puhaindran and H. P. Wong, “A case of Anterior Interosseous Nerve Syndrome after Peripherally Inserted Central Catheter (PICC) Line Insertion,” Singapore Medical Journal, Vol. 44, No. 12, 2003, pp. 653-655.
[10] M. J. Parsonage and J. W. A. Turner, “Neuralgic amyotrophy: The Shoulder-Girdle Syndrome,” Lancet, Vol. 251, No. 6513, 1948, pp. 973-978. doi:10.1016/S0140-6736(48)90611-4
[11] L. G. Kiloh and S. Nevin, “Isolated Neuritis of the Anterior Interosseous Nerve,” British medical journal, Vol. 1, No. 4763, 1952, pp. 850-851.
[12] C. B. Fearn and J. W. Goodfellow, “Anterior Interosseous Nerve Palsy,” Journal of Bone & Joint Surgery, Vol. 47B, No. 1, 1965, pp.91-93.
[13] E. B. Kaplan, M. Spinner, “The Anterior Interosseous Nerve Syndrome,” Journal of Bone & Joint Surgery, Vol. 50, No. 3, 1968, pp. 521-523.
[14] H. M. Englert, “Partielle Faszikul?re Medianus-Atrophie Unekl?rter Genese,” Handchirurgie, Vol. 8, 1976, pp. 61 -62.
[15] P. Haussmann and K. Kendel, “Oligofaszikulares Medianus-Compressions Syndrome,” Handchirurgie, Vol. 13, 1981, pp. 268-271.
[16] A. Nagano, K. Shibata, H. Tokimura, S. Yamamoto and Y. Tajiri, “Spontaneous Anterior Interosseous Nerve Palsy with Hourglass-Like Fascicular Constriction within the Main Trunk of the Median Nerve,” The Journal of Hand Surgery, Vol. 21A, No. 2, 1996, pp. 266-270.
[17] D. Ulrich, A. Piatkowski and N. Pallua, “Anterior Interosseous Nerve Syndrome: Retrospective Analysis of 14 Patients,” Archives of Orthopaedic and Traumatic Surgery, Vol. 131, No. 11, 2011, pp. 1561-1565. doi:10.1007/s00402-011-1322-5
[18] M. K. Sood and F. D. Burke, “Anterior Interosseous Nerve Palsy,” The Journal of Hand Surgery, Vol. 22, No. 1, 1997, pp. 64-68. doi:10.1016/S0266-7681(97)80020-4
[19] A. L. Dellon and S. E. Mackinnon, “Musculoaponeurotic Variations along the Course of the Median Nerve in the Proximal Forearm,” The Journal of Hand Surgery, Vol. 12, No. 3, 1987, pp. 359-363. doi:10.1016/0266-7681(87)90189-6
[20] C. S. Oh, I. H. Chung and K. S. Koh, “Anatomical Study of the Accessory Head of the Flexor Pollicis Longus and the Anterior Interosseous Nerve in Asians,” Clinical Anatomy, Vol. 13, No. 6, 2000, pp. 434-438.
[21] R. S. Tubbs, J. W. Custis, E. G. Salter, J. C. Wellons, J. P. Blount and W. J. Oakes, “Quantification of and Superficial Surgical Landmarks for the Anterior Interosseous Nerve,” Journal of Neurosurgery, Vol. 104, No. 5, 2006, pp. 787-791. doi:10.3171/jns.2006.104.5.787
[22] F. Canovas, P. Mouilleron and F. Bonnel, “Biometry of the Muscular Branches of the Median Nerve to the Forearm,” Clinical Anatomy, Vol. 11, No. 4, 1998, pp. 239-245.
[23] P. Seror, “Anterior Interosseous Nerve Lesions: Clinical and Electrophysiological Features,” Journal of Bone & Joint Surgery, Vol. 78B, No. 2, 1996, pp. 238-241.
[24] D. H. Kim, J. A. Murovic, Y. Y. Kim and D. G. Kline, “Surgical Treatment and Outcomes in 15 Patients with Anterior Interosseous Nerve Entrapments and Injuries,” Journal of Neurosurgery, Vol. 104, No. 5, 2006, pp. 757-765. doi:10.3171/jns.2006.104.5.757
[25] R. K. Johnson, M. Spinner and M. M. Shrews, “Median Nerve Entrapment in the Proximal Forearm,” The Journal of Hand Surgery, Vol. 19, No. 1, 1979, pp. 48-51.
[26] M. M. Pai, S. R. Nayak, A. Krishnamurthy, R. Vadgaonkar, L. V. Prabhu, A. V. Ranade, J. P. Janardhan and R. Rai, “The Accessory Head of Flexor Pollicis Longus and Flexor Digitorum Profundus: Incidence and Morphology,” Clinical Anatomy, Vol. 21, No. 3, 2008, pp. 252-258. doi:10.1002/ca.20612
[27] R. A. Bergman, A. K. Afifi and R. Mlyauchi, “Illustrated Encyclopedia of Human Anatomic Variation, Opus I: Muscular System: Alphabetical Listing of Muscles: F,” 2007. www.anatomyatlases.org/AnatomicVariants/MuscularSystem/Text/F/22Flexor.shtml
[28] U. Mangini, “Flexor Pollicis Longus Muscle: Its Morphology and Clinical Significance,” Journal of Bone & Joint Surgery, Vol. 42, No. 3, 1960, pp. 467-470.
[29] P. Mahakkanukrauh, P. Surin, N. Ongkana, M. Sethadavit, P. Vaidhayakarn, “Prevalence of Accessory Head of Flexor Pollicis Longus Muscle and Its Reltion to Anterior Interosseous Nerve in Thai Population,” Clinical Anatomy, Vol. 17, No. 8, 2004, pp.631-635. doi:10.1002/ca.20016
[30] A. Nagano, “Spontaneous Anterior Interosseous Nerve Palsy,” Journal of Bone & Joint Surgery, Vol. 85B, No. 3, 2003, pp. 313-318. doi:10.1302/0301-620X.85B3.14147
[31] F. Duteille, B. Amara, G. Dautel and M. Merle, “Atteinte Isolée Du Long Fléchisseur Du Pouce Dans Le Syndrome Du Nerf Inter-Osseux Antérieur,” Revue De Chirurgie Orthopedique, Vol. 86, 2000, pp. 306-309.
[32] C. O. Werner, “The Anterior Interosseous Nerve Syndrome,” International Orthopaedics, Vol. 13, No. 3, 1989, pp. 193-197. doi:10.1007/BF00268047
[33] T. Omura, A. Nagano, H. Murata, M. Takahashi, H. Ogihara and K. Omura, “Simultaneous Anterior and Posterior Interosseous Nerve Paralysis with Several Hourglass-Like Fascicular Constrictions in the Both Nerves,” The Journal of Hand Surgery, Vol. 26A, No. 6, 2001, pp. 1088-1092.

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.