Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Posterior Interosseous Nerve Palsy Caused by a Ganglion of the Arcade of Frohse

  • Lee, Seung Jin (Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Hyun, Yoon Suk (Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Baek, Seung Ha (Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Seo, Ji Hyun (Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Kim, Hyun Ho (Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center)
  • Received : 2018.09.10
  • Accepted : 2018.10.22
  • Published : 2018.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

A 51-year-old male who is right-handed visited the outpatient for right fingers-drop. The patient's fingers, including thumb, were not extended on metacarpophalangeal joint. The active motion of the right wrist was available. The electromyography and nerve conduction velocity study were consistent with the posterior interosseous neuropathy. Further evaluation was done with the magnetic resonance imaging for finding the space-occupying lesion or any possible soft tissue lesion around the radial nerve pathway. On magnetic resonance imaging, the ganglion cyst, which was about 1.8 cm in diameter, was observed on the proximal part of the superficial layer of the supinator muscle (Arcade of Frohse). The surgical excision was done on the base of ganglion cyst at the base of stalk of cyst which looked to be connected with proximal radioulnar joint capsule. The palsy had completely resolved when the patient was observed on the outpatient department a month after the operation.

Keywords

GJGJB6_2018_v21n4_252_f0001.png 이미지

Fig. 1. (A) Sagittal T2-weighted magnetic resonance imaging (MRI) shows well-defined hyperintense cystic mass consistent with ganglion overlying the proximal radius. (B) Axial T2-weighted MRI shows well-defined hyperintense cystic mass consistent with ganglion overlying the proximal radius (arrow: ganglion stalk). (C) Two serial axial T1-weighted MRI images show posterior interosseous nerve (PIN) compression by ganglion (arrows: PIN, solid lines: ganglion cyst, arrowheads: supinator muscle).

GJGJB6_2018_v21n4_252_f0002.png 이미지

Fig. 2. (A) Brachioradialis is retracted with ragnell retractor and common extensors are retracted with Volkmann retractor (4 prong) (arrow: Arcade of Frohse, solid line: posterior interosseous nerve under the cyst, arrowhead: direction of stalk). (B) Ganglion cyst was excised at the base of the stalk of the cyst which seemed to be connected to the proximal radioulnar joint capsule.

References

  1. Bowen TL, Stone KH. Posterior interosseous nerve paralysis caused by a ganglion at the elbow. J Bone Joint Surg Br. 1966; 48(4):774-6.
  2. Hashizume H, Nishida K, Nanba Y, Shigeyama Y, Inoue H, Morito Y. Non-traumatic paralysis of the posterior interosseous nerve. J Bone Joint Surg Br. 1996;78(5):771-6.
  3. McCollam SM, Corley FG, Green DP. Posterior interosseous nerve palsy caused by ganglions of the proximal radioulnar joint. J Hand Surg Am. 1988;13(5):725-8. https://doi.org/10.1016/S0363-5023(88)80134-5
  4. Seki Y. Posterior interosseous nerve palsy caused by a ganglion: conservative treatment with ultrasound-guided needle aspiration. J Ultrason. 2017;17(68):73-5. https://doi.org/10.15557/JoU.2017.0010
  5. Jou IM, Wang HN, Wang PH, Yong IS, Su WR. Compression of the radial nerve at the elbow by a ganglion: two case reports. J Med Case Rep. 2009;3:7258. https://doi.org/10.4076/1752-1947-3-7258
  6. Tonkin MA. Posterior interosseous nerve axonotmesis from compression by a ganglion. J Hand Surg Br. 1990;15(4):491-3. https://doi.org/10.1016/0266-7681(90)90100-I
  7. Mak WY. A rare cause of compression neuropathy of upper limbs - ganglionic cysts. J Orthop Trauma Rehabil. 2013;17(1): 30-2. https://doi.org/10.1016/j.jotr.2012.04.007
  8. Kim YM, Kim DS, Choi ES, et al. Incomplete compressive neuropathy of posterior interosseous nerve caused by ganglion: a case report. J Korean Soc Surg Hand. 2009;14(1):28-32.
  9. Latinovic R, Gulliford MC, Hughes RA. Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry. 2006;77(2):263-5. https://doi.org/10.1136/jnnp.2005.066696
  10. Moradi A, Ebrahimzadeh MH, Jupiter JB. Radial tunnel syndrome, diagnostic and treatment dilemma. Arch Bone Jt Surg. 2015;3(3):156-62.
  11. Ogino T, Minami A, Kato H. Diagnosis of radial nerve palsy caused by ganglion with use of different imaging techniques. J Hand Surg Am. 1991;16(2):230-5.
  12. Hermansdorfer JD, Greider JL, Dell PC. A case report of a compressive neuropathy of the radial sensory nerve caused by a ganglion cyst at the elbow. Orthopedics. 1986;9(7):1005-6.
  13. Harshavardhana NS. Comprehensive review of isolated posterior interosseous nerve palsy. Orthop Surg Traumatol. 2017; 1(5):182-94.
  14. Yamazaki H, Kato H, Hata Y, Murakami N, Saitoh S. The two locations of ganglions causing radial nerve palsy. J Hand Surg Eur Vol. 2007;32(3):341-5. https://doi.org/10.1016/J.JHSB.2006.09.014
  15. Jang HS, Lee YH. Radial nerve neuropathy. J Korean Med Assoc. 2017;60(12):958-62. https://doi.org/10.5124/jkma.2017.60.12.958
  16. Cho TK, Kim JM, Bak KH, Kim CH. Posterior Interosseous Nerve(PIN) syndrome caused by anomalous vascular leash. J Korean Neurosurg Soc. 2005;37(4):293-5.