The Fate of Anterior Interosseous Nerve Syndrome

Myung-Jae Yoo; Hee-Chan Ahn; Jae-Sung Seo; Sang-Hyun Woo

doi:10.12790/jkssh.2017.22.1.49

Journal List > J Korean Soc Surg Hand > v.22(1) > 1106578

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Yoo, Ahn, Seo, and Woo: The Fate of Anterior Interosseous Nerve Syndrome

Original Article

Journal of the Korean Society for Surgery of the Hand 2017; 22(1): 49-56.

Published online: 30 March 2017

DOI: https://doi.org/10.12790/jkssh.2017.22.1.49

The Fate of Anterior Interosseous Nerve Syndrome

Myung-Jae Yoo, Hee-Chan Ahn, Jae-Sung Seo, Sang-Hyun Woo

W Institute for Hand and Reconstructive Microsurgery, W Hospital, Daegu, Korea.

Correspondence to: Sang-Hyun Woo. W Institute for Hand and Reconstructive Microsurgery, W Hospital, 1632 Dalgubeol-daero, Dalseo-gu, Daegu 42642, Korea. TEL: +82-53-550-5000, FAX: +82-53-550-4000, handwoo@hotmail.com

Received 11 December 2016 Revised 16 January 2017 Accepted 16 January 2017

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We report the causes and prognosis of anterior interosseous nerve syndrome (AIN) according to the treatment.

Methods

From March 2009 to December 2015, the 20 patients with the clinical symptom of AIN syndrome were enrolled in the study and electromyography (EMG) of AIN was performed. We retrospectively reviewed hand function test, active range of motion, the disabilities of the arm, shoulder and hand (DASH) score and EMG during the recovery from disease. We further surveyed the time of recovery and residual symptoms.

Results

The patients with unknown cause of the disease (12 cases), heavy work or trauma (6 cases) and infection (2 cases) were investigated in the study. Thirteen out of 15 cases with conservative treatment and 2 out of 5 cases with a surgical treatment at an average of 8 months from disease were recovered. In addition, 8 cases with fine motor disturbance and 3 cases with tingling residual symptom were observed.

Conclusion

Due to the low possibility of entrapment neuropathy, conservative treatment for 7 months is the first choice rather than surgical treatment. If there is no improvement from the conservative treatment, surgical exploration of AIN is the indication of treatment. After recovery, patients may have the symptoms of fine motor disturbance and tingling.

Keywords: Anterior interosseous nerve, Neuritis, Nerve compression syndrome

Figures and Tables

Fig. 1

In 12th case, a 53-year-old man hurt by conveyer belt could not flex interphalangeal joint of thumb and distal interphalangeal joint of index finger in right hand. (A) When he visited the out-patient clinic, he didn't make an ‘O’ sign in the right hand. The power of interphalangeal joint of thumb and distal interphalangeal joint of index finger was decreased. (B) His electromyography test showed weakness of flexor pollicis longus of thumb, flexor digitorum profundus of index finger and pronator quadratus. (C) Magnetic resonance axial images showed high signal intensity of edema in flexor pollicis longus of thumb, flexor digitorum profundus of index finger and pronator quadratus. AIN was also swollen. (D) He took an operation at 3 months. During operation, the finding was swelled anterior interosseous nerve. After operation, he recovered at 9 months. Ins Act., insertional activities; Fibs., fibrillation; Pos. Wave, positive wave; Low Amp., low amplitude; High Amp., high amplitude; Dur, duration; Int. Patt., interference pattern; Flex. Carpi Radialis, flexor carpi radialis; Flex. Carpi Ulnaris, flexor carpi ulnaris; Flex. Digitorum Pro, flexor digitorum profundus; Flex. Pollicis Longus, flexor pollicis longus; Abduc. Digiti Minimi, abductor digiti minimi; Abduc. Pol. Brevis, abductor pollicis brevis; FPL, flexor pollicis longus of thumb; 2nd FDP, flexor digitorum profundus of index finger of index finger; PQ, pronator quadratus; AIN, anterior interosseous nerve syndrome.

Fig. 2

In 4th case, a 26-year-old man could not flex interphalangeal joint of thumb and distal interphalangeal joint of index finger in left hand after lifting heavy object. (A) When he visited the out-patient clinic, he didn't make an ‘O’ with the thumb and index finger in the left hand. (B) He started to recovery at 4 months from symptom. After 14 months, when he visited, he could flex the recovered power of thumb interphalangeal joint and index distal interphalangeal joint flexion.

Table 1

Demographics of the patients with AIN and treatment

AIN, anterior interosseous nerve syndrome; F, female; Rt., right; FPL, flexor pollicis longus of thumb; 2nd FDP, flexor digitorum profundus of index finger of index finger; M, male; Lt., left.

Table 2

The clinical results of cases with conservative treatment

Pinch, pinch meter (lb); Grip, dynamometer (lb); DASH, the disabilities of the arm, shoulder and hand; ROM, active range of motion; T, flexor pollicis longus of thumb; I, flexor digitorum profundus of index finger.

p<0.005, Wilcoxon signed-rank test.

Table 3

The clinical results of cases with surgical treatment

p<0.005, Wilcoxon signed-rank test.

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