A Case of Posterior Interosseus Neuroapathy due to Intrasupinator Ganglion Mimicking Iatrogenic Injection Nerve Injury
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Posterior interosseus (PI) nerve compression is a rare form of compressive neuropathy. It can cause pain along the radial nerve course and weakness of radial nerve innervating muscles without sensory symptoms. A 65-year-old man visited our institution complaining weakness of finger extension and thumb abduction after 2 times of injections at the right elbow in local clinic. The patient’s clinical history and physical examination implied an iatrogenic radial nerve injury caused by the injection. The electrophysiologic study revealed of posterior interosseus neuropathy (PIN) with incomplete conduction block. However, the ultrasound study showed that the PI nerve was compressed by an anechoic cyst. The magnetic resonance imaging also confirmed of a ganglion cyst, not a hematoma. After repeated aspirations and a steroid injection, the electrophysiologic study showed recovery of motor weakness. Despite of the clue which implying an iatrogenic injury, clinician should consider other possibilities such as ganglion cysts and ultrasound guided aspiration and steroid injection could be an effective option for conservative management.
Abstract
Posterior interosseus (PI) nerve compression is a rare form of compressive neuropathy. It can cause pain along the radial nerve course and weakness of radial nerve innervating muscles without sensory symptoms. A 65-year-old man visited our institution complaining weakness of finger extension and thumb abduction after 2 times of injections at the right elbow in local clinic. The patient’s clinical history and physical examination implied an iatrogenic radial nerve injury caused by the injection. The electrophysiologic study revealed of posterior interosseus neuropathy (PIN) with incomplete conduction block. However, the ultrasound study showed that the PI nerve was compressed by an anechoic cyst. The magnetic resonance imaging also confirmed of a ganglion cyst, not a hematoma. After repeated aspirations and a steroid injection, the electrophysiologic study showed recovery of motor weakness. Despite of the clue which implying an iatrogenic injury, clinician should consider other possibilities such as ganglion cysts and ultrasound guided aspiration and steroid injection could be an effective option for conservative management.
참고문헌 (10)
- Redler LH, "Supinator Cyst in a Young Female Softball Player Successfully Treated With Aspiration", American journal of orthopedics, 44, pp.E235~E238 (2015)
- Walker FO, "Neuromuscular ultrasound : emerging from the twilight", Muscle & nerve, 43, pp.777~779 (2011)
- Bowen TL, "Posterior interosseous nerve paralysis caused by a ganglion at the elbow", The Journal of bone and joint surgery British volume, 48, pp.774~776 (1966)
- Steiger R, "Compression of the radial nerve caused by an occult ganglion. Three case reports", Journal of hand surgery, 23, pp.420~421 (1998)
- Ogino T, "Diagnosis of radial nerve palsy caused by ganglion with use of different imaging techniques", The Journal of hand surgery, 16, pp.230~235 (1991)
- Yamazaki H, "The two locations of ganglions causing radial nerve palsy", The Journal of hand surgery, European volume, 32, pp.341~345 (2007)
- Huisstede BM, "Interventions for treating the posterior interosseus nerve syndrome : a systematic review of observational studies", Journal of the peripheral nervous system : JPNS, 11, pp.101~110 (2006)
- Broomhead IW, "Ganglia associated with elbow and knee joints", Lancet, 269, pp.317~319 (1955)
- Pandian JD, "Nerve injuries following intramuscular injections : a clinical and neurophysiological study from Northwest India", Journal of the peripheral nervous system : JPNS, 11, pp.165~171 (2006)
- Gaur SC, "Radial nerve palsy caused by injections", Journal of hand surgery(Edinburgh, Scotland), 21, pp.338~340 (1996)