Surgical treatment of spontaneous posterior interosseous nerve palsy: A RETROSPECTIVE STUDY OF 50 CASES

• Published in: Journal of bone and joint surgery. British volume Vol. 93; no. 2; pp. 217 - 222
• Main Authors: OCHI, K, HORIUCHI, Y, TAZAKI, K, TAKAYAMA, S, NAKAMURA, T, IKEGAMI, H, MATSUMURA, T, TOYAMA, Y
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.02.2011
• Subjects: Adolescent; Adult; Age Factors; Aged; Biological and medical sciences; Diseases of the osteoarticular system; Forearm - innervation; Humans; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Paralysis - etiology; Paralysis - surgery; Peripheral Nervous System Diseases - etiology; Peripheral Nervous System Diseases - surgery; Retrospective Studies; Tendon Transfer; Treatment Outcome; Young Adult; Nervous system diseases; Treatment; Motor system disorder; Surgery; Orthopedics; Spontaneous; Interosseous nerve; Posterior; Paralysis; Neurological disorder
• ISSN: 0301-620X; 2044-5377
• DOI: 10.1302/0301-620X.93B2.24748

We have reviewed 38 surgically treated cases of spontaneous posterior interosseous nerve palsy in 38 patients with a mean age of 43 years (13 to 68) in order to identify clinical factors associated with its prognosis. Interfascicular neurolysis was performed at a mean of 13 months (1 to 187) after the onset of symptoms. The mean follow-up was 21 months (5.5 to 221). Medical Research Council muscle power of more than grade 4 was considered to be a good result. A further 12 cases in ten patients were treated conservatively and assessed similarly. Of the 30 cases treated surgically with available outcome data, the result of interfascicular neurolysis was significantly better in patients < 50 years old (younger group (18 nerves); good: 13 nerves (72%), poor: five nerves (28%)) than in cases > 50 years old (older group (12 nerves); good: one nerve (8%), poor: 11 nerves (92%)) (p < 0.001). A pre-operative period of less than seven months was also associated with a good result in the younger group (p = 0.01). The older group had a poor result regardless of the pre-operative delay. Our recommended therapeutic approach therefore is to perform interfascicular neurolysis if the patient is < 50 years of age, and the pre-operative delay is < seven months. If the patient is > 50 years of age with no sign of recovery for seven months, or in the younger group with a pre-operative delay of more than a year, we advise interfascicular neurolysis together with tendon transfer as the primary surgical procedure.