HSS Journal ®

, Volume 8, Issue 2, pp 184–189

Posterior Interosseous Neuropathy: Electrodiagnostic Evaluation

  • Anna-Christina Bevelaqua
  • Catherine L. Hayter
  • Joseph H. Feinberg
  • Scott A. Rodeo
Electrodiagnostic Corner


Electrodiagnostic studies are used to anatomically localize nerve injuries. These tests help differentiate between cervical radiculopathies, brachial plexopathies, and peripheral nerve injuries. They also help to identify or rule out other underlying neurological diseases and disorders. In this case report, a 22-year-old male swimmer presented with left finger extensor weakness following pull-up exercises. Left wrist extension remained intact. Electrodiagnostic testing revealed a severe but incomplete posterior interosseous neuropathy. Magnetic resonance imaging confirmed inflammation of the nerve in the forearm. Posterior interosseous neuropathy is an uncommon but well-studied condition. Typically, this condition presents with weakness in finger and thumb extension with preserved wrist extension as the extensor carpi radialis longus is innervated proximal to the site of nerve compression in most cases. It is important to understand the anatomic course and distribution of the radial nerve in order to make an accurate diagnosis. Once the anatomy is understood, electrodiagnostic testing may be used to identify the location of nerve injury and exclude other disorders.


posterior interosseous nerve nerve injury electromyography (EMG) electrodiagnostics finger extension weakness 


  1. 1.
    Akuthota V., Herring SA. Nerve and vascular injuries in sports medicine. Springer, New York. 2009: 79–81Google Scholar
  2. 2.
    Bayramoglu M. Entrapment neuropathies of the upper extremity. Neuroanatomy. 2004, 3: 18–24.Google Scholar
  3. 3.
    Braddom, RL. Physical medicine and rehabilitation. Elsevier Science, Saunders, 3rd Edition, Philadelphia. 2007: 211–212.Google Scholar
  4. 4.
    Brown, WF, Bolton CF, Aminoff MJ. Neuromuscular function and Disease. Basic, clinical, and electrodiagnostic aspects. Volume 1. Elsevier Science, Saunders, Philadelphia. 2002: 924–926.Google Scholar
  5. 5.
    Cho CH, Lee KJ, Min BW. Tardy posterior interosseous nerve palsy resulting from residual dislocation of the radial head in a Monteggia fracture: a case report. Journal of Medical Case Reports. 2009; 3:9300.PubMedCrossRefGoogle Scholar
  6. 6.
    Cho TK, Kim JM, Bak KH, Kim CH. Posterior interosseous nerve (PIN) syndrome caused by anomalous vascular leash. J Korean Neurosurgery. 2005; 37:293–295.Google Scholar
  7. 7.
    Dang AC, Rodner CM. Unusual compression neuropathies of the forearm, part II: median nerve. J Hand Surg. 2009;34A:1915–1920Google Scholar
  8. 8.
    Dhall U, Kanta S. Variations in the nerve supply to extensor carpi radialis brevis. J Ant Soc India. 2001; 50(2). 134–136.Google Scholar
  9. 9.
    Dickerman R.D, Stevens Q.E.J., Cohen A.J., Jaikumar S. Radial tunnel syndrome in an elite power athlete: a case of direct compressive neuropathy. Journal of the Peripheral Nervous System. 2002; 4: 229–232.CrossRefGoogle Scholar
  10. 10.
    Hazani R, Engineer N J, Mowlavi A, Neumeister M, Lee A, Wilhelmi BJ. Anatomic Landmarks for the Radial Tunnel. Eplasty. 2004; 8: 377–382.Google Scholar
  11. 11.
    Kirichi Y., Irmak M.K. Investigation of two possible compression sites of the deep branch of the radial nerve and the nerve supply of the extensor carpi radialis brevis muscle. Neurol Med Chir (Tokyo) 2004; 44: 14–19.CrossRefGoogle Scholar
  12. 12.
    Kromberg A.J., Pestronk A. Chronic motor neuropathies: diagnosis, therapy, and pathogenesis. Annals of Neurology. 1995: 37(1): 43–50.CrossRefGoogle Scholar
  13. 13.
    Latinovic R, Gulliford MC, Hughes RAC. Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry. 2006; 77:263–265PubMedCrossRefGoogle Scholar
  14. 14.
    Loh YC, Lam WL, Stanley JK, Soames RW. A new clinical test for radial tunnel syndrome: the rule of nine test: a cadaveric study. J Orthop Surg (Hong Kong) 2004: 12(1): 83–86.Google Scholar
  15. 15.
    McCarty E.C, Tsairis P., Warten R.F. Brachial neuritis. Clinical Orthopedics and Related Research. 1999; 368: 37–42.CrossRefGoogle Scholar
  16. 16.
    Miclan A, Ozge A, Sahin G, Saracoglu M, Kuyurtar F. The role of electrophysiologic tests in the early diagnosis of posterior interosseous neuropathy in patients thought to have lateral epicondylitis.Acta Orthop Traumatol Turc 2004; 38(5): 326–329.Google Scholar
  17. 17.
    Molina A.E.P, Bout C., Oberline C., Nzeusseu A., Vanwijk R. The posterior interosseous nerve and the radial tunnel syndrome: an anatomical study. International Orthopaedics. 1998; 22: 102–106.CrossRefGoogle Scholar
  18. 18.
    Monteiro E., Moura A., Barros F., Carvalho P. Lipoma causing a posterior interosseous nerve syndrome. European Journal Plastic Surgery. 2002; 25: 35–37.CrossRefGoogle Scholar
  19. 19.
    Mulholland R.C. Non-traumatic progressive paralysis of the posterior interosseous nerve. Journal of Bone and Joint Surgery. 1966; 48B, No. 4: 781–785.Google Scholar
  20. 20.
    Planchier KD, Peterson RK, Steichen JB. Compressive neuropathies and tendinopathies in the athletic elbow and wrist. Clin Sports Med 1996;15(2):331–71.Google Scholar
  21. 21.
    Prasartritha T., Prasert L., Rohanakit A., A study of the posterior interosseous nerve (PIN) and the radial tunnel in 30 Thai cadavers. The Journal of Hand Surgery. 1993; 18A:107–12.CrossRefGoogle Scholar
  22. 22.
    Ragoonwansi R., Kirkpatrick NW, Moss ALH. Posterior interosseous nerve palsy after intravenous cannulation of the forearm. Journal of the Royal Society of Medicine. 1999; 92: 411.Google Scholar
  23. 23.
    Roles NC, Maudsley RH: Radial tunnel syndrome: resistant tennis elbow as a nerve entrapment, Journal of Bone and Joint Surgery. 1972; 54B(3): 499–508.Google Scholar
  24. 24.
    Rosenbaum R. Disputed radial tunnel syndrome. Muscle and Nerve. 1999; 22: 960–967.PubMedCrossRefGoogle Scholar
  25. 25.
    Russel SM. (2006) Examination of peripheral nerve injuries: An anatomical approach. Thieme Medical Publishers, New York. 2006: 62–64.Google Scholar
  26. 26.
    Siegel IM. Dorsal interrosseous nerve compression syndrome from the use of a Canadian crutch. Muscle Nerve. 1988. 11 (12):1273–1274.PubMedGoogle Scholar
  27. 27.
    Spinner M. The arcade of Frohse and its relationship to posterior interosseous nerve paralysis. The Journal of Bone and Joint Surgery. 1968; 50B: 809–812.Google Scholar
  28. 28.
    Sunderamoorthy D, Chaudhury M. An uncommon peripheral nerve injury after penetrating injury to the forearm: the importance of clinical examination. Emerg Med Journal. 2003; 20: 565–566.CrossRefGoogle Scholar
  29. 29.
    Werner CO, Haeffner F., Rosen I. Direct recording of local pressure in the radial tunnel during passive stretch and active contraction of the supinator muscle. Archives of Orthopaedic and Traumatic Surgery. 1980; 96: 299–301.CrossRefGoogle Scholar
  30. 30.
    Werner CO. Paralysis of the posterior interosseous nerve caused by tumour: brief report. The Journal of Bone and Joint Surgery. 1987; 69 B(4): 670–671.Google Scholar
  31. 31.
    White SH, Goodfellow JW, Mowat A. Posterior interosseous nerve palsy in rheumatoid arthritis. J Bone Joint Surg Br. 1988. 70B (3): 468–471.Google Scholar
  32. 32.
    Vreiling C., Robinson P.H., Geertzen, J.H.B. Posterior interosseous nerve syndrome: literature review and report of 14 cases. Eur J Plast Surg. 1998; 21: 196–202.CrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2012

Authors and Affiliations

  • Anna-Christina Bevelaqua
    • 1
  • Catherine L. Hayter
    • 2
  • Joseph H. Feinberg
    • 2
  • Scott A. Rodeo
    • 2
  1. 1.Department of Physical Medicine and RehabilitationNew York Presbyterian HospitalNew YorkUSA
  2. 2.Hospital for Special SurgeryNew YorkUSA

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