Skeletal Radiology

, Volume 36, Issue 12, pp 1155–1162 | Cite as

MR imaging findings of anterior interosseous nerve lesions

  • Andrew J. DunnEmail author
  • David C. Salonen
  • Dimitri J. Anastakis
Scientific Article



To study and characterise the MR imaging findings of lesions of the anterior interosseous nerve (AIN).

Materials and methods

Magnetic resonance imaging (MRI) findings of the forearm of ten patients referred to our institution with suspected AIN lesions were retrospectively studied. Five healthy volunteers with normal forearm MRI findings formed a control group. Two musculoskeletal radiologists assessed the forearm musculature for oedema in the distribution of the AIN, median, posterior interosseous and radial nerves on T2-weighted (T2W) fat-saturated sequences. T1-weighted (T1W) images were assessed and graded for the presence of muscle atrophy and fatty involution.


Six patients had undergone surgical exploration; five of these had surgically confirmed AIN compression. Four patients had diagnoses other than AIN compression made on imaging features. Of the cases of proven AIN compression, oedema within the pronator quadratus (PQ) muscle was identified in all cases. PQ atrophy and fatty involution were seen in three (43%) surgically confirmed cases. Cases 2 and 3 also demonstrated oedema in the flexor digitorum profundus (FDP)1 and FDP2 muscles. These cases also showed oedema in the flexor-carpi radialis (FCR) and FDP3/FDP4 muscles, respectively. The four cases of non-AIN compression demonstrated muscle oedema patterns that were atypical for the AIN distribution. They included a rupture of the flexor pollicis longus (FPL) tendon, brachial neuritis, amyotrophic lateral sclerosis and compression of the proximal median nerve.


MRI is a useful investigation in the diagnostic workup of AIN syndrome. AIN syndrome is likely when there is diffuse oedema of AIN innervated muscles on T2W fat-saturated images. The most reliable sign of an AIN lesion is oedema within the PQ. Oedema in the flexor carpi radialis, FDP3 and FDP4, although not in the classical distribution of the AIN, does not preclude the diagnosis of AIN syndrome.


Magnetic resonance imaging Anterior interosseous nerve Lesions 


  1. 1.
    Bendszus M, Koltzenburg M. Visualization of denervated muscle by gadolinium-enhanced MRI. Neurology 2001; 57: 1709–1711.PubMedGoogle Scholar
  2. 2.
    Elsayes KM, Shariff A, Staveteig PT, Mukundan G, Khosla A, Rubin DA. Value of magnetic resonance imaging for muscle denervation syndromes of the shoulder girdle. J Comput Assist Tomogr 2005; 29: 326–329.PubMedCrossRefGoogle Scholar
  3. 3.
    Meyer DC, Pirkl C, Pfirrmann CW, Zanetti M, Gerber C. Asymmetric atrophy of the supraspinatus muscle following tendon tear. J Orthop Res 2005; 23: 254–258.PubMedCrossRefGoogle Scholar
  4. 4.
    Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part II: abnormalities of the ligaments, tendons, and nerves. Skeletal Radiol 2005; 34: 1–18.PubMedCrossRefGoogle Scholar
  5. 5.
    Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part I: normal anatomy, imaging technique, and osseous abnormalities. Skeletal Radiol 2004; 33: 685–697.PubMedCrossRefGoogle Scholar
  6. 6.
    Martinoli C, Bianchi S, Pugliese F, et al. Sonography of entrapment neuropathies in the upper limb (wrist excluded). J Clin Ultrasound 2004; 32: 438–450.PubMedCrossRefGoogle Scholar
  7. 7.
    Koltzenburg M, Bendszus M. Imaging of peripheral nerve lesions. Curr Opin Neurol 2004; 17: 621–626.PubMedCrossRefGoogle Scholar
  8. 8.
    Bendszus M, Koltzenburg M, Wessig C, Solymosi L. Sequential MR imaging of denervated muscle: experimental study. AJNR Am J Neuroradiol 2002; 23: 1427–1431.PubMedGoogle Scholar
  9. 9.
    Chien AJ, Jamadar DA, Jacobson JA, Hayes CW, Louis DS. Sonography and MR imaging of posterior interosseous nerve syndrome with surgical correlation. AJR Am J Roentgenol 2003; 181: 219–221.PubMedGoogle Scholar
  10. 10.
    Pecina M, Boric I, Anticevic D. Intraoperatively proven anomalous Struthers’ ligament diagnosed by MRI. Skeletal Radiol 2002; 31: 532–535.PubMedCrossRefGoogle Scholar
  11. 11.
    Yao L, Mehta U. Infraspinatus muscle atrophy: implications? Radiology 2003; 226: 161–164.PubMedCrossRefGoogle Scholar
  12. 12.
    Ryan M, Twair A, Nelson E, Brennan D, Eustace S. Whole body magnetic resonance imaging in the diagnosis of Parsonage Turner syndrome. Acta Radiol 2004; 45: 534–539.PubMedCrossRefGoogle Scholar
  13. 13.
    Nagano A. Spontaneous anterior interosseous nerve palsy. J Bone Joint Surg Br 2003; 85: 313–318.PubMedCrossRefGoogle Scholar
  14. 14.
    Yanagisawa H, Okada K, Sashi R. Posterior interosseous nerve palsy caused by synovial chondromatosis of the elbow joint. Clin Radiol 2001; 56: 510–514.PubMedCrossRefGoogle Scholar
  15. 15.
    Ludig T, Walter F, Chapuis D, Mole D, Roland J, Blum A. MR imaging evaluation of suprascapular nerve entrapment. Eur Radiol 2001; 11: 2161–2169.PubMedCrossRefGoogle Scholar
  16. 16.
    May DA, Disler DG, Jones EA, Balkissoon AA, Manaster BJ. Abnormal signal intensity in skeletal muscle at MR imaging: patterns, pearls, and pitfalls (review). Radiographics 2000; 20: S295–S315.PubMedGoogle Scholar
  17. 17.
    Grainger AJ, Campbell RS, Stothard J. Anterior interosseous nerve syndrome: appearance at MR imaging in three cases. Radiology 1998; 208: 381–384.PubMedGoogle Scholar
  18. 18.
    Missankov AA, Sehgal AK, Mennen U. Variations of the posterior interosseous nerve. J Hand Surg [Br] 2000; 25: 281–282.CrossRefGoogle Scholar
  19. 19.
    Ozkan M, Bacakoglu AK, Gul O, Ekin A, Magden O. Anatomic study of posterior interosseous nerve in the arcade of Frohse. J Shoulder Elbow Surg 1999; 8: 617–620.PubMedCrossRefGoogle Scholar
  20. 20.
    Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 1999; 8: 599–605.PubMedCrossRefGoogle Scholar
  21. 21.
    Sallomi D, Janzen DL, Munk PL, Connell DG, Tirman PF. Muscle denervation patterns in upper limb nerve injuries: MR imaging findings and anatomic basis. AJR Am J Roentgenol 1998; 171: 779–784.PubMedGoogle Scholar
  22. 22.
    Kim YS, Yeh LR, Trudell D, Resnick D. MR imaging of the major nerves about the elbow: cadaveric study examining the effect of flexion and extension of the elbow and pronation and supination of the forearm. Skeletal Radiol 1998; 27: 419–426.PubMedCrossRefGoogle Scholar
  23. 23.
    Hide IG, Grainger AJ, Naisby GP, Campbell RS. Sonographic findings in the anterior interosseous nerve syndrome. J Clin Ultrasound 1999; 27: 459–464.PubMedCrossRefGoogle Scholar
  24. 24.
    Zanetti M, Gerber C, Hodler J. Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol 1998; 33: 163–170.PubMedCrossRefGoogle Scholar
  25. 25.
    Puhaindran ME, Wong HP. A case of anterior interosseous nerve syndrome after peripherally inserted central catheter (PICC) line insertion. Singapore Med J 2003; 44: 653–655.PubMedGoogle Scholar
  26. 26.
    Degreef I, De Smet L. Anterior interosseous nerve paralysis due to Gantzer’s muscle. Acta Orthop Belg 2004; 70: 482–484.PubMedGoogle Scholar
  27. 27.
    Rodriguez-Niedenfuhr M, Vazquez T, Parkin I, Logan B, Sanudo JR. Martin-Gruber anastomosis revisited. Clin Anat 2002; 15: 129–134.PubMedCrossRefGoogle Scholar
  28. 28.
    Kikuchi Y, Nakamura T, Takayama S, Horiuchi Y, Toyama Y. MR imaging in the diagnosis of denervated and reinnervated skeletal muscles: experimental study in rats. Radiology 2003; 229:861–867. Erratum in Radiology 2004; 230: 597.Google Scholar
  29. 29.
    Aagaard B, Lazar DA, Lankerovich L, Andrus K, Hayes CE, Maravilla K. Hight-resolution magnetic resonance imaging is a noninvasive method of observing injury and recovery in the peripheral nervous system. Neurosurgery 2003; 53: 199–204.PubMedCrossRefGoogle Scholar
  30. 30.
    Goutallier D, Postel JM. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg 2003; 12: 550–554.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2007

Authors and Affiliations

  • Andrew J. Dunn
    • 1
    Email author
  • David C. Salonen
    • 2
  • Dimitri J. Anastakis
    • 3
  1. 1.Department of Medical ImagingRoyal Liverpool University HospitalLiverpoolUK
  2. 2.Department of Medical ImagingUniversity of Toronto, Toronto Western HospitalTorontoCanada
  3. 3.Division of Plastic SurgeryUniversity of Toronto, Toronto Western HospitalTorontoCanada

Personalised recommendations