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Cross-sectional sonographic assessment of the posterior interosseous nerve

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Abstract

Purpose

Cross-sectional sonographic measurements are considered first-line confirmatory tests in diagnosing peripheral nerve entrapment syndromes. Our aim is to establish normal values of cross-sectional area of the posterior interosseous nerve (PIN) at the arcade of Frohse, the most common site of compression of this nerve.

Methods

The PIN was identified with ultrasound on 50 healthy adults and 30 cadavers. Measurements of the cross-sectional area (CSA), antero-posterior (AP) and lateral (L) distances were taken immediately proximal and distal to the arcade of Frohse.

Results

The mean AP and L distances of the PIN proximal to the arcade of Frohse were 0.111 cm (0 ± 0.021) and 0.266 cm (±0.058), respectively, while the mean AP and L distances of the PIN distal to the arcade of Frohse were 0.085 cm (±0.019) and 0.343 cm (±0.057), respectively. P squared testing showed a statistically significant difference between the AP and lateral distances of the PIN when comparing proximal and distal to the arcade (p ≤ 0.001). However, the mean CSA of the PIN measured immediately proximal to the arcade of Frohse was 0.022 cm2 (±0.005); immediately distal to the arcade of Frohse, it was 0.023 cm2 (±0.004). t test showed no statistical difference between the two regions (p = 0.11).

Conclusions

Our study has provided reference values for the PIN in healthy individuals at the arcade of Frohse. Although, there is a flattening of the nerve as it enters the supinator muscle, this should not be mistaken for nerve entrapment as the size of the nerve remains consistent.

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References

  1. Baklaci K, Ozgul A (2012) Posterior interosseous nerve entrapment in a patient with rheumatoid arthritis. Turk J Rheumatol 27:200–204

    Article  Google Scholar 

  2. Beekman R, Visser L (2004) High resolution sonography of the peripheral nervous system: a review of the literature. Eur J Neurol 11:305–314

    Article  CAS  PubMed  Google Scholar 

  3. Bianchi S, Martinoli C (2007) Nerves and blood vessels. In: Baert AL, Knauth M, Sartor K (eds) Ultrasound of the musculoskeletal system. Springer, Germany, pp 104–108

    Google Scholar 

  4. Bowen T, Stone K (1966) Posterior interosseous nerve paralysis caused by a ganglion at the elbow. J Bone Joint Surg Br 48:774–776

    CAS  PubMed  Google Scholar 

  5. Cartwright M, Passmore L, Yoon J, Brown M, Caress J, Walker F (2008) Cross-sectional area reference values for nerve ultrasonography. Muscle Nerve 37:566–571

    Article  PubMed  Google Scholar 

  6. Chien AJ, Jamadar DA, Jacobson JA, Hayes CW, Dean SL (2003) Sonography and MR imaging of posterior interosseous nerve syndrome with surgical correlation. AJR Am J Roentgenol 181:219–221

    Article  PubMed  Google Scholar 

  7. Chiou HJ, Chou YH, Chiou SY, Lui JB, Chang CY (2003) Peripheral nerve lesions: role of high resolution US. Radiographics 23:E15. doi:10.1148/rg.e15

    Article  PubMed  Google Scholar 

  8. Cho H, Lee HY, Gil YC, Choi YR, Yang HJ (2013) Topographical anatomy of the radial nerve and its muscular branches related to surface landmarks. Clin Anat 26:862–869

    Article  PubMed  Google Scholar 

  9. Dilberti T, Botte MJ, Abrams RA (2000) Anatomical considerations regarding the posterior interosseous nerve during posterolateral approaches to the proximal part of the radius. J Bone Joint Surg Am 82:809–813

    Google Scholar 

  10. Dong Q, Jamadar D, Robertson B, Jacobson J, Caoili E, Guest T, Gandikota G (2010) Posterior interosseous nerve of the elbow: normal appearances simulating entrapment. J Ultrasound Med 29:691–696

    PubMed  Google Scholar 

  11. Fowler J, Gaughan J, Ilyas A (2011) The sensitivity and specificity of ultrasound for the diagnosis of carpal tunnel syndrome: a meta-analysis. Clin Orthop 469:1089–1094

    Article  PubMed Central  PubMed  Google Scholar 

  12. Heidari N, Kraus T, Weinberg A, Weiglein A, Grechenig W (2010) The risk injury to the PIN in standard approaches to the proximal radius: a cadaveric study. Surg Radiol Anat 33:353–357

    Article  PubMed  Google Scholar 

  13. Huisstede B, Miedema H, van Opstal T, de Ronde M, Kuiper J, Verhaar J, Koes B (2006) Interventions for treating the posterior interosseous nerve syndrome: a systematic review of observational studies. J Peripher Nerv Syst 11:101–110

    Article  PubMed  Google Scholar 

  14. Joy V, Cheun CY, Wilder-Smith E (2009) Diagnostic utility of ultrasound in posterior interosseous nerve syndrome. Arch Neurol 66:902–903

    Article  PubMed  Google Scholar 

  15. Jung J, Kim K, Choi S, Shim J (2013) Usefulness of ultrasound for detecting suspected peripheral nerve lesions in diagnosis of peripheral neuropathy: case report and brief review of the literature. J Korean Neurosurg Soc 53:132–135

    Article  PubMed Central  PubMed  Google Scholar 

  16. Klauser A, Halpern E, DeZordo T, Feuchtner G, Arora R, Gruber J, Martinoli C, Loscher W (2008) Carpal tunnel syndrome assessment with us: value of additional cross-sectional area measurements of the median nerve in patients versus healthy volunteers. Radiology 250:171–177

    Article  PubMed  Google Scholar 

  17. Koenig R, Pedro M, Heinen C, Richter H, Antoinaiadis G, Kretscher T (2009) High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma. Neurosurg Focus 26:E13. doi:10.3171/FOC.2009.26.2.E13

    Article  PubMed  Google Scholar 

  18. Koyuncuoglu H, Kutluhan S, Yesildag A, Orhan O, Guler K, Ozden A (2005) The value of ultrasonographic measurements in carpal tunnel syndrome in patients with negative electrodiagnostic test. Eur J Radiol 56:365–369

    Article  PubMed  Google Scholar 

  19. Lallemand RC, Weller RO (1973) Intraneural fibromas involving the posterior interosseous nerve. J Neurol Neurosurg Psychiatry 36:991–996

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Martiloni C, Bianchi S, Gandolfo N, Valle M, Simonetti S, Lorenzo DE (2000) US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics 20:S199–S213. doi:10.1148/radiographics.20.suppl_1.g00oc08s199

    Article  Google Scholar 

  21. Mohammadi A, Afshar A, Etemadi A, Masoudi S, Baghizadeh A (2010) Diagnostic value of cross-sectional area of median nerve in grading severity of carpal tunnel syndrome. Arch Iran Med 13:516–521

    PubMed  Google Scholar 

  22. Ong C, Nallamshetty HS, Nazarian LN, Rekant MS, Mandel S (2007) Sonographic diagnosis of posterior interosseous nerve entrapment syndrome. Radiol Case Rep 2:67. doi:10.2484/rcr.v2i1.67

    Article  Google Scholar 

  23. Posadzy-Dziedzic M, Molini L, Bianchi S (2011) Sonographic findings of parosteal lipoma of the radius causing posterior interosseous nerve compression with radiographic and magnetic resonance imaging correlation. J Ultrasound Med 30:1030–1036

    Google Scholar 

  24. Spinner M (1968) The arcade of Frohse and its relationship to posterior interosseous nerve paralysis. J Bone Joint Surg Br 50:809–812

    CAS  PubMed  Google Scholar 

  25. Standring S (2008) Chap 45 Pectoral girdle and upper limb. In: Standring S (ed) Gray’s anatomy, 40th edn. Williams and Wilkins, Philadelphia, pp 777–856

    Google Scholar 

  26. Sungjun K, Choi JY, Huh YM, Song HT, Lee SA, Kim SM, Suh JS (2006) Role of magnetic resonance imaging in entrapment and compressive neuropathy—what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2 upper extremity. Eur Radiol 17:509–522

    Google Scholar 

  27. Uerpairojkit C, Ketwongwiriya S, Leechavengvongs S, Malungpaishrope K, Witoonchart K, Mekrungcharas N, Chareonwat B, Ongsiriporn M (2013) Surgical anatomy of the radial nerve branches to triceps muscle. Clin Anat 26:386–391

    Article  PubMed  Google Scholar 

  28. Won SY, Cho YH, Choi YJ, Favero V, Woo HS, Chang KY, Hu KS, Kim HJ (2015) Intramuscular innervation patterns of the brachialis muscle. Clin Anat 28:123–127

    Article  PubMed  Google Scholar 

  29. Yesildag A, Kutluhan S, Sengul N, Koyuncuoglu HR, Oyar O, Guler K, Gulsoy UK (2004) The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. Clin Radiol 59:910–915

    Article  CAS  PubMed  Google Scholar 

  30. Zaidman C, Seelig M, Baker J, Mackinnon S, Pestronk A (2013) Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology 80:1634–1640

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank Jessica Holland, MS, Medical Illustrator at St. George’s University, Grenada, West Indies, for the creation of her illustrations used in this publication. We also wish to acknowledge the persons who kindly volunteered to participate in this project as well as the individuals who donated their bodies, without whom this project would not have been possible.

Conflict of interest

The authors declare that there are no conflicts of interest of any kind.

Ethical considerations

The study was approved by the institutional review board (IRB/13053) and written individual informed consent was obtained from all participants. All cadaver specimens were handled in accordance to the laws and regulations of the country in which the study was performed. The specimens used for this research are protected under IRB approval (06014) as issued by the School of Medicine at St Georges University Grenada.

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Authors and Affiliations

  1. Department of Anatomical Sciences, School of Medicine, St. George’s University, St. George’s, Grenada, West Indies

    Kazzara Raeburn, Danny Burns, Robert Hage, R. Shane Tubbs & Marios Loukas

  2. Pediatric Neurosurgery, Children’s Hospital of Alabama, Birmingham, AL, USA

    R. Shane Tubbs

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  1. Kazzara Raeburn
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  2. Danny Burns
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Correspondence to Marios Loukas.

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Raeburn, K., Burns, D., Hage, R. et al. Cross-sectional sonographic assessment of the posterior interosseous nerve. Surg Radiol Anat 37, 1155–1160 (2015). https://doi.org/10.1007/s00276-015-1487-7

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  • DOI: https://doi.org/10.1007/s00276-015-1487-7

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