Surgical Procedures

Posterior Interosseous Nerve Release

Compression of the posterior interosseous nerve can exhibit clinical weakness or functional loss of finger / thumb extension and lack of ulnar wrist extension. Provocative tests can confirm whether the radial tunnel in the region of the posterior interosseous nerve is the area of compression. Multiple anatomical structures can be involved in compressing the nerve in the tunnel, however the primary site of compression is the arcade of Froshe; this being the tendinous proximal border of the superficial head of the supinator. Other compressive structures can include the radial recurrent vessels (Leash of Henry) and tendinous proximal border of the extensor carpi radialis brevis. Decompression of the posterior interosseous nerve involves releasing these structures. If there is an associated lateral epicondylitis, release of the extensor carpi radialis brevis is taken further laterally. In this case, this patient presented with a recovering traumatic C7,8,T1 plexus injury. However, recovery of radial nerve function was halted for a few weeks with marked discomfort over the radial tunnel. Release of the posterior interosseous nerve was elected to promote more prompt and complete functional recovery.

Standard 130731

Extended 130731




An incision is made in the interval between the brachioradialis and extensor carpi radialis longus. The brachioradialis can be palpated during pre-operative staging with the lateral border of the brachioradialis muscle being marked.


  1. Colbert SH, Mackinnon SE. Nerve compressions in the upper extremity. Mo Med. 2008 Nov-Dec;105(6):527-35. Review. PMID: 19052017.
  2. Mackinnon SE. Surgical approach to the radial nerve. Tech Hand Up Extrem Surg. 1999 Jun;3(2):87-98. PMID: 16609441.
  3. Lowe JB 3rd, Sen SK, Mackinnon SE. Current approach to radial nerve paralysis. Plast Reconstr Surg. 2002 Sep 15;110(4):1099-113. PMID: 12198425.
  4. Lowe JB 3rd, Tung TR, Mackinnon SE. New surgical option for radial nerve paralysis. Plast Reconstr Surg. 2002 Sep 1;110(3):836-43. No abstract available. PMID: 12172148.
  5. Ehrlich W, Dellon AL, Mackinnon SE. Classical article: Cheiralgia paresthetica (entrapment of the radial nerve). A translation in condensed form of Robert Wartenberg’s original article published in 1932. J Hand Surg Am. 1986 Mar;11(2):196-9. PMID: 3514740.
  6. Hall HC, MacKinnon SE, Gilbert RW. An approach to the posterior interosseous nerve. Plast Reconstr Surg. 1984 Sep;74(3):435-7. PMID: 6473564.

Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.


  1. Dear Dr.Mackinnon
    Absolutely fantastic demonstration , and a wonderful video of a PIN decompression!! Have been a long time fan of your work and have seen it on Vumedi,Youtube and now on Passio.. thank you!!
    best regards
    Dr.parag shah

  2. Dear Dr.Mackinnon,

    You are an inspiration, keep it up. If you ever consider traveling the world and pass from the island of Cyprus do give us a shout, we could prepare a case for you to review and teach or even only take you and your team out for drinks!

    Thanks again to you and your team for putting together such nice teaching material, out for everyone to enjoy and learn from.

    You are a delight to watch

  3. Dear Dr Mackinnon,
    I have been a fan of your work especially teaching material already available on You Tube. Now with Passio, I have converted to being a disciple. It is next best thing to actually being there in OT with you, in fact I think I had a better view of dissection than the assistant had. My sincere thanks for this wonderful effort for teaching us and I hope to learn loads from Passio. Thanks again
    Yours Sincerely,
    Dr Nilesh Darawade
    Pune, India.

  4. Thank you so much for your clear excellent presentation. I have done 3 so far through this approach with excellent results( all pain free return to activities)

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