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.
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.
- Colbert SH, Mackinnon SE. Nerve compressions in the upper extremity. Mo Med. 2008 Nov-Dec;105(6):527-35. Review. PMID: 19052017.
- Mackinnon SE. Surgical approach to the radial nerve. Tech Hand Up Extrem Surg. 1999 Jun;3(2):87-98. PMID: 16609441.
- 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.
- 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.
- 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.
- 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.