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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 12, 1606-1609.
doi: 10.1302/0301-620X.88B12.17700  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Neurolysis is not required for young patients with a spontaneous palsy of the anterior interosseous nerve

RETROSPECTIVE ANALYSIS OF CASES MANAGED NON-OPERATIVELY

M. Seki, MD, PhD, Deputy Director1; H. Nakamura, MD, PhD, Chief Director2; and H. Kono, MD, PhD, Orthopaedic Surgeon1

1 Department of Orthopaedic Surgery, Osaka City Sumiyoshi Hospital, 1-2-16, Higashikagaya, Suminoe-ku, Osaka 559-0012, Japan.
2 Department of Orthopaedic Surgery, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka 534-0021, Japan.

Correspondence should be sent to Dr M. Seki; e-mail: mseki{at}leto.eonet.ne.jp

We studied 21 patients with a spontaneous palsy of the anterior interosseous nerve. There were 11 men and 10 women with a mean age at onset of 39 years (17 to 65).

Pain around the elbow or another region (forearm, shoulder, upper arm, systemic arthralgia) was present in 17 patients and typically lasted for two to three weeks. It had settled within six weeks in every case. In ten cases the palsy developed as the pain settled. A complete palsy of flexor pollicis longus and flexor digitorum profundus to the index finger was seen in 13 cases and an isolated palsy of flexor pollicis longus in five. All patients were treated without operation. The mean time to initial muscle contraction was nine months (2 to 18) in palsy of the flexor digitorum profundus to the index finger, and ten months (1 to 24) for a complete palsy of flexor pollicis longus. An improvement in muscle strength to British Medical Research Council grade 4 or better was seen in all 15 patients with a complete palsy of the flexor digitorum profundus and in 16 of 18 with a complete palsy of flexor pollicis longus.

There was no significant correlation between the duration of pain and either the time to initial muscle contraction or final muscle strength. Prolonged pain was not always associated with a poor outcome but the age of the patient when the palsy developed was strongly correlated. Recovery occurred within 12 months in patients under the age of 40 years who achieved a final British Medical Research Council grade of 4 or better. Surgical decompression does not appear to be indicated for young patients with this condition.




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Spontaneous palsy of the anterior interosseous nerve
Martti Vastamäki
J Bone Joint Surg Br Online, 9 Jul 2007 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General