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Upper Limb: M. Seki, H. Nakamura, and H. Kono Neurolysis is not required for young patients with a spontaneous palsy of the anterior interosseous nerve: RETROSPECTIVE ANALYSIS OF CASES MANAGED NON-OPERATIVELY J Bone Joint Surg Br 2006; 88-B: 1606-1609 [Abstract] [Full text] [PDF]

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Spontaneous palsy of the anterior interosseous nerve

Martti Vastamäki   (9 July 2007)

Spontaneous palsy of the anterior interosseous nerve 9 July 2007
Martti Vastamäki, chief hand surgeon ORTON Hospital of the Invalid Foundation Send letter to journal: Re: Spontaneous palsy of the anterior interosseous nerve martti.vastamaki{at}invalidisaatio.fi Martti Vastamäki	Sir, Seki et al presented in December 2006 a good paper on spontaneous anterior interosseus nerve palsy. They stated that non-surgical treatment yields acceptable results. They also mention hourglass-like fascicular constriction. After treating this condition for 30 years, mostly operatively, I have come to realise that fascicular constriction may be much more common than is thought. One may even miss the diagnosis peri-operatively if one does not use magnification and open the epineurium. But if you find that entity and perform internal neurolysis, recovery may be surprisingly quick. Therefore, I still prefer quick operative treatment of anterior interosseus, and also posterior interosseus nerve palsy, during the first six weeks, especially in complete spontaneous palsies. As many authors have stated,1-3 fascicular constriction may recover spontaneously but if not, a long operative delay - even up to one year - may be harmful. On the other hand, if the diagnosis does not appear to be nerve compression or constricton, the complications of surgery are not very harmful. Personally, I have seen only one case without recovery after surgery, but undoubtedly some of those operated on would have recovered without surgery, although perhaps not so quickly. M. Vastamäki, MD, PhD, Chief Hand Surgeon, ORTON Hospital of the Invalid Foundation, Helsinki, Finland. 1. Vastamaki M. Prompt interfascicular neurolysis for the successful treatment of hourglass-like fascicular nerve compression. Scand J Plast Reconstr Surg Hand Surg 2002;36:122-4. 2. Haussmann P. Fascicular median nerve compression in the elbow. In: Vastamäki M, Vilkki S, Göransson H, et al, eds. Congress Book of the International Federation of Societies for Surgery of the Hand. Bologna: Monduzzi Editore, 1995:949-2. 3. Nagano A, Shibata K, Tokimura H, Yamamoto S, Tajiri Y. Spontaneous anterior interosseous nerve palsy with hourglass-like fascicular constriction within the main trunk of the median nerve. J Hand Surg [Am] 1996;21:266-70.