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LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 5  |  Page : 527-528

Anterior interosseous nerve involvement in a patient due to weight lifting: MRI and EMG finding


1 Department of Neurology, Fatih University, Ankara, Turkey
2 Department of Physical Medicine and Rehabilitation, Fatih University, Ankara, Turkey

Date of Web Publication3-Nov-2012

Correspondence Address:
Ozlem Cemeroglu
Department of Physical Medicine and Rehabilitation, Fatih University, Ankara
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.103209

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How to cite this article:
Koc ER, Cemeroglu O, Ayturk Z, Ilhan A. Anterior interosseous nerve involvement in a patient due to weight lifting: MRI and EMG finding. Neurol India 2012;60:527-8

How to cite this URL:
Koc ER, Cemeroglu O, Ayturk Z, Ilhan A. Anterior interosseous nerve involvement in a patient due to weight lifting: MRI and EMG finding. Neurol India [serial online] 2012 [cited 2019 Aug 25];60:527-8. Available from: http://www.neurologyindia.com/text.asp?2012/60/5/527/103209


Sir,

Anterior interosseous syndrome (AINS) is rare and is due to compression of the anterior interosseous nerve, a motor branch of median as a result of trauma at the elbow, often associated with hemorrhage and edema in the deep muscles of the forearm. Patients often present initially with acute pain in the proximal forearm followed by paresis or total paralysis of the pronator quadratus, flexor pollicis longus, and the radial half of the flexor profundus, either individually or together. [1] A complete lesion causes a characteristic deformity of pinch between the thumb and the index finger. [2] Depending on the location and the degree of neuronal damage, AIN syndrome can present with a variety of clinical manifestations. This report presents a patient who developed AIN syndrome following weight training of upper extremities.

A 45-year-old female presented with the complaint of pain in the medial side of right forearm and difficulty in gripping objects between her thumb and index finger. She had been on weight training program of upper extremities since 3 months. Neurological examination revealed weakness of forearm pronation (grade 4/5), flexion of distal phalanx of the thumb (grade 1/5), and flexion of distal phalanx of the index and third finger (grade 4/5). She had different attitude of the index finger and thumb during the pinch [Figure 1]. No sensory deficit was present. Nerve conduction studies of the upper extremities revealed normal median and ulnar motor and sensory nerve conductions. F responses were normal. Needle examination of pronator quadratus showed denervation patterns and moderate reduced MUAP activity. Needle examination of flexor pollicis longus and flexor digitorum profundus muscles showed intense positive sharp waves and fibrillation potentials. Magnetic resonance imaging (MRI) of the right forearm showed diffuse edema in the interosseous muscles in the 1/3 middle section of the forearm [Figure 2]. On the basis of the clinical, neurological, and MRI findings, the diagnosis of AINS was considered. She was on deltacortril 8 mg/ day to reduce the edema of distal forearm muscles. She was told to stop weight training. At the end of 6 months, all symptoms disappeared completely.

AIN can result from traumatic and nontraumatic causes. Traumatic causes range from blunt trauma, local pressure, excessive exercise, penetrating injury, forearm fractures, open reduction, and interior fixation. [3],[4],[5] In this patient, the AIN palsy probably resulted from the weight-training program which the patient was on. There are a few case reports of exercise or effort-related median nerve compression. Hypertrophied muscles increase intracompartmental pressure during muscle activity, and this intracompartmental pressure results in local pressure on the AIN. [6],[7] MRI is the investigation modality in the diagnosis of AIN syndrome. AIN syndrome is likely when there is diffuse edema of AIN innervated muscles on T2 weighted fat-saturated images. The most reliable sign of an AIN lesion is edema within the pronator quadratus muscle. [8] Treatment modality depends on the specific disease etiology. Conservative treatment includes rest and avoidance of strenuous forearm activity, removal of the precipitating cause, and using nonsteroidal anti-inflammatory drugs. Surgical exploration is only rarely necessary if conservative treatment fails. [7] In conclusion, AIN syndrome is a rare entrapment neuropathy. Clinical, electrophysiological, and MRI examinations should be done appropriately for the accurate diagnosis and proper treatment of AIN syndrome.
Figure 1: Normal left hand can perform "O" with index finger and thumb, whereas; the affected right hand cannot perform "O"

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Figure 2: T2 weighted MRI shows increased intensity due to edema of the muscles innervated by AIN

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  References Top

1.Spinner M. The anterior interosseous-nerve syndrome, with special attention to its variations. J Bone Joint Surg Am 1970;52:84-94.  Back to cited text no. 1
    
2.Seror P. Anterior interosseous nerve lesions. Clinical and electrophysiological features. J Bone Joint Surg Br 1996;78:238-41.  Back to cited text no. 2
    
3.Wu F, Ismaeel A, Siddiqi R. Anterior interosseous nerve palsy following the use of elbow crutches. N Am J Med Sci 2011;3:296-8.  Back to cited text no. 3
    
4.Arenas AJ, Artázcoz FJ, Tejero A, Arias C. Anterior interosseous nerve injury associated with a Monteggia fracture-dislocation. ActaOrthopBelg 2001;67:77-80.  Back to cited text no. 4
    
5.Puhaindran ME, Wong HP. A case of anterior interosseous nerve syndrome after peripherally inserted central catheter (PICC) line insertion. Singapore Med J 2003;44:653-5.  Back to cited text no. 5
    
6.Shimokawa A, Tateyama S, Shimizu Y, Muramatsu I, Takasaki M. Anterior interosseous nerve palsy after cardiopulmonary resuscitation in a resuscitator with undiagnosed muscle anomaly. AnesthAnalg 2001;93:290-1.  Back to cited text no. 6
    
7.Schuurman AH, van Gils AP. Reversed palmarislongus muscle on MRI: Report of four cases. EurRadiol 2000;10:1242-4.  Back to cited text no. 7
    
8.Dunn AJ, Salonen DC, Anastakis DJ. MR imaging findings of anterior interosseous nerve lesions. Skeletal Radiol 2007;36:1155-62.  Back to cited text no. 8
    


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