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Posterior Interosseous Nerve Palsy Caused by a Soft-Tissue Mass: Considerations for Treatment
Peter D Gibson, MD; Joseph A Ippolito, BS; Joseph Benevenia, MD; John S Hwang, MD
Rutgers-NJMS, Newark, NJ
Background: Posterior interosseous nerve (PIN) palsy due to local compression is relatively infrequent and rarely caused by a pathologic lesion. Less than 100 cases have been reported in the literature This paucity of cases has left many questions unanswered about this subject. The reported recovery time has been attributed to several factors including: duration of pre-operative paralysis, pathologic diagnosis, and surgical approach. The purpose of this case series was to add to the current literature in regards to PIN palsy due to compression from a local soft-tissue mass and demonstrate that, prior to resection of the mass, adequate exposure and extensive neurolysis of involved structures ensure best the possible patient outcome.
Methods: From 2011-2015, a retrospective review of seven consecutive patients treated for PIN palsy was performed. Charts were reviewed for patient demographic information, pathologic diagnosis, size of mass, surgical approach performed, and pre-operative duration of nerve deficits. Protocol for surgical technique was consistent throughout all cases. Prior to resection of tumor, the first priority was identification of the posterior interosseous, superficial radial, and common radial nerves, followed by neurolysis under magnification. After nerve structures were adequately released, resection of associated lesion was performed. Post-operatively, patients were placed in a protective splint for a week to allow soft-tissue healing.
Results: Of the seven cases reviewed, diagnoses included four lipomas, one schwannoma, one hemangioma, and one osteochondroma. Review included four males and three females with a mean age of 52 years (range,13-75). Mean follow-up was 20 months (range,9-36). On initial presentation, all patients experienced motor weakness on the Oxford scale (range, 2/5-4/5). Five patients (71%) experienced pain on presentation. Mean mass size was 56 ccs (range,4-144). Mean duration of symptoms pre-operatively was 44 months (range, 1-120). All patients experienced full recovery in motor strength and pain by the twelve-months (mean 9;range 3-12). There was no difference in time to recovery for patients with lipomatous vs non-lipomatous tumors (10+0.9 vs 7+2.6;p=0.298). Mean MSTS scores were 29.4 (98%) (range,26-30)
Conclusion: Posterior interosseous nerve palsy secondary to tumor is a rare, but treatable condition. This case series demonstrates that patients typically recover fully within a year post-operatively. The authors of this study recommend neurolysis of the PIN, superficial radial nerve, and common radial nerve prior to removal of pathologic mass.
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