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Another publication by a Certified F.A.P. Instructor: Dr. John Saratsiotis outlines a case of posterior interosseous nerve syndrome

February 19, 2010

Diagnosis and treatment of posterior interosseous nerve syndrome using soft tissue manipulation therapy: A case study

John Saratsiotis, BSc, BA, DC  &  Emmanouil Myriokefalitakis MD

Journal of Bodywork and Movement Therapies, Dec 2009

SUMMARY: Peripheral nerve entrapments of the upper and lower extremity are commonly seen in practice. Chronically repetitive movement patterns lead to constriction of the nerve due to the development of local fibrosis within the soft tissues surrounding the nerve which also affects nerve traction, mobility, and function. A case is presented of a patient with motor weakness in the wrist and hand in order to illustrate the diagnosis and treatment of posterior interosseous nerve (PIN) syndrome. Using Active Release Techniques Soft Tissue Management and Peripheral Nerve Release Systems® the patient’s symptomatology was resolved. Soft tissue-based management in conjunction with neural gliding may be beneficial in the conservative management of PIN syndrome. Further research into the pathophysiology of nerve entrapments will have immediate impact on the management of neuropathies and likely result in emphasizing conservative management and rehabilitation rather than surgical intervention particularly in cases not involving denervation or paralysis.

Anatomy Review …provided by Dr. Spina

In the forearm, the deep branch of the radial nerve curves around the lateral and posterior aspects of proximal radius, penetrating the supinator muscle. It emerges from supinator as the posterior interosseous nerve (PIN).  A purly motor nerve, the PIN supplies the extensor muscles of the forarm including the extensors digitorum, digiti minimi, and carpi ulnaris. It then passes inferiorly with the posterior interosseous artery on the surface of abductor pollicis longus, supplying the muscle. It also gives branches to extensors pollicis longus and brevis, extensor indicis, and the carpus.  It is important to note that with PINS (Posterior Interosseous nerve syndrome) there are no sensory changes.  The cutaneous branch of the radial nerve that supplies the skin of the dorsum of the forearm comes off proximal to the elbow in the region of the triceps, thus bi-passing the arcade of froshe (the fibrous tunnel made by the supinator).  Thus sensory symptoms in this area indicate an irritation of the nerve more proximally (it may also indicate problems at the level of the nerve roots).

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