Lipoma causing posterior interosseous nerve palsy or superficial radial nerve paraesthesia

Superficial radial nerve compression due to fibroma of the brachioradialis tendon sheath: A case report

Fibroma of the tendon sheath (FTS) is a rare benign tumour that usually develops in the upper extremity, particularly in the fingers, hands and wrists. Herein, we present the case of a patient with an unusually localised FTS compressing the superficial branch of the radial nerve. A 62-year-old woman presented with a superficial radial nerve compression due to FTS of the brachioradialis. Histopathological diagnosis was confirmed as a FTS after marginal excision. The patient who had compression-related symptoms in the superficial branch of the radial nerve recovered completely at one month after surgery. One year later, the patient remained free of symptoms and no recurrence was observed.

Posterior interosseous nerve entrapments: review of the literature. Is the entrapment distal to the arcade of Frohse a really rare condition?

INTRODUCTION

Spontaneous posterior interosseous nerve palsy is a rare condition. Entrapment is mostly at level of the arcade of Frohse, and a few cases of distal entrapment have been described.

METHODS

A case of entrapment distal to the arcade of Frohse is described here. Cases of distal entrapment have been reviewed from the published literature in order to evaluate the frequency of atraumatic mechanical palsy.

RESULTS

Seven cases of distal entrapment have been identified. Lesion is the cause of palsy in 58.7% of the cases and entrapment in 20.65%. The pathology is at the elbow in 33.7% of the cases, at the arcade of Frohse in 28.26%, and at the supinator canal in 10.33%. Entrapment is at the arcade of Frohse in 64.45%, proximal in 20%, and distal in 15.55%.

CONCLUSION

Posterior interosseous nerve distal entrapment is a rare condition; therefore, further investigation is needed when radiological images at the arcade of Frohse do not show any entrapment.

Intraneural Posterior Interosseous Nerve Lipoma with Complete Paralysis: Case Report and Review of the Literature

An intraneural posterior interosseous nerve (PIN) lipoma is a rare entity consisting of two types and only two previously reported cases. Treatment involves total excision for the well-encapsulated “true intraneural lipomas” type and subtotal resection for the other type, fibrolipomatous hamartomas of the nerve. We present the management and surgical treatment of a case that illustrates a variation of the traditional posterolateral surgical approach for the complete excision of an intraneural PIN lipoma—contrary to the more commonly used anterior approach in literature—along with a literature review of intraneural PIN lipomas.

Delayed diagnosed intermuscular lipoma causing a posterior interosseous nerve palsy in a patient with cervical spondylosis: the "priceless" value of the clinical examination in the technological era

BACKGROUND

Posterior interosseous nerve (PIN) palsy may present with various symptoms, and may resemble cervical spondylosis.

CASE REPORT

We report about a 59-year-old patient with cervical spondylosis which delayed the diagnosis of posterior interosseous nerve (PIN) palsy due to an intermuscular lipoma. Initial right hand paraesthesias and clumsiness, together with MR findings of right C5-C6 and C6-C7 foraminal stenosis, misled the diagnostic investigation. The progressive loss of extension of all right hand fingers brought to detect a painless mass compressing the PIN. Electrophysiological studies confirmed a right radial motor neuropathy at the level of the forearm.

RESULTS

Surgical tumor removal and nerve decompression resulted in a gradual motor deficits recovery.

CONCLUSIONS

A thorough clinical examination is paramount, and electrophysiology may differentiate between cervical and peripheral nerve lesions. Ultrasonography and MR offer an effective evaluation of lipomas, which represent a rare cause of PIN palsy. Surgical decompression and lipoma removal generally determine excellent prognoses, with very few recurrences.

Posterior interosseous nerve palsy secondary to pigmented villonodular synovitis of the elbow: case report and review of literature

Local tumor compression is the main mechanical cause of posterior interosseous nerve (PIN) palsy. The reported cases of these tumors do not include that of pigmented villonodular synovitis (PVNS). Here, we report a case of a 53-year-old male with a 9-year history of painless swelling in his left elbow and a few months of progressive weakness in his left hand. Imaging identified the mass, and histological examination of the biopsy specimens revealed PVNS. The mass was compressing the nerve at the arcade of Frohse, and we performed a complete resection of the mass. Following removal of the mass, the patient regained complete function in his left upper extremity, and no local recurrence has been detected after 2 postoperative years. The possibility of PVNS should be considered in the differential diagnosis of PIN palsy.