The Anterior Interosseous

The Anterior Interosseous-Nerve
Syndrome
WITH SPECIAL .A_TTENTION TO ITS VARI:kTIONS*
:BY MORTONSPINNER, M.D.t,
BROOKLYN~NE~.V YORK
Fromthe Combined HandService (Orthopaedic, Plaslic, and General Surgery),
The Albert Einsiein College of Medicine, New York City, and the Deparlrnents of Orlho
and Hand Surgery, The Brookdale Hospital Center, Brooklyn
Since I(iloh and Nevin 11 described isolated neuritis of the anterior
nerve, Seyffarth 19, Bell and Goldner 2, Thomas2s, Warren ~, Fearn and
fellow 6, Stern, Rosner, and Blinderman 24, Farber and Bryan ~, Sharrard-~,
Vichare 90 have all madecontributions to the understanding of the subje:~:.
papers described a total of nineteen cases. Amongthe earlier publications, ~hose
Borchardt and Wjasmenski6, Ranschburg ~s, Wilson ~-~, and Parsonage and
are to be noted.
FIG.1
The right hand has an anterior interosseous-nerve
paralysis.
is characteristic of this paralysis (see text).
The pinch attitude
of this hand
This paper reports on ~en new cases of anterior interosseous-nerve paralysis
collected during a fourteen-year period, describes the typical pattern of. this entity
along with variants of the syndrome, and offers probable anatomical explanation
for these c5ical variations.
A presumptive diagnosis of anterior interosseous-nerve paralysis can be made
from the attitude of the thumb and index finger during pinch (Fig. 1). Normally
there are varying degrees of flexion of all joints of the thumb and index finger.
With anterior interosseous paralysis the index finger shows extension of the ~stal
interphalangeal joint and increased flexion of the proximal interplmIangeal joint,
* Read in par~ at &e Anm.u~:,[eeung of The American Or~ho~aedic Associa~i,.,n.
V~ginia, June 26.
~ 1235 2,indei~
s¢
[Iot Sprin~,
ANTERIOR
INTERO~SEOUS-NERVE
SYNDROME
the involved thumb ~’eveals increased flexion of the metacarpophalangeal
and %-:yperextension of the interphalangeal ioint. In addition, the pulp contact
::~e thumb and index finger is abnormal, the area of contact of the pulp
thumb with the index finger being muchmore proximal than normal.
Confirmatory findings are lack of function of the long flexors of the thumband
and long fingers as well as lack of function of the pronator quadratus of the
~all changes which result from localized paralysis of the anterior interosnerve. There are also no sensory abnormalities or ~nvolvement of other
supplied by the main median-nerve trunk.
the commondistribution of the median nerve the superficial flexors,
thenar muscles, and the deep flexors to the ring and little fingers are
I:~ the extreme "all median hand" the anterior interosseous nerve supplies
Syndrome .
ONS*
¯ YORK
!eneral Surgery),
,artrnents of Ortho
rooklyn
.e anterior
t3i, Fearn and Go~
can’~, Sharrard~-~,
:of the subject. The~
’publications,
arsonage and Turne:
ach attitude
85
of this hand
FIG. 2
Left forearm specimen. Note the multiple branches of the motor nerve to the flexor pollicis
(FPL) entering the muscle proximally. The forceps is beneath a tendinous origin of the
)erficialis.
;seous-nerve paralysis
pattern of this entity
~atomical explanation.
::
all of the profundi. Accordingly in this and the other variants of the median nerve,
!aralysis can be made
attitude of the thumb and index finger in the pinch position would be the same
(Fig. 1). Normally
as described but there would be weakness or paralysis of some or all of the commband index finger, i:
~:i0onents of the flexor digitorum profundus.
xtension of the distal
~:
i Conversely, when the ulnar nerve innervates more of the profundi: the long:
mterphalangeal joint,
tinge,. ~rof,,~du~is ,maffect,~dor is ontv~)artia!l~’ ~x~r:~i?,’zedby loss of funcsionof the
Association,
Hot Sprin~, ~ : anterior interosseous aerve. Here too, the inw~[ved ~mm!would have the same pinch
)NE
AND JOINT
SURGEXY
~
VOL. 22-A,
NO. 1,
JANUARY 1970
MORTON SPINNER
nm:mal. Sunderland observed that the portion of the flexor digitorum profundus
serving the index finger is the only part of this muscle that is exclusively and constantly supplied by the median nerve. If the ulnar nerve did supply the entire ~exor
profundus group of muscles, then paralysis of the anterior interosseous nerve would
be manifest only by lack of flexion of the interphalangeal joint of the thumb and
paralysis of the pronator quadratus. One such rare case was recently reported by
Sunderland -~
~
"
In testing for the function of the pronator quadratus, one must eliminate the
rotatory action of the pronator teres on the forearm by fully flexing the elbow.
Since the pronator teres usuaily has two heads, the humeral head can be made ineffective by elbow flexion so that only about 25 per cent of the muscle’s pronatorv
strength from the ulnar head remains. In this position, if there is paralysis of the
pronator quadratus, there will be very weak resistance to forced supination of the
forearm, whereasif the pronator quadratus is not paralyzed, resistance ~o supina~ion
will be normal when the elbow is flexed or extended. Whenthe pronator fetes has
no ulnar head, a variation found in 9 per cent of limbs, there will be a~ most only a
trace of active pronation in the presence of anterior’interosseous-nerve paralysis
whenthe elbowis fully flexed. TILeelinieaI evaluation of the function of t.he pronator
quadratus can be corroborated by direct electrical stimulation of the muscle.
Anatomical~’eatures
The anterior interosseous nerve arises from tile
median nerve five to eight
ANTERIOR INTEROSSEOUS-NERVE
SYNDROME
87
exor digitorum
~at is exclusively and
lid supply the entire
g interosseous nerve wo
~1 joint of the thumb
was recently reported
s, one must eliminate
!~ fully flexing the
~’ral head can be made
Iof the muscle’s pronatoD,
f thei’e is paralysis of
~ forced supination of th~
], resistance to supination
-~n the pronator fetes
ere ~ill be at most only a
erosseous-nerve paralysis
~ function of the pronator
ation of the muscle.
dian nerve five to eight
Fro. 4
forearm specimen. Note the Martin-Grubertype communicationbetweenthe median
mrvethrougha branchof the anterior interosseousnerve.Theulnar origin of’the flexor
has beendetachedto exposethe details of the anastomosis(Courtesyof Dr. Emanuel
).
~ofiStheCr°ssedanterio~rbV
BONE AND JOINT
SURGEI~"Y
distal to the level of the lateral epicondyle and during its course through
the forearm it usually innervates three muscles, the flexor pollieis longus, the radial
of the flexor digitorum profundus, and the pronator quadratus. At the end of
its passage it supplies sensory fibers to the radioearpal, interearpal, earpometaearpal,
distal radio-ulnar ioints.
I made detailed anatomical studies of t~venty-five forearms with particular
attention to the branching of the anterior interosseous nerve in an attempt to exan unusual isolated paralysis of the flexor pollieis longus in this syndrome
1, 9, and 10). The motor branch of the flexor pollieis longus muscle usually
arises from the anterior interosscous nerve approximately four centimeters distal
interosseot~sa tendinous . i ) to its origin from the main median-nerve trunk. Tl~e motm~branchpromptly divides
~,
~ato
*~’,-e~.~,~.~ or four branche~
andentersthe proximal
et~dof the muscleonits medial
~’OL. :-~-A,
NO. 1, JANUAI~Y 1970
88
Fro. 5
¯ ]~[opsy specimen of the flexor Pollicis lon
~us reticle , , taken at th~ ~[~ ...........
~f ~
nlcreasein.
the number of nn~l~;
.. .........
....... oko ou~. ~ne
transfer.
muscle fibers ~s Indicative ofe denervation
(hematoxylin
abd eosln, X i000),
border in close proximity to the radius (Fig. 2). Near its site of origin the
branch is vulnerable to injury or to compressio~ by a tenqinous origin of ghe gexor
SUperficialis ~o ~he long ~nger, In addition since it is crOSsedby collateral vessels
of the anterior inteross~us artery, thrombosis of these veasels maycause dysfunetion (Fig. 3). Finally the bollieis motor hraa~k ~ ~u~nera~le go injury during open
reduction of fractures of the ~iddle third of the radius if the dissection is extrape~iosteal.
In connection ~th this Syndromeit is important to remembertha~a Martin- ~:/
Gruber type of eommu~eatio~ between the median and Ulnar nerves occurs in 15,
per cent of ~mbs (Fig. 4), and that half of these commhnications, aecor~ng
~
Thomson~, arise from the a~terior interosseous nerve¯ This communication b~
tW~enthe median and ulnar nerves is of sig~ficance because tl~e an~stomosing~be~
carey ~he motor innerva~ion of several of the intrinsic muaeles of the hand¯ M
nerfelg ~ demonstrated that these crossing fibers may inhervate the first dorsal
interosseus, adductor pollieis, and probab[~- tke ahdu~t~ d~gi~i qu~nti.
and I ~ confirmed Mannerfelt’s observations by electrical ~eghods. In addition t0
the intrinsic museles previously mentioned the second and third dorsal interosseu~
muscles were also found to be SUppliedby these crossing fibers in somelimbs.
a Patient with a full-blown anterior interosseous-nerve paralysis mayhave not
the hsual dysfunction of the deeD flexors of the thumband the index and lon~
and the pronator quadratus but also paralysis of some intrinsic muscles of the
Such a communicationis a. not too infrequen~ anatomical
~Illustrative Cases
(Lts~ t. On July 15, 1959, a female bank te!Ier, twentg-fa~r yea~s okl, n~)te5 sudden
across tke a~xt~rior aspect of her left t~mm
b and the lower ~art of her f~)rearm after lifting an
treme~v heaw, i)a~ of
~,
= corns. ofShortly
she poHleus
noted tha/:dm
could
not
flex Six
r he ti~)’ ,)f her thum
A pre~umntive.Cl:~osis
ruptur~~he~.eafter
of the ~e:vor
1 ~r ~*"s
w~s
maJ{,
88
MORTON SPINNER
FIG. 5
¯ Biopsy specimen of the flexor P.ollicis longus muscle taken at the time of muscle transfer. Th,
lacrease in the number of nuclei about the muscle fibers is indicative of denervation (hematoxylin
arid eosin, X i000).
border in close proximity to the radius (Fig. 2). N~ear its site of origin the motor
b~anch is vulnerable to injury or fo compreaaion~ ~ te~no~s or~g’~n oK the ~exor
of
the anterior
inteross~us
a~ery
thrombosis
vesselsbymay
cause dysfuncSUper~ciaI~s
to ~he
1on~ ~n~er,
~n ~addition
sinceofit these
is crossed
collateral
vessels
tion (Fig. 3). Finally the ~olli~s m~tor hr~k ~ ~k~ra~le Zo ~n)ury durin~ open
~uc~ion of fractures of the ~iddle third of the radius if the dissection is extrape~iosteal.
~n connection ~th this Syndrome it is important to ~memberfha~a
Graber type of commu~catioa between the median and Ulnar nerves occurs in
pe~ cent of ~mbs (Fig. 4), and that half of these commhnications, accor~ng
Thomson ~, arise from the a~terior interosseous nerve¯ ~his communication b~
tW~enthe median and ulnar nerves is of siK~ficance
t~
car~y ~he motor inner~ation of several of the intrinsic mUaclesof the hand¯ 5~an
nerfel~ ~ demonstrated that t~ese crossing fibers may inhervate the first dorsal
interosseus,
adductor pollicis,
an~ prob~hty tk~ ~t~ d~ q~n~i.
an~ I ~ confirmed ~/Iannerfelt’s observations by electrical ~ethods. In additio~
~.~
the intrinsic muscles previously mentioned the second and ~hird dorsal interosseus
muscles were also found to be SUppiiedby these crossing fibers in somelimbs.
a Patient with a full-blown anterior interosseous-nerve paralysis mayhave not
the hsual dysfunction of the deeb flexors of the thumb and th~ index and
and the pronator quadratus but also paralysis of some intrinaic muscles of the hand.
Such a communicationis a. not too infreg~en~ an~omi~,~l
~Illustrative Cases
(L~s~ t. On July 15~ 1959, a fe~al e ban~ ~e!Ier~ tweu~y-~x~ ~’~s ~ch, n~)~ecl sudden ~2~
~cr~ t~ ~x~rkor a~pec~ o~ her le~t t~mmb and ~he lower ~art of her t’~)re~’m after l~ng au ex
treme~yheavyb~ of co~us. Shortly the~.eafte~- she noted tt~a~he ca~l~l ~ ~. f ~,.. ~.,~, ,.?
90
MORTON
SPINNER
Anelectromyogramrevealed fibrillations in the pronator quadratus and the flexor
longus.
Exploration of the median nerve was performed on April 29, 1968. The median nerve
identified proximal to the lacertus fibrosus and was traced through the pronator teres, where
passed betweenthe two heads of the muscle. There were adhesions between the mediannerve and:
Fro. 7
Case 3. Neuromainvolves only a portion of the mediannerve.
the deep head. Whenthese were cleared, a distinct tendinous origin to the deep head of the
pronator teres was found. After this dcep tendinous origin of the pronator teres was severed and
an internal neurolysis of the anterior interosseous nerve wasperformedby injecting normalsaline,
the vessels on the surface of the mediannm"vefilled with blood and becamevisible.
Thelimb was immobilizedin a cast for three weekspostoperatively. Within a few days, function returned to the flexor profundusof the index finger. At three weekscontraction of the flexor
pollicis longus wasevident. By the sixth postoperative weekthere was normal powerin the flexor
pollicis longus, flexor profundusof the index finger, and ~he ,~r~lmt.or mtadra:us.
Thebiopsy report of the specimenof the tendonof the c!e:et~ b.ead o[:i~e p:;~na~orteres tendon
wasnon-specific tendinitis.
’quadratus and the flexor
29, 1968. The median nerve
:ough the pronator teres, when
ons between the median nerve
ledian nerve.
igin to the deep head of the
ronator
teres was severed and
~ed by injecting normalsaline,
becamevisible.
::i
zely. Within a few days,
eeks contraction of the
as normal powerin the flexor
)r quadratus.
of the pronator teres tendon :
ANTERIOR INTEROSSEOUS-NERVESYNDROME
91
recovery pattern of the patient after neurolysis suggests that the nerve
wasa mixedneuropraxia and axonotmesis.Thepromptreturn of full function
paretic flexor profundusto the index finger is indicative of neuropr~xia.The
delayedrecoveryin the flexor pollicis longusand pronator quadratus
axonotmesis~ith Wallerian degeneration.
3: A Puerto Rican man, twenty-seven years old, sustained multiple small laceratio~ of
one-third of the right forearm. Whenthe patient was first seen on July 25, 1968,
after injury, he was unable to flex the thumband index finger. Sensation was intact
; the hand.Therewasparalysis of the flexor pollicis longus, flexor profundusto the index
and the pronator quadratus. In addition there was someweaknessof the flexor superficialis
long and ring fingers. Electromyography
performedat this time revealed fibrillatioas in all
innervated by the anterior interosseous nerve and in part of the flexor superficiMis.
Anterior
224rnm
234mm
250ram
Fro. 8
topographyof the mediannerve at the involved level. I fibers are those of the interos; the Fe fibers are those of the flexor superficialis. (Reprinted from The Intraneural
of the Radial, ~iedian and Ulnar Nerves by SydneySunderland. Brain, 68 : 243-299,
August 7, 1968, six weeksafter injury, exploration of the mediannerve in the proximal
forearm revealed a neuromaon the posterior aspect of the nerve (Fig. 7) about two
proximalto the origin of the anterior interosseous nerve. Since the interosseous nerve
~arate bundle approximately2.5 centimeters proximal to its departure from the main
point 224 to 234 millimeters proximal to the radial styloid process
the bundles of the mediannerve were teased out in an effort to removethe neuromaand
damagedfasciculi. However,whenthe bundles involved in neuromawere identified and
stimulated proximally, there wasa definite response in the flexor superficialis mtmcles.
the lesion was firm and grossly appeared to resemble a non-functioning neuroma,it
$:~ot excised in order not to weakenthe active mtmclesof the handor lose somecritical mediansensation. Instead, the tourniquet was released for twenty minutes. It was then reinflated
entire brachioradialis compartmentwas openedthrough the proximal incision. A separate
curved velar incision was made at the wrist, and the brachioradialis tendon was
to the flexor pollicis loners tendon. In addition the tendon of the flexor profundusto
finger was severed at its musculotendinousjunction and transferred to the tendon of the
profundusto the ring finger at proper tension. Postoperatively, the fingers, wrist, andforearm
ized with dorsal and velar splints holding the tiand in a functional position for three
The patient’s sensation remained undisturbed. Whenthe plaster splints were removed
w~r~.arkedly improved and whenlast seen, eight weeks after operation, the patient
52-A, ::C,. ’., ,3"Ab:U,~,.F~y 1970
92
MORTON
SPINNER
could flex the pulp of the index finger to the distal pMmarcrease. The thumb could easily tou
the. index, long, and ring fingers with its interphalangeal joint flexed. The patient returned
work as a jeweler’s apprentice.
Case 4. A man, thirty-three
years old, was seen in June 1964, two months after a fall
flight of stairs. He sustained multiple hematomas and contusions and his right forearm was sw,
He stated he could use his hand fully at first but about three to four weeks after the injury ~
noted weakness in his right hand and inability to grasp small obiects in his fingers. The
examination revealed a complete paralysis of the flexor pollicis longus, the flexor profundus to
index and long fingers, and the pronator quadratus. There were no sensory abnormalities and
other forearm and hand muscles were grossly normal. Electromyographic studies revealed
tions in the paralyzed muscles. The intrinsic muscles were not sampled.
In July 1964, surgical exposure of the two heads of the pronator teres revealed scarring
fascia of the deep head and thrombosed vessels crossing the anterior interosseotts nerve.
were released and internal neurolysis using saline was performed. Four weeks
trace of flexion of the terminal ptmlanges of the long and index fingers was first noted. Acti~
motion of the interphalangeal joint of the thumb was seen at six weeks. Ftdl function
twelve weeks postoperatively. At follow-up three years later, the patient had a normal function
hand.
The patient had a complete ~nterior interosseous-nerve lesion wi%h~xom
~s evidenced ~y ~he ~brillations and the recovery p~t~ern.
C~s~ 5. A twenty-four-year-old
male plumber was first seen thirty months after onset,
paralysis of the deep flexors to the thumb and index finger of the right hand. In December
he was bending pipe when he noted sudden pain in the forearm. The following day he was
to use his thumb and index finger as well. Electromyogr~phic studies at that time were
and a presumptive diagnosis of probable rupture of the deep flexors to the thumb and index fin~er i
was proposed. Whe~he was ten years old he had sustained a penetrating wound of %he proxim~
part of %he right forearm that "went down to bone," but the wound healed without di~culty
complications.
Approximately fourteen months after his injur~
of the terminal phalanges of the thumb and index fingers. Twoand one-half years after onset he had
moderate weakness of the flexor pollicis longus, the flexor profundus to the index finger, and the
pronator quadratus.
C~s~ 6. A twenty-eight-year-old
male double bass player first noted weakness of the left
thumb and index finger while playing his instrument the day before he was first examined. At that
time he was unable to flex the terminal ioints of the thumb and index finger. With no treatment
except for rest of the extremity in a sling, full f~mction returned three weeks after onset. At followup two years after the episode of weakness he was continuing his musical career and h~d had
further trouble.
C.~SE 7. A fifty-eight-year-old
womanfirst noted pain in the proximal part of her
while she was carrying her heavy pocketbook suspended by a strap across this region. When
was first examined one week after the onset of pain~ there was no pain or local tenderness in
arm, but she had paralysis of the flexor muscles of the terminal ioint of the thumb and index finge~
Spontaneous recovery occurred four to six weeks after onset. Six years later she had had no further :i
difficulty.
C.~SE 8. A twenty-two-year-old
man noted weakness in his right thumb and index
arising one morning. He recalled no specific injury. The paralysis Of the flexor pollicis longus
flexor proflmdus to the index finger subsided over a three-week period. At follow-up
eighteen months after onset, there was no recurrence nor had any systemic disease developed
would explain his symptoms.
C.~SE 9. An eighteen-year-old girl had an open reduction of a fracture of the mid-shaft of th~
right radius and fixation with a plate and screws in March 1961. WhenI first saw the patient nine
months after operation, she was unable to flex the distal phalanx of the thumb; but other
flexors of the forearm and the pronator quadratt~ muscle were intact. The flexor t
not respond to electrical stimulation of the median nerve or to direct stimulation in the
motor end plate. Transfer of the flexor superficialis of the ring finger to the flexor pollicis longus
sulted in excellent function.
C~s~ 10. A forty-six-year-old
manhad an open reduction and pla~e fixation of radial fracture ........
..
93
rose. The thumbcould
flexed. The patient
}64, two monthsafter a fall do
s and his right forearm was
~ to four weeksafter the iniury
[ obiects in his fingers. The
longtm,the flexor profundus
.~ no sensory abnormalities and~
yographic studies reveMed
sampled.
tutor teres revealed scarring
nterior interosseotm nerve.
d. Four weeks postoperativel
~x fingers wasfirst noted.
~ixweeks.
Fullfunction
patient had a normal func
erve lesionzJth axonotm~
~rn.
,en thirty monthsafter
~e right hand. In December
:the following day he was
tudies at that time were
rs to the thumband index fin
mtrating woundof the ¯
rand healed without di~cult
regained some
one-half years after onset he
us to the index finger, and
junction of the pr.oximal and middle thirds in May1964. Whenhe was first seen, eight
s later, he wasunable to flex the terminal joint of the thumb.Therewasno electricM evidence
function in the flexor pollicis fondus. A transfer of the ring finger flexor superficialis
rmedwith subsequentreturn of full flexion of the thumb.
Discussion
::There are significant
variations in the anatomical relationship
of the median
to the pronator terns. Knowledge of these variations is essential when one
this region surgically.
Benton and Anson ~, reporting on 240 dissected
found that the course of the median nerve was between the superficial
and
, hems of the pronator terns in 82 per cent of limbs. In 9 per cent there was no
, head of the pronator terns. In 7 per cent the median nerve passed deep to the
~ head. In 2 per cent the nerve passed through the humeral head of the pronator
The:’~ are isolated reports of the median nerve passing anterior to the pronator
;~,:0. Because of these many variations,
the best surgical approach when exthe anterior interosseous nerve is to identify the median nerve proximal to
fibrosus and to trace it distally through the region of the pronator.
on the sixteen cases of anterior interosseous-nerve
paralysis which I
observed, my detailed anatomical dissections,
and a review of the nineteen
reported in the literature,
the following conclusions are suggested:
1. Patients who have spontaneous paralysis of the anterior interosseous nerve
initially
be treated by non-surgical
methods because many have a sarisreturn of function and no recurrence. However, if there is no sign of clinical
graphic improvement in six to eight weeks, exploration of the anterior
nerve is indicated.
Patients
who have had a penetrating
wound of the forearm and have an
to the anterior interosseous nerve or to the anterior-interosseous-fasieular
i: ~ponent of the median nerve are best treated
by primary exploration
and repair,
rat noted ~’eakness of the l~~l~e condition of the wound and the time elapsed since injury permit.
~ he w~first examined.At tt~/:!~i(;
8. If the angenor mterosseous nerve is irrelJarable,
appropriate muscle transfers
,~:,
~dex finger. With no treutm~i~U d~::
be1 performed. The flexor superficialis
of the ring finger is an excellent motor
ee weeks after onset At follow~: ~;the flexor pollicis longus tendon. The brachioradialis is a satisfactory substitute.
mtmieal career and had had ~ ~transfer of the distal portion of the flexor profundus tendon of the index finger
: :.;;~{he
functioning
profundus tendon of the ring or long finger at the wrist can proproximal pa~ of her forea~::;~9 satisfactory
flexion of the distal phala~ of the index finger.
p across this region. When s .~~:’4 There are variants of the syndrome. An isolated paralysis
of the flexor
~
pain or local tendernessin t~;~
.<.."
,,~:.~cm
longus
from ~ rupture of the muscle
can occur and must be differentiated
of the thumb and index ~:~j~i;
M
rs later she had had no f~h~~ tendon. Some of the intrinsic
muscles of the hand (especially
the firsg dorsal
adductor pollicis,
abductor digi~i quinti, and the second and third
~::~;~~
interossei)
may show gross parMysis or partial electrical
denervation in an
ht thumb and index
interosseous-nerve
syndrome.
The
finding
of
intrinsic
muscle
involvement
’the flexor po~icis
)d. At follow-up
paralysis of the long flexors of the thumb and the index and long fingers and
stemic dise~
pronator quadratus is not inconsistent
with the diagnosis of injury to the
interosseous nerve in the proximal par~ of the forearm.
acture ofthemid-shaft of
Finally, the anterior interosseous nerve and its branches are vulnerable to
?n I first sawthe patient
~en reduction of fraegures of the midshaft of the radius and in the muscle,f the thumb; but other
procedure. Page ~, in his original description of the procedure, drew attention
Theflexor pollicis iong~s
Jmulation in
~ the flexor pollicis longusr
Summary
Ten new cases of paralysis of the interosseous
nerve are described and the
~te fixation of radial fractu~
in these eases are correlated with anatomical studies and the findings preBONE AND JOINT
rep, orted in the literature.
MORTON SPINNER
The hand so paralyzed
has a typical
appearance
tUr~ance of pinch. The clinical
picture
is as constant
well known peripheral
nerve injuries.
Recommendations
for
treatment
are
with a characteristic
as that presented
by
offered.
References
I. BEATON,L. E., and ANSON,B. J.: The Relation of the Median Nerve to the Pronator ’
MI~scle. Anat. Rec., ~5: 23-26, 1939.
2. BELL, G. E., JR., and GOLDNER,
J. L.: Compression Neuropathy of the Median Nerve.
em Med. J., 49: 966-972, 1956.
3. BORCHARDT,
~i., and WJASMENSKI:
Der Nervus Medianus. Beitr. f. Klin. Chir., 107:
1917.
4. BR.~sH, J. C.: Neuro-Vascular Hila of Limb Muscles Edinbin’~h E and S Liv n~
5. F.~RBER, J. S., and BRY.~_x, R. S.: The Antermr Interosseous Nerve Syndrome. J. Bone
JointSurg.,50-A:521-523.
Apr.196~.
6. FE.~RN,
C. B. D’A.,and GO~)D~ELLO(V~
J. W.: Anterior
Inte,’osseous
NervePalsy.J. Bone
JointSurg.,47-B:91-93,Feb.1965.
7. FERNER,I~I.:Ein abnormer
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