Stemcelldoc's Weblog

November 22, 2012

Lateral Elbow Pain: Posterior Interosseous Nerve Compression

At the Centeno-Schultz Clinic we acknowledge that lateral elbow pain can be debilitating and impact daily function.

Not all lateral elbow pain is lateral epicondylitis as illustrated by a recent patient seen in clinic.

Joey is a 17 y/o hocky player with 1 year history of lateral elbow pain which was constant, progressive in nature and aggravated with rotation of his palm upward (supination).  He has undergone PT, trial of NSAID’s, heat, ice and 2 steroid injections without relief.  High dose steroids have signficant side effect both on tissue and stem cell function.

Joey had compression of posterior interosseus nerve which was confirmed by MSK ultrasound.  Treatment options include US guided Regenexx PL/SCP injections and possible hydrodissection.   A patient’s testimonial illustrates the potential of treating nerve injuries with ulrasound guided platelet therapy.

The posterior interosseous nerve (PIN) is nerve in the forearm. 

Posterior Interosseous Nerve

It is the continuation of the deep branch of the radial nerve.  It passes thru supinator muscle in its course from anterior to the posterior surface of the forearm. The PIN may become entrapped at the tendinous border of the supinator known as Aracade of Froshse. Posterior interosseous neuropathy is purely a motor syndrome resulting in finger drop, and radial wrist deviation on extension.  

Other causes of PIN dysfunction include trauma, synovitis, tumors, and iatrogenic injuries.

Exam:

Pain with resisted supination of the forearm.

Pain with resisted extension of extension of middle finger.

Tenderness over lateral epicondyle and distally over the aracade of Froshe. 

Other causes of lateral elbow pain which warrant consideration include:

C7 radiculopathy

Lateral epicondylitis

Extensor tendon rupture

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