Anterior Interosseous Nerve Syndrome with Preserved FPL Flexion Treatment by Fascicular Microneurolysis at the Elbow

Description

This video presentation features a detailed case report led by Scott Wolfe from New York, discussing a unique instance of anterior interosseous nerve syndrome in a 57-year-old right-hand dominant female patient. The presentation begins with a review of the patient's medical history, highlighting her severe weakness in the right thumb and index finger, which was preceded by significant elbow pain and has shown an enigmatic preservation of thumb interphalangeal (IP) flexion. The team outlines the diagnostic process including electrodiagnostic testing and advanced imaging techniques like MRI and high-resolution ultrasound to identify nerve constrictions.



The discussion is supported by visual aids, including MRI imaging that illustrates the hourglass constriction of the anterior interosseous nerve. Specialists Carlo Milani and Dr. Darryl Sneag contribute their findings, explaining the electrodiagnostic patterns indicative of denervation, which ultimately leads to the diagnosis of anterior osseous nerve syndrome caused by neuralgic amyotrophy. The report focuses on the surgical intervention of vesicular micro neurolysis as an experimental approach, documenting the technical details of the surgery including the identification and treatment of fascicular constrictions. The presence of a previously unidentified accessory muscle, the Ganser muscle, is also explored, suggesting its potential role in the patient's limited thumb flexion.



Post-operative outcomes are promising, with the patient reporting improved strength in thumb and finger flexion, and the presentation concludes with suggestions for the indications of surgery in similar cases, highlighting the importance of precise diagnostic imaging and surgical techniques in treating nerve injuries.

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