Clinics in Shoulder and Elbow

대한견·주관절의학회 (Korean Shoulder and Elbow Society)
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Posterior Interosseous Nerve Palsy Caused by a Ganglion of the Arcade of Frohse

  • Lee, Seung Jin (Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Hyun, Yoon Suk (Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Baek, Seung Ha (Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Seo, Ji Hyun (Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center) ;
  • Kim, Hyun Ho (Department of Orthopedic Surgery, Kangdong Sacred Heart Hospital, Hallym University Medical Center)
  • 투고 : 2018.09.10
  • 심사 : 2018.10.22
  • 발행 : 2018.12.01
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초록

A 51-year-old male who is right-handed visited the outpatient for right fingers-drop. The patient's fingers, including thumb, were not extended on metacarpophalangeal joint. The active motion of the right wrist was available. The electromyography and nerve conduction velocity study were consistent with the posterior interosseous neuropathy. Further evaluation was done with the magnetic resonance imaging for finding the space-occupying lesion or any possible soft tissue lesion around the radial nerve pathway. On magnetic resonance imaging, the ganglion cyst, which was about 1.8 cm in diameter, was observed on the proximal part of the superficial layer of the supinator muscle (Arcade of Frohse). The surgical excision was done on the base of ganglion cyst at the base of stalk of cyst which looked to be connected with proximal radioulnar joint capsule. The palsy had completely resolved when the patient was observed on the outpatient department a month after the operation.

키워드

GJGJB6_2018_v21n4_252_f0001.png 이미지

Fig. 1. (A) Sagittal T2-weighted magnetic resonance imaging (MRI) shows well-defined hyperintense cystic mass consistent with ganglion overlying the proximal radius. (B) Axial T2-weighted MRI shows well-defined hyperintense cystic mass consistent with ganglion overlying the proximal radius (arrow: ganglion stalk). (C) Two serial axial T1-weighted MRI images show posterior interosseous nerve (PIN) compression by ganglion (arrows: PIN, solid lines: ganglion cyst, arrowheads: supinator muscle).

GJGJB6_2018_v21n4_252_f0002.png 이미지

Fig. 2. (A) Brachioradialis is retracted with ragnell retractor and common extensors are retracted with Volkmann retractor (4 prong) (arrow: Arcade of Frohse, solid line: posterior interosseous nerve under the cyst, arrowhead: direction of stalk). (B) Ganglion cyst was excised at the base of the stalk of the cyst which seemed to be connected to the proximal radioulnar joint capsule.

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