A Rare Case of Focal Neuropathy: Posterior Interosseous Neuropathy due to Lipoma
Küçük Resim Yok
Tarih
2017
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Posterior interosseöz sinir; radiyal sinirin supinator kası geçtikten sonra ayrılan saf motor dalıdır. Özellikle ön kolda parmak ekstansörlerini inerve eder. Posterior interosseöz sinir tutuluşu en çok ulna kırığı ile proksimal radius başı çıkığının kombinasyonu olan monteggia kırıklarında görülür. Travmatik olmayan nedenleri arasına idiyopatik, enflamatuvar hastalıklar, supinator kas geçişinde sıkışma, nöraljik amiyotrofi, yer kaplayan oluşum gibi nedenler yer almaktadır. Hastaların özellikle parmak ekstansörleri etkilenmektedir. Duyu kusu yoktur. Kırk dokuz yaşında kadın hasta, 4 sene önce sağ el üçüncü, dördüncü parmaklarından başlayıp diğer parmaklara yayılan güçsüzlük nedeniyle başvurdu. Nörolojik muayenesinde duyu kusuru olmaksızın parmak ve bilek ekstansiyonunda zafiyet saptandı. Özgeçmişinde aynı yakınma ile başvurduğu hekimler tarafından önce karpal tünel sendromu ardından kubital tünel sendromu tanısı konularak ameliyat öyküsü mevcuttu. Şikayetlerinde düzelme olmaması nedeniyle bize başvuran hastaya yapılan tetkikler sonucunda nadir olarak görülen lipoma bağlı gelişen posterior interosseöz nöropati (PİN) tanısı konuldu. Operasyon sonrası rehabilitasyon programına alınan hastada 5 ay sonra belirgin düzelme saptanmadı. Nadir görülen PİN'li hastalarda erken tanı ve tedavi yaklaşımının prognoz açısından önemli olması nedeniyle olgumuzu sizlerle paylaşmak istedik
The posterior interosseous nerve is a pure motor branch of the radial nerve after passing the supinator muscle. It especially innervates the extensor muscles of fingers in the forearm. Injury of the posterior interosseous nerve is most commonly seen in Monteggia fractures, which results from a combination of ulna fracture and proximal radius head dislocation. Idiopathic-inflammatory disease, impingement of the nerve at supinator muscle, neuralgic amyotrophy, and space-occupying lesions are other non-traumatic causes of posterior interosseous neuropathy (PIN). Motor deficits of finger extensors is the main clinical manifestation in the posterior interosseous nerve injury and sensory loss is never seen. A woman aged 49 years presented due to weakness that began 4 years ago in the right 3rd and 4th fingers, which had spread to other fingers. on neurologic examination, paresis of finger and wrist extensors without sensory loss was detected. the patient underwent surgery due to carpal tunnel syndrome and later, cubital tunnel syndrome because of her symptoms. After the operations, her symptoms did not regress and she was evaluated again by us. With her clinical and electrophysiological findings, PIN was diagnosed and on radiologic imaging, a focal lesion and lipoma was found. A rare cause of PIN due to lipoma was diagnosed and she underwent surgery again. A physiotherapy program was started after the operation but after 5 months, there was no significant regression of paresis. We want to report this case because early diagnosis and treatment is important in regaining motor functions in this rare clinical entity
The posterior interosseous nerve is a pure motor branch of the radial nerve after passing the supinator muscle. It especially innervates the extensor muscles of fingers in the forearm. Injury of the posterior interosseous nerve is most commonly seen in Monteggia fractures, which results from a combination of ulna fracture and proximal radius head dislocation. Idiopathic-inflammatory disease, impingement of the nerve at supinator muscle, neuralgic amyotrophy, and space-occupying lesions are other non-traumatic causes of posterior interosseous neuropathy (PIN). Motor deficits of finger extensors is the main clinical manifestation in the posterior interosseous nerve injury and sensory loss is never seen. A woman aged 49 years presented due to weakness that began 4 years ago in the right 3rd and 4th fingers, which had spread to other fingers. on neurologic examination, paresis of finger and wrist extensors without sensory loss was detected. the patient underwent surgery due to carpal tunnel syndrome and later, cubital tunnel syndrome because of her symptoms. After the operations, her symptoms did not regress and she was evaluated again by us. With her clinical and electrophysiological findings, PIN was diagnosed and on radiologic imaging, a focal lesion and lipoma was found. A rare cause of PIN due to lipoma was diagnosed and she underwent surgery again. A physiotherapy program was started after the operation but after 5 months, there was no significant regression of paresis. We want to report this case because early diagnosis and treatment is important in regaining motor functions in this rare clinical entity
Açıklama
Anahtar Kelimeler
Nörolojik Bilimler
Kaynak
Türk Nöroloji Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
23
Sayı
1
