Fascicular constrictions above elbow typify anterior interosseous nerve syndrome

• Published in: Muscle & nerve 2020-03, Vol.61 (3), p.301-310
• Main Authors: Sneag, Darryl B., Arányi, Zsuzsanna, Zusstone, Esther M., Feinberg, Joseph H., Queler, Sophie C., Nwawka, O. Kenechi, Lee, Steve K., Wolfe, Scott W.
• Format: Article
• Language: English
• Subjects: anterior interosseous nerve syndrome; Compression; Constriction, Pathologic - diagnostic imaging; Constrictions; Elbow; Elbow (anatomy); Elbow Joint - innervation; fascicular constriction; Female; Forearm; Humans; Magnetic resonance; Magnetic Resonance Imaging; Male; Median nerve; Median Nerve - diagnostic imaging; Median Nerve - pathology; MRI; Nerves; neuralgic amyotrophy; Neuropathy; Parsonage‐Turner syndrome; Peripheral Nervous System Diseases - diagnostic imaging; Peripheral Nervous System Diseases - pathology; Syndrome; Ultrasonography; Ultrasound
• ISSN: 0148-639X; 1097-4598
• DOI: 10.1002/mus.26768

Introduction In this study we tested the hypothesis that fascicular constrictions (FCs) of the median nerve proximal to the elbow joint characterize anterior interosseous nerve syndrome (AINS). Methods Magnetic resonance neurography (MRN) and ultrasound (US) examinations were evaluated in 45 patients with clinically suspected AINS. All 22 patients at site 1 underwent MRN and 8 underwent US; all 23 patients at site 2 underwent US. Results Median nerve FCs were identified in all MRN cases; FCs and/or fascicular enlargements were identified in 88% of US cases. Most FCs were in the mediannerve posterior/posteromedial region and were proximal to the elbow joint line (mean distance: MRN, 5.4 cm; US, 7.5 cm), with the exception of a single FC (located 1 cm distal). No extrinsic compression of median or anterior interosseous nerves was identified in the arm or forearm. Discussion AINS is a noncompressive neuropathy characterized by median nerve FCs in the arm. See editorial on pages 268–270 in this issue.