Disclosures: Clay Guynn, DO, FAAPM&R, BC, AOAPMR, CAQSM: No financial relationships or conflicts of interest

Case Diagnosis: A 45-year-old male with Posterior Interosseous Nerve (PIN) Syndrome.

Case Description or Program Description: The patient presented with right-sided upper extremity pain radiating down to his elbow and hand. The patient reported having used a combination of NSAIDs, TENS unit, and stretches to no relief. The patient has a past medical history of lateral epicondylitis, hypertension, hyperlipidemia, obesity, with no prior history of relevant surgeries. During the physical exam, tenderness was elicited over the right infraspinatus which radiated down to the lateral arm/elbow along with a positive Tinel’s sign at the myotendinous junction of the extensor tendon at the lateral arm. Ultimately, the patient was referred for an EMG evaluation.

Setting: Outpatient Clinic

Assessment/Results: EMG was negative for cervical radiculopathy but indicated entrapment consistent with Posterior Interosseous Nerve (PIN) Syndrome.Ultrasound examination showed hypoechoic changes of the PIN nerve at the lateral elbow. The patient underwent a right-sided infraspinatus tender point injection which relieved the pain radiating down to the right elbow. However, his pain from the right elbow to the dorsal hand persisted. Then, the patient underwent a PIN hydro-dissection which relieved the pain from his right elbow to his dorsal hand. At the two-week follow-up, all presenting symptoms were resolved.

Discussion (relevance): Ultrasound-guided nerve hydro-dissection is a technique that involves the injection of an anesthetic, saline, or 5% dextrose in water to separate the nerve from surrounding tissue. Current literature supports a treatment algorithm for PIN syndrome which includes conservative measures such as rest, activity modification, stretching, splinting, and NSAIDS followed by lidocaine/corticosteroid injections or ultimately surgical decompression.

Conclusions: This case’s favorable outcome shows the need for high-powered studies to evaluate the efficacy of ultrasound-guided nerve hydro-dissection in treating various kinds of nerve entrapments.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/treatment-of-posterior-interosseous-nerve-syndrome-with-nerve-hydro-dissection-a-case-report/