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(a) T2 weighted axial (black arrow) and (b) T1 weighted saggital MRI sections demonstrated a mass surrounding the proximal radius with signal intensity compatible with a lipoma (white arrow).
Source publication
Several different pathologies may play a role in the etiology of posterior interosseous nerve (PIN) palsy such as trauma, radial tunnel syndrome, tumors, vasculitis, septic arthritis, and rheumatoid synovitis. The most common atraumatic factor is the compression of the nerve through its anatomic path. Parosteal lipoma around the proximal radius is...
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Citations
... There is an agreement among surgeons that the recovery of the nerve function depends mainly on the duration of symptoms, and early surgical decompression will offer faster recovery and better functional outcomes [1,9]. However, despite the success of lesion surgical excision to provide PIN full recovery, in some cases, even with early surgical intervention, full recovery was not gained, requiring further tendon transfer [10]. Vikas et al. suggested that surgical decompression delay beyond 18 months may lead to fibrosis of the muscles innervated by the PIN, increasing the chance for further tendon transfer to gain accepted functional outcomes [1]. ...
... The approach used for surgery should offer a wide exposure and a safe window to perform dissection and excision of the mass for the safety of the neural structures. We used the anterior approach for excising the mass, which was recommended in previous studies, as it offered better visualization and access to the lesion, and better use of the anterior approach for excising these lesions [5,8,10]. However, in their case report, Vikas et al. used the posterior approach to access a parosteal bilobed lipoma, and they reported excellent visualization of PIN and its branches, which guarded against iatrogenic injury nerve during dissecting and excising the lesion [1]. ...
Background: Lipomas are benign, slow-growing tumors frequently subcutaneous and asymptomatic, intramuscular lipoma constituting a rare subtype. However, a lipoma occurring nearby the proximal radius may cause posterior interosseous nerve (PIN) entrapment.
Case presentation: We described an uncommon case of a 45-year-old-man with a history of progressive, painless proximal right (dominant) forearm swelling for 4 months associated with PIN entrapment syndrome, presenting as fingers extension weakness. Intramuscular lipoma was observed in the supinator muscle in the magnetic resonance imaging (MRI). Lipoma surgical excision and release of the PIN through proximal forearm direct anterior approach was performed.
Results: The histopathological examination confirmed the diagnosis of benign intramuscular lipoma. The follow-up of the patient showed full recovery within three months postoperatively.
Discussion: Intramuscular lipoma is rare; however, it could originate from supinator muscle in the forearm, presenting with vague pain and could lead to compression of nearby neurovascular structures such as the PIN. Clinical evaluation and imaging studies, especially MRI, are crucial for diagnosis. If neural compression is evident, surgical resection is mandatory.
Conclusion: Intramuscular lipoma entrapping PIN is rare and requires early clinical diagnosis confirmed by imaging and neurophysiological studies, surgical excision being the method of choice for optimum functional outcomes.
Entrapment of posterior interosseous nerve (PIN) can be due to fracture dislocation of elbow, fibrous arcade of Frohse, neoplasms (lipoma, schwannoma), ganglion cysts and rheumatoid synovitis. Parosteal lipomas are extremely rare. These tumors grow slowly and as they grow, they can compress a nearby nerve producing sensory and motor disturbances. Till date less than 50 cases of PIN entrapment due to parosteal lipoma have been reported in literature. However, to the best of our knowledge, none was bilobed. A 54-year-old female patient presented with progressive weakness of the right-hand extensors including thumb for the last 5 months with no sensory loss. Clinico-radiological findings and electophysiological studies revealed parosteal lipoma causing entrapment of PIN. Surgical excision of the lesion was done through posterior approach. The excised mass was sent for histopathological examination which confirmed the diagnosis of lipoma. Appreciable recovery was first noticed at 3 months and complete recovery was seen at 7 months. No recurrence was seen until 2 years of follow up. Urgent surgical excision is necessary to prevent entrapment of this nerve and facilitate early functional and neurological recovery.
