Posterior interossous neuropathy in rheumatoid arthritis

Area of Science:

• Orthopedics
• Rheumatology
• Neurology

Background:

• Non-traumatic posterior interosseous nerve entrapment is rare.
• Elbow synovitis from rheumatoid arthritis is a potential cause.
• Presents as inability to extend metacarpophalangeal joints, mimicking extensor tendon rupture.

Purpose of the Study:

• To evaluate treatment outcomes for posterior interosseous nerve entrapment caused by rheumatoid arthritis-induced synovitis.
• Compare the efficacy of corticosteroid injections versus surgical decompression.

Main Methods:

• Review of cases with posterior interosseous nerve entrapment due to rheumatoid arthritis synovitis.
• Analysis of treatment modalities including corticosteroid injection and surgical nerve decompression with synovectomy.

Main Results:

• Corticosteroid injection achieved a 43% success rate.
• Early surgical nerve decompression, with or without synovectomy, resulted in good or excellent nerve recovery in all reported cases.
• Delayed treatment leading to chronic denervation may necessitate tendon transfers.

Conclusions:

• Surgical decompression is superior to corticosteroid injection for rheumatoid arthritis-associated posterior interosseous nerve entrapment.
• Timely surgical intervention is crucial for optimal nerve recovery.
• Tendon transfers are a viable option for chronic cases with significant denervation.