Anterior Interosseous Nerve Syndrome: Is it a Compressive Neuropathy?

Anterior interosseous nerve (AIN) syndrome is a rare disease whose pathophysiology is controversial. Despite efforts to elucidate the pathophysiology of AIN syndrome, it has not yet been resolved. We reinterpret electrodiagnostic studies, magnetic resonance imaging (MRI), and surgical findings to clarify the pathophysiology of AIN syndrome.

In this retrospective case series, we included surgically treated 20 cases of nontraumatic AIN syndrome. Surgery was performed after a minimum of 12 weeks of conservative treatment. The clinical data and operation records were extracted from the medical records for analysis. All electrodiagnostic tests were reinterpreted by physicians with an American Board Certification in electrodiagnostic medicine. Moreover, every contrast-enhanced MRI performed during the assessment was reviewed by a musculoskeletal radiologist.

Of the twenty re-analyzed cases, nine AIN syndromes (45%) showed abnormal electromyography in non-AIN innervated muscles. Sensory nerve conduction studies were normal in all cases. Five magnetic resonance images (46%) showed signal changes in non-AIN-innervated muscles. Only four cases (20%) revealed definitive compression of the AIN during surgery.

Electrodiagnostic study and MRI indicated that many patients with AIN syndrome exhibited a diffuse pathologic involvement of the motor component of the median nerve. We conclude that the main pathophysiology of AIN syndrome would be diffuse motor fascicle neuritis of the median nerve in the upper arm.