Difficulty writing or holding small items

Introduction Patients with anterior interosseous nerve compression syndrome often complain of difficulty in writing or taking small items, but no change in hand feeling.

Cause

Causes

The etiology of anterior interosseous nerve compression can be divided into three categories:

1. Direct trauma.

2. Partial median nerve injury causes anterior interosseous nerve injury.

3. Cardiac or neuropathy caused by inflammation of the anterior interosseous nerve. There are other reasons that can cause anterior interosseous nerve compression.

an examination

Related inspection

Deep flexor muscle strength test refers to total extensor muscle strength test

The anterior interosseous nerve compression syndrome is pure motor neuron paralysis, which is characterized by weakening of the flexor digitorum of the flexor digitorum of the thumb, the index finger and the middle finger. In addition, the anterior interosseous nerve has a partial sensation that supports the wrist. Therefore, pain in the forearm and wrist is a common clinical manifestation of this disease.

1. Typical signs: spontaneous pain in the proximal forearm volar, pronated round muscle area and volar palmar side, the symptoms are aggravated during activity, especially when the forearm is active. Due to pain, the activity of the limb is limited. Pain can be relieved within weeks or months. The typical clinical manifestations are weakening of the flexor digitorum of the flexor hallucis longus, the index finger and the middle finger, and the muscles of the anterior muscle. The patient complains that it is often difficult to write or take small items, but there is no change in the hand.

The clinical signs are still mainly due to the weakening of the flexor digitorum of the flexor hallucis longus, the index finger and the middle finger, and the muscle strength of the anterior spine. The thumb and index finger grip test is helpful for diagnosis.

2. Anatomical and clinical features of atypical anterior interosseous nerve compression syndrome: Due to the frequent anatomical variation, the clinical manifestations of anterior interosseous nerve compression often have certain changes.

(1) The middle finger refers to the deep flexor: it can be innervated by the ulnar nerve (about 50%), so sometimes the clinical manifestation is only the weakening of the flexor digitorum of the flexor hallucis longus and the index finger.

(2) The median nerve and the ulnar nerve Martin-Gurber anastomosis: about 17%, of which the more common abnormal anastomosis is the anastomosis of the anterior interosseous nerve and the ulnar nerve. When the interosseous nerve is stuck, it can cause the muscle strength of the hand to weaken.

(3) refers to deep flexor: can be completely dominated by the anterior interosseous nerve, therefore, clinical manifestations of all the fingers of deep flexor muscle weakness.

(4) anterior interosseous nerve: can be branched to control the superficial flexor. In the diagnosis of anterior interosseous nerve compression, the most common misdiagnosis is the fracture of the flexor hallucis longus and the deep flexor tendon. Of the 33 cases of anterior interosseous nerve compression reported by Hill, 10 were diagnosed with a tear. There have also been reports of misdiagnosis of tendon tears as anterior interosseous nerve compression. Therefore, clinical attention should be paid to identification. The disease should be differentiated from thoracic outlet syndrome, radiculopathy, and brachial plexus neuritis, partial medial nerve injury. Electrophysiological examination has important diagnostic value for the identification of anterior interosseous nerve compression.

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Improper holding: The upper limb symptoms of cervical spondylosis are unstable. Cervical spondylosis, also known as cervical vertebra syndrome, is a general term for cervical osteoarthritis, proliferative cervical spondylitis, cervical nerve root syndrome, and cervical disc herniation. It is a disease based on degenerative pathological changes. Mainly due to long-term cervical vertebrae strain, bone hyperplasia, or disc herniation, ligament thickening, resulting in cervical spinal cord, nerve root or vertebral artery compression, a series of clinical syndromes of dysfunction. The manifestations of cervical disc degeneration and its secondary pathological changes, such as vertebral instability, loosening; nucleus protruding or prolapse; spur formation; ligament hypertrophy and secondary spinal stenosis, etc., stimulated or oppressed Adjacent nerve roots, spinal cord, vertebral artery, and cervical sympathetic nerves, and cause a variety of symptoms and signs of the syndrome.

2. Hand grip weakness: Hand grip weakness is mainly manifested in the absence of strength when holding an object. Hand nerve compression syndrome, pre-spinal syndrome, cervical spondylosis, tennis elbow and other diseases can cause hand grip weakness. The nerve compression syndrome is one of the bone-fiber tube and ventricular compression syndrome. For the peripheral nerves, a certain part of the bone fiber tube, a small number of fibrous edges caused by compression and chronic damage caused by inflammatory reactions, resulting in abnormal neurological function.

3. The feeling of the little finger disappears: The symptoms of the ulnar nerve injury are mainly the wrist injury mainly manifested as interosseous rib, sacral muscle, ring of the abductor muscle paralysis, small finger claw deformity and finger adduction, abduction obstacle and Froment A half-finger sensation of the sign and the ulnar side of the hand and the ulnar side, especially the little finger feeling disappeared.

The anterior interosseous nerve compression syndrome is pure motor neuron paralysis, which is characterized by weakening of the flexor digitorum of the flexor digitorum of the thumb, the index finger and the middle finger. In addition, the anterior interosseous nerve has a partial sensation that supports the wrist. Therefore, pain in the forearm and wrist is a common clinical manifestation of this disease.

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