Case Report
Volume 11 Issue 8 - 2022
Post Traumatic Anterior Interosseous Nerve Syndrome in a Child, Wait and See Approach - A Case Report
Asha Satish Barge1*, Satish Mahadeo Barge2, Siddhesh Satish Barge3, Kapil Ravikant Jagtap4 and Shivam Sambhaji Salunkhe5
1Department of Pain Management, Barge Pain Clinic, Satara, Maharashtra, India
2Department of Orthopedics, Mangalmurti Nursing Home, Satara, Maharashtra, India
3MBBS Internship, B.Y.L. Nair Charitable Hospital and Topiwala National Medical College, Mumbai, Maharashtra, India
4Senior Resident Doctor, Department of Orthopedics ESIC hospital and Model hospital, Andheri, Mumbai, Maharashtra, India
5MBBS Internship, King Edward Hospital, and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India
*Corresponding Author: Asha Satish Barge, Department of Pain Management, Barge Pain Clinic, Satara, Maharashtra, India.
Received: June 28, 2022; Published: July 27, 2022


Introduction: Peripheral entrapment neuropathies commonly present as pain and sensory-motor changes in the area innervated by that particular nerve. There are multiple causes of entrapment neuropathies and trauma is one of them. Involvement of the anterior interosseous nerve (AIN) is the most commonly seen entity following supracondylar humerus fractures in children. In the forearm, the motor division of the median nerve is known as AIN. Together with the anterior interosseous artery, the AIN travels deep in the forearm and supplies flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) to the index finger and pronator quadratus (PQ) muscles. The clinical manifestations of AIN compression are seen as a weakness in the thumb and the index finger. This is typically presented as the inability to flex the interphalangeal joints of the thumb and the distal interphalangeal joint of the index finger.

Presentation of Case: A nine-year-old male child from a poor family presented in our pain clinic with right forearm pain along with weakness in the right thumb and index finger, because of which the patient was not able to hold the pen and write in the classroom. There was restricted joint movement at the elbow. The patient gave a history of right-sided supracondylar fracture humerus (Gartland type III with posterior displacement), four and half months back. The fracture was treated with C-arm guided closed reduction and pinning with Kirschner wires under general anesthesia. There was no history of vascular compromise or any other associated nerve involvement. Diagnosis of AIN injury was missed when the child had visited the orthopedic hospital for the initial injury, as the child was extremely anxious, noncooperative, and frightened. Also, there was lot of edema around the elbow joint due to the fracture.

On the basis of detailed history taking and physical examination, the clinical diagnosis of AIN syndrome was made by us. The diagnosis was confirmed after performing different clinical tests including a positive pinch grip test on the affected side. The electrophysiological studies showed typical electromyographic findings. No further investigations were possible because of the poor economic condition of the family. The child was treated with wait and see policy along with physiotherapy, stretching exercises, and rehabilitation. The patient was regularly coming for follow-ups for the next three months. All the complaints of the patient were resolved spontaneously and complete restoration of AIN function was observed within six months of the initial trauma.

Discussion: Understanding the anatomy of the anterior interosseous nerve as well as the etiology of the anterior interosseous syndrome. Primary diagnosis, analysis of sensory-motor involvement and the multimodal treatment approach in children with AIN syndrome. An interdisciplinary and multimodal treatment plan will lead us to an exact diagnosis and this is how the health care providers can help the patient most effectively.

Keywords: Anterior Interosseous Nerve Palsy; Supracondylar Fracture Humerus; Clinical Suspicion; Wait and See


  1. Shrader MW. “Pediatric supracondylar fractures and pediatric physeal elbow fractures”. Orthopedic Clinics of North America2 (2008): 163-171.
  2. Lipscomb PR. “Vascular and neural complications in supracondylar fractures of the humerus in children”. Journal of Bone and Joint Surgery American3 (1955): 487-492.
  3. Lyons ST., et al. “Neurovascular injuries in type III humeral supracondylar fractures in children”. Clinical Orthopaedics and Related Research 367 (2000): 62-67.
  4. D’Ambrosia RD. “Supracondylar fractures of humerus-prevention of cubitus varus”. Journal of Bone and Joint Surgery American1 (1972): 60-66.
  5. Culp RW., et al. “Neural injuries associated with supracondylar fractures of the humerus in children”. Journal of Bone and Joint Surgery American8 (1990): 1211-1215.
  6. Campbell CC., et al. “Neurovascular injury and displacement in type III supracondylar humerus fractures”. Journal of Pediatric Orthopaedics1 (1995): 47-52.
  7. Cramer KE., et al. “Incidence of anterior interosseous nerve palsy in supracondylar humerus fractures in children”. Journal of Pediatric Orthopaedics4 (1993): 502-505.
  8. Spinner M and Schreiber SN. “Anterior interosseous-nerve paralysis as a complication of supracondylar fractures of the humerus in children”. Journal of Bone and Joint Surgery American8 (1969): 1584-1590.
  9. Campbell CC., et al. “Neurovascular injury and displacement in type III supracondylar humerus fractures”. Journal of Pediatric Orthopaedics1 (1995): 47-52.
  10. Sunderland S. “The intraneural topography of the radial, median, and ulnar nerves”. Brain 68 (1945): 243-299.
  11. Kiloh LG and Nevin S. “Isolated neuritis of the anterior interosseous nerve”. British Medical Journal4763 (1952): 850-851.
  12. Ulrich D., et al. “Anterior interosseous nerve syndrome: retrospective analysis of 14 patients”. Archives of Orthopaedic and Trauma Surgery1 (2011): 1561-1565.
  13. Dormans JP., et al. “Acute neurovascular complications with supracondylar humerus fractures in children”. The Journal of Hand Surgery 20 (1995): 1-4.
  14. Suso S., et al. “Compression of the anterior interosseous nerve after use of a Robert-Jones type ban dage for a distal end clavicle fracture. Case report”. The Journal of Trauma 36 (1994): 737-739.
  15. Geutjens GG. “Ischaemic anterior interosseous nerve injuries following supracondylar fractures of the humerus in children”. Injury 26 (1995): 343-344.
  16. McGraw JJ., et al. “Neurological complications resulting from supracondylar fractures of the humerus in children”. Journal of Pediatric Orthopaedics6 (1986): 647-650.
  17. PC Spinner and RJ Amadio. “Compressive neuropathies of the upper extremity”. Clinics in Plastic Surgery 30 (2003): 155-173.
  18. RA Berger. “Hand Surgery”. Lippincott Williams and Wilkins (2004).
  19. Harris N and Ali F. “Examination techniques in orthopaedics”. 2nd Cambridge: Cambridge University Press (2014).
  20. Tindall A., et al. “Case of the month: The skin wrinkle test: a simple nerve injury test for paediatric and uncooperative patients”. Emergency Medicine Journal11 (2006): 883-886.
  21. NA Hill., et al. “The incomplete anterior interosseous nerve syndrome”. The Journal of Hand Surgery American 10 (1985): 4-16.
  22. TW Proudman and PW Menz. “An anomaly of the median artery associated with the anterior interosseous nerve syndrome”. The Journal of Hand Surgery: British 17 (1992): 507-509.
  23. Grutter PW., et al. “The accuracy of distal posterior interosseous and anterior interosseous nerve injection”. The Journal of Hand Surgery American 29 (2004): 865-870.
  24. Choi SJ., et al. “Ultrasonography for nerve compression syndromes of the upper extremity”. Ultrasonography (2015).
  25. Miller TT and Reinus WR. “Nerve entrapmentsyndromess of the elbow, forearm, and wrist”. AJR 195 (2010): 585-594.
  26. AJ Dunn., et al. “MR imaging findings of anterior interosseous nerve lesions”. Skeletal Radiology 36 (2007): 1155-1162.
  27. Ochi K., et al. “Fascicular constrictions in patients with spontaneous palsy of the anterior interosseous nerve and the posterior interosseous nerve”. Journal of Plastic Surgery and Hand Surgery 1 (2012): 19-24.
  28. Park IJ., et al. “Spontaneous anterior interosseous nerve syndrome: clinical analysis of eleven surgical cases”. Journal of Plastic Surgery and Hand Surgery6 (2013): 519-523.
  29. Lubahn J and Cermak M. “Uncommon nerve compression syndromes of the upper extremity”. Journal of the American Academy of Orthopaedic Surgeons 6 (1998): 378-386.
  30. Miller-Breslow A., et al. “Nonoperative treatment of anterior interosseous nerve paralysis”. The Journal of Hand Surgery 15A (1990): 493-496.
  31. Nakano KK., et al. “Anterior interosseous nerve syndromes: diagnostic methods and alternative treatments”. Archives of Neurology 34 (1977): 477-480.
Citation: Asha Satish Barge., et al. “Post Traumatic Anterior Interosseous Nerve Syndrome in a Child, Wait and See Approach - A Case Report”. EC Paediatrics 11.8 (2022): 55-63.

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