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      Anterior interosseous nerve syndrome : Fascicular motor lesions of median nerve trunk

      research-article
      , MD , , MD, , MD, , MD, , MD, , MD, , MD
      Neurology
      Lippincott Williams & Wilkins

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          Abstract

          Objective:

          We sought to determine lesion sites and spatial lesion patterns in spontaneous anterior interosseous nerve syndrome (AINS) with high-resolution magnetic resonance neurography (MRN).

          Methods:

          In 20 patients with AINS and 20 age- and sex-matched controls, MRN of median nerve fascicles was performed at 3T with large longitudinal anatomical coverage (upper arm/elbow/forearm): 135 contiguous axial slices (T2-weighted: echo time/repetition time 52/7,020 ms, time of acquisition: 15 minutes 48 seconds, in-plane resolution: 0.25 × 0.25 mm). Lesion classification was performed by visual inspection and by quantitative analysis of normalized T2 signal after segmentation of median nerve voxels.

          Results:

          In all patients and no controls, T2 lesions of individual fascicles were observed within upper arm median nerve trunk and strictly followed a somatotopic/internal topography: affected were those motor fascicles that will form the anterior interosseous nerve further distally while other fascicles were spared. Predominant lesion focus was at a mean distance of 14.6 ± 5.4 cm proximal to the humeroradial joint. Discriminative power of quantitative T2 signal analysis and of qualitative lesion rating was high, with 100% sensitivity and 100% specificity ( p < 0.0001). Fascicular T2 lesion patterns were rated as multifocal (n = 17), monofocal (n = 2), or indeterminate (n = 1) by 2 independent observers with strong agreement (kappa = 0.83).

          Conclusion:

          It has been difficult to prove the existence of fascicular/partial nerve lesions in spontaneous neuropathies using clinical and electrophysiologic findings. With MRN, fascicular lesions with strict somatotopic organization were observed in upper arm median nerve trunks of patients with AINS. Our data strongly support that AINS in the majority of cases is not a surgically treatable entrapment neuropathy but a multifocal mononeuropathy selectively involving, within the main trunk of the median nerve, the motor fascicles that continue distally to form the anterior interosseous nerve.

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          Most cited references34

          • Record: found
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          Neuralgic amyotrophy; the shoulder-girdle syndrome.

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            Peripheral nerve fascicles: anatomy and clinical relevance.

            Within a peripheral nerve, the individual nerve fibers are grouped together in fascicles. Whether there is somatotopic organization within these fascicles has long been of interest, the subject of many investigations, and somewhat controversial. Evidence from diverse sources now points to important somatotopic clustering of nerve fibers within most of the length of the nerve. Information is lacking regarding proximal segments, particularly the plexus and spinal nerve root levels. As a result of this somatotopic arrangement, partial focal nerve lesions can produce restricted clinical deficits that defy the classic rules of localization. Examples of such restricted nerve lesions are provided in this review. Recognition of fascicle somatotopy is also important in the surgical approach to disorders of peripheral nerves.
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              • Record: found
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              Nerves and nerves injuries

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                Author and article information

                Contributors
                Journal
                Neurology
                Neurology
                neurology
                neur
                neurology
                NEUROLOGY
                Neurology
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0028-3878
                1526-632X
                18 February 2014
                18 February 2014
                : 82
                : 7
                : 598-606
                Affiliations
                From the Departments of Neuroradiology (M.P., P.B., M.B.) and Neurology (H.-M.M., M.W.), Heidelberg University Hospital; Clinical Cooperation Unit Neurooncology (M.W.), German Cancer Research Center (DKFZ), Heidelberg; Department of Neurology (J.S.), RWTH University Hospital Aachen; and Center for Neurology and Clinical Neurophysiology Neuer Wall (H.K.), Hamburg, Germany.
                Author notes
                Correspondence to Dr. Pham: mirko.pham@ 123456med.uni-heidelberg.de

                Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

                Article
                NEUROLOGY2013540237
                10.1212/WNL.0000000000000128
                3963415
                24415574
                36dcaf0f-cc12-4056-8e80-90b377e0385e
                © 2014 American Academy of Neurology

                This is an open access article distributed under the terms of the Creative Commons Attribution-Noncommercial No Derivative 3.0 License, which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.

                History
                : 25 July 2013
                : 10 October 2013
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