Title : Traumatic iatrogenic posterior interosseus nerve axonotmesis due to peripheral intravenous insertion: A case report
Abstract:
We present a case of a 43-year-old patient with a past medical history of intravenous drug abuse who presented with one month of numbness, pain, and paresthesia localized to the left posterior forearm and dorsum of hand. The patient also endorsed subjective weakness affecting grip strength and wrist movement. The onset of these symptoms was associated with an emergency room visit, during which the patient required multiple attempts at peripheral intravenous insertion. During the final attempt, the patient felt a sharp “electric” pain in his forearm. Access was then obtained via ultrasound guidance. On evaluation, there was decreased sensation in the superficial radial nerve sensory territory, and weakness with wrist and finger extension. The patient underwent an urgent electrodiagnostic study which revealed posterior interosseus neuropathy, axon loss in type, severe in degree, with motor axon denervation limited to the posterior interosseus nerve muscles. Superficial radial sensory testing was normal. The patient was then referred to occupational therapy. After 6 sessions there was objective improvement in wrist extension and grip strength, along with subjective improvement in tolerance of fine motor tasks such as braiding hair. This case illustrates the prompt diagnosis and treatment of a rare case of traumatic posterior interosseus neuropathy due to peripheral intravenous insertion. Traumatic cases of PIN neuropathy have very rarely been described in case reports after intravenous cannulation of the forearm, last described in 1999. In addition, traumatic posterior interosseus neuropathies are often associated with fractures and/or local hematoma causing a compression neuropathy leading to neurapraxia, not axonotmesis.
