Ann Rehabil Med.  2013 Feb;37(1):138-142. 10.5535/arm.2013.37.1.138.

Pseudo-Anterior Interosseous Nerve Syndrome by Multiple Intramuscular Injection

• Kim MY
• Kim DH
• Park BK
• Kim BH

• KMID: 2266663
• DOI: http://doi.org/10.5535/arm.2013.37.1.138

Abstract

Blind intramuscular injection might cause severe neurovascular injury if it would be performed with insufficient knowledge of anatomy around the injection area. We report a case of pseudo-anterior interosseous syndrome caused by multiple intramuscular steroid injections around the antecubital area. The patient had weakness of the 1st to 3rd digits flexion with typical OK sign. Muscle atrophy was noted on the proximal medial forearm, and sensation was intact. The electrophysiologic studies showed anterior interosseous nerve compromise, accompanying with injury of the other muscles innervated by the median nerve proximal to anterior interosseous nerve. Magnetic resonance imaging of the left proximal forearm revealed abnormally increased signal intensity of the pronator teres, flexor carpi radialis, proximal portion of flexor digitorum superficialis, and flexor digitorum profundus innervated by the median nerve on the T2-weighted images. This case shows the importance of knowledge about anatomic structures in considering intramuscular injection.

Keyword

Pseudo-anterior interosseous nerve syndrome; Intramuscular injections

MeSH Terms

Forearm
Humans
Injections, Intramuscular
Magnetic Resonance Imaging
Median Nerve
Muscles
Muscular Atrophy
Sensation

Figure

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  Fig. 1 OK sign was present in the left hand (A) and muscle atrophy (arrow) was observed in the medial side of the proximal forearm (B).

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  Fig. 2 Fat-suppressed T2-weighted magnetic resonance imaging of the left proximal forearm showed increased signal intensity in the PT, FCR, some portion of FDS, and deep portion of FDP. PT, pronator teres; FCR, flexor carpi radialis; FDS, flexor digitorum superficialis; FDP, flexor digitorum profundus; FCU, flexor carpi ulnaris; PL, palmaris longus; R, radius; U, ulna; arrowhead, median nerve; short arrow, superficial radial nerve; long arrow, anterior interosseous nerve; thick arrow, ulnar nerve.

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  Fig. 3 Schematic diagram of possible injury mechanism of this case demonstrates injury of anterior interosseous nerve (AIN) branch accompanied by muscular branch injury of proximal median nerve in multiple sites on the antecubital area. FCR, flexor carpi radialis; FDP, flexor digitorum profundus to 2nd and 3rd digits; FDS, flexor digitorum superficialis; FPL, flexor pollicis longus; PL, palmaris longus; PQ, pronator quadratus; PT, pronator teres.

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