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. 2009 Dec;53(4):300-10.

Conservative management of posterior interosseous neuropathy in an elite baseball pitcher's return to play: a case report and review of the literature

Andrew Robb  1 , Sandy Sajko
Affiliations

Conservative management of posterior interosseous neuropathy in an elite baseball pitcher's return to play: a case report and review of the literature

Andrew Robb et al. J Can Chiropr Assoc. 2009 Dec.

Abstract
in English, French

This report documents retrospectively a case of Posterior Interosseous Neuropathy (PIN) occurring in an elite baseball pitcher experiencing a deep ache in the radial aspect of the forearm and altered sensation in the dorsum of the hand on the throwing arm during his pitching motion. The initial clinical goal was to control for inflammation to the nerve and muscle with active rest, microcurrent therapy, low-level laser therapy, and cessation of throwing. Minimizing mechanosensitivity at the common extensor region of the right elbow and PIN, was achieved by employing the use of myofascial release and augmented soft tissue mobilization techniques. Neurodynamic mobilization technique was also administered to improve neural function. Implementation of a sport specific protocol for the purposes of maintaining throwing mechanics and overall conditioning was utilized. Successful resolution of symptomatology and return to pre-injury status was achieved in 5 weeks. A review of literature and an evidence-based discussion for the differential diagnoses, clinical examination, diagnosis, management and rehabilitation of PIN is presented.

Ce rapport documente rétrospectivement un cas de neuropathie interosseuse postérieure (NIP) s’étant produit chez un lanceur élite au baseball qui avait une forte douleur dans la face radiale de l’avant-bras et une sensation modifiée de la face dorsale de la main du bras qui lance lors du mouvement du lancer. Le premier objectif clinique était de contrôler l’inflammation du nerf et du muscle avec un repos actif, un traitement par micro-courant, une thérapie au laser à faible niveau et la cessation des lancers. On a réussi à minimiser la mécano-sensibilité à la région commune de l’extenseur du coude droit et à la NIP par un soulagement des douleurs myofaciales et des techniques d’augmentation de la mobilisation des tissus mous. La technique de mobilisation neurodynamique a également été administrée pour améliorer la fonction neurale. On a mis en place un protocole propre aux sports aux fins de maintien des mécaniques de lancer et de conditionnement général. La résolution réussie de la symptomatologie et le retour à l’état qui prévalait avant la blessure ont été réalisés en cinq semaines. Une revue de la littérature et une discussion fondée sur des preuves pour les diagnostics différentiels, l’examen clinique, le diagnostic, le traitement et la réadaptation pour la NIP sont présentées.

Keywords: arm injury; baseball; posterior interosseous nerve; radial nerve; radial neuropathy.

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Figures

Figure 1
Figure 1
Graphic depiction of the Radial Nerve at the distal humeral and elbow joint. (A) Radial Nerve branches coursing along the posterior compartment of the upper arm superficial to the brachioradialis. (B) Radial Nerve trunk and its branches (posterior interosseous (arrow head) and superficial radial (small arrow) nerves) coursing distally through the elbow and forearm region. (3D anatomy images copyright Primal Pictures Ltd.)
Figure 2
Figure 2
Upper Limb Tension Test: Radial Nerve Protocol. (A) Starting Position: shoulder is in 90 degrees of abduction, elbow in full flexion, the forearm is fully pronated, the wrist and fingers placed in full extension and ipsilateral lateral flexion of the cervical spine. (B) Initiation of motion is first conducted by placing the fingers and wrist in to full flexion while maintaining the elbow, forearm, shoulder, and cervical spine positions. (C) Elbow extension and forearm pronation is started while still maintaining the shoulder in 90 degrees of abduction. (D) The shoulder is depressed and the cervical spine is laterally flexed to the contra-lateral side.
Figure 3
Figure 3
Myofascial Release of the Elbow employing (A) Active Release Technique and (B) Graston Technique.
Figure 4
Figure 4
Neuromobilization Technique for the radial nerve. (A) Start with the wrist and fingers in flexion, elbow in flexion, shoulder at 90 degrees of abduction. This is intended to permit maximal radial nerve excursion at the wrist and less at the elbow joint. (B) Commence by placing the wrist and fingers into extension and the elbow into extension. This is intended to permit maximal excursion of the radial nerve at the elbow joint and less at the wrist joint.
Figure 5
Figure 5
Comparison of the Follow-through (A) and the Upper Limb Tension Test for the Radial Nerve (B). The extension that is observed in the follow-through is similar to the extension necessary to test the radial nerve as presented in the Upper Limb Tension Test.
See this image and copyright information in PMC

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