Posterior interosseous syndrome

　　The supinator syndrome refers to a syndrome caused by compression of the radial nerve at the distal part of the elbow joint by the supinator muscle, also known as the interosseous nerve compression syndrome of the dorsal forearm, radial tunnel syndrome, etc., which is relatively common in clinical practice. The age of patients is mostly between 40 to 70 years old, with occasional onset at the age of 9, and the majority are male. The disease is more common in manual workers, keyboard operators, and some athletes due to chronic traumatic inflammation of the supinator muscle caused by excessive use of the extensor muscles of the forearm. Non-infectious inflammation caused by rheumatoid arthritis can lead to hyperplasia, adhesion, and scar formation at the supinator arch. In addition, benign occupying lesions such as synovial cysts, lipomas, and abnormal pathways of the radial nerve within the supinator muscle can all cause excessive pressure on the nerve and lead to dysfunction. The common etiology and pathogenesis are as follows:

　　(1) Occupations with frequent rotation of the forearm

　　For professionals who repeatedly perform rotational movements of the forearm, such as weightlifters, carpenters, barbers, conductors, etc., the nerve is compressed at the edge of the already tense supinator muscle arch due to repeated stretching of the supinator muscle.

　　(2) Trauma

　　After sprain of the supinator muscle, local tissue congestion, edema, or formation of scar tissue may occur, leading to local adhesion, often not fully recovered. Friction or compression between the nerve and the supinator muscle arch may cause neuropathy. In addition, the fracture of the upper third of the ulna in a straight type combined with anterior dislocation of the radius head can directly pull on the deep branch of the radial nerve in the forearm.

　　(3) Occupying lesions

　　Thickening of the supinator tendon arch or the occurrence of lipoma, synovial cyst, hemangioma, the interosseous dorsal nerve is directly compressed on the tendon arch.

　　(4) Dislocation of the radial head

　　Fracture of the upper third of the ulna in a straight type, accompanied by anterior dislocation of the radius head, the dislocated radial head compresses the deep branch of the radial nerve, or the nerve is compressed by the fingers during manipulation.

　　The pathogenesis of the disease mainly manifests as compression of the interosseous dorsal nerve of the forearm at the thickened supinator tendon arch, with the proximal part of the nerve being thickened and showing pseudotumor changes. The compressed part of the nerve becomes pale, flattened, and has pressure marks, and in long-standing cases, there are also pressure marks at the corresponding part of the supinator tendon arch. Early onset includes perineurial edema and fibrosis below the supinator tendon arch, with no change in axons. Timely treatment leads to a good prognosis. If neglected or misdiagnosed, long-term compression of the interosseous dorsal nerve can cause local axonal degeneration of the nerve, which is often irreversible.

　　The supinator syndrome refers to the syndrome caused by compression of the radial nerve by the supinator muscle at the distal part of the elbow joint, also known as the interosseous dorsal nerve compression of the forearm, radial tunnel syndrome, etc., which is relatively common in clinical practice. The age of patients is mostly between 40-70 years old, and there are occasionally cases of onset at 9 years old, with the majority being male. The pathogenesis of the disease mainly manifests as compression of the interosseous dorsal nerve of the forearm at the thickened supinator tendon arch, with the proximal part of the nerve being thickened and showing pseudotumor changes. The compressed part of the nerve becomes pale, flattened, and has pressure marks, and in long-standing cases, there are also pressure marks at the corresponding part of the supinator tendon arch. Early onset includes perineurial edema and fibrosis below the supinator tendon arch, with no change in axons. Timely treatment leads to a good prognosis. If neglected or misdiagnosed, long-term compression of the interosseous dorsal nerve can cause local axonal degeneration of the nerve, which is often irreversible.

　　The supinator syndrome is a syndrome in which the deep branch of the radial nerve (interosseous dorsal nerve) is caught near the supinator tendon arch, with the main manifestation being dysfunction of the extensor muscles of the forearm, which is often seen in clinical practice.

　　The clinical manifestations are usually incomplete paralysis of the muscles innervated by the deep branch of the radial nerve, including extensor and abduction disorders of the thumb, inability to actively extend the metacarpophalangeal joints of the 2-5 fingers, and possibly less severe supination disorders of the forearm, with the wrist joint being able to actively extend (the deep wrist flexor muscle of the radial side is not innervated by the deep branch of the radial nerve), but it is biased towards the radial side, without any sensory abnormalities in the thenar eminence.

　　Once the diagnosis is established, a neurotomy should be performed immediately, with the incision of the supinator tendon arch to relieve pressure, removal of the compressive material, and, if necessary, neurolysis between nerve bundles. After treatment, the function of the deep branch of the radial nerve can usually be restored well. In terms of prevention, we should first pay attention to and improve those factors closely related to our lives, such as quitting smoking, reasonable diet, regular exercise, and weight loss. Appropriate exercise, strengthening physical fitness, and improving one's ability to resist diseases. Anyone who follows these simple and reasonable lifestyle common sense can reduce the chance of getting sick. Strengthen physical exercise, pay attention to dietary hygiene, maintain a pleasant mood, combine work and rest, and enhance the body's resistance.

　　The supinator syndrome is a syndrome in which the deep branch of the radial nerve (interosseous dorsal nerve) is caught near the supinator tendon arch, with the main manifestation being dysfunction of the extensor muscles of the forearm, which is often seen in clinical practice.

　　The clinical manifestations are usually incomplete paralysis of the muscles innervated by the deep branch of the radial nerve, including extensor and abduction disorders of the thumb, inability to actively extend the metacarpophalangeal joints of the 2-5 fingers, and possibly less severe supination disorders of the forearm, with the wrist joint being able to actively extend (the deep wrist flexor muscle of the radial side is not innervated by the deep branch of the radial nerve), but it is biased towards the radial side, without any sensory abnormalities in the thenar eminence. In diagnosis, the following examinations can be used to clarify the diagnosis:

　　1. X-ray examination.

　　2. Electromyography examination

　　A single discharge impulse of a motor neuron can cause the simultaneous contraction of all the muscle fibers it支配, and the recorded potential is MUP. Normally, a nerve impulse causes all the muscle fibers of a motor unit to discharge synchronously, producing a MUP; however, in denervated muscle fibers, it is not like this. After 2 weeks, the sensitivity of denervated muscle fibers to acetylcholine increases, reaching 100 times normal. They will spontaneously discharge potentials, known as fibrillation potentials. Electromyography has important diagnostic value for peripheral nerve injuries. Abnormal electromyography can only prove neurogenic damage, while changes in electromyography make the localization of the damage more obvious. MCV is very sensitive to peripheral nerve trauma, which is related to the fact that large-diameter motor fibers are easily injured.

　　In terms of prevention, we should first focus on and improve those factors closely related to our lives, such as quitting smoking, reasonable diet, regular exercise, and weight reduction. Appropriate exercise can enhance physical fitness and improve the body's ability to resist diseases. Anyone who adheres to these simple and reasonable lifestyle常识 can reduce the chance of getting sick. In terms of diet, the following points should be noted:

　　1. Spicy and刺激性 foods, fried and grilled foods, rough foods, cold foods, hard foods, etc. Because spicy and hot刺激性 foods, such as chili, spicy sauce, onions, black pepper, coffee, strong tea, etc., enter the human body and are easy to produce heat and dampness, exacerbating the condition, so they should be avoided.

　　2. Cigarettes and alcohol are also contraindicated. Traditional Chinese medicine believes that alcohol is a pure yang toxin, similar to fire, and is easy to produce dampness and heat.

　　3. Consume high-quality protein foods and high-vitamin foods, and pay attention to meticulous cooking and slow chewing while eating.

　　4. It is advisable to consume high-vitamin foods. The main components of fresh fruits are glucose and fructose, which can be directly absorbed by the human body. Moreover, they contain a variety of inorganic salts and trace elements, such as iron, copper, potassium, sodium, magnesium, manganese, phosphorus, silicon, chromium, nickel, etc., which are similar to the components in human blood, have high utilization rate, and have a strong nourishing effect.

　　The posterior interosseous syndrome refers to a syndrome caused by compression of the radial nerve at the distal part of the elbow joint by the supinator muscle, also known as the anterior forearm interosseous nerve compression syndrome, radial tunnel syndrome, etc., which is relatively common in clinical practice. The age of patients is mostly between 40 to 70 years old, and occasionally there are cases of onset at 9 years old, with the highest incidence in males. The pathogenesis of this disease mainly manifests as compression of the dorsal interosseous nerve of the forearm at the thickened supinator aponeurosis, with the nerve proximal end thickened, showing pseudoneuroma changes. The compressed part of the nerve becomes pale, flattened, and has indentation, and in long-standing cases, there are also indentations at the corresponding site of the supinator aponeurosis. Early onset is neuritis and fibrosis below the supinator aponeurosis, with no general change in axons, and timely treatment leads to a good prognosis. If left untreated or misdiagnosed, long-term compression of the dorsal interosseous nerve can cause local axonal degeneration of the nerve, which is often irreversible. The dialectical treatment is as follows:

　　Early local immobilization, use a triangular bandage to hang or a plaster splint to fix, but avoid long-term external fixation.

　　(1) Manipulation Treatment

　　1. Pain point splitting method: At the posterior muscle tendinous arch and the painful site, the physician places the thumb on the muscle knot, deeply pressing on the bone, and firmly pushing and splitting the muscle 5 or 6 times.

　　2. Flexion and rotation method: The physician supports the affected elbow with the palm, holds the wrist with the hand, and makes the affected limb passively flex and pronate, and supinate 10 or more times, with local massage or muscle relaxation techniques.

　　(2) Drug Treatment

　　1. Internal medicine: This disease is often caused by injury to the meridians and collaterals, blood stasis, blood and Qi congestion, and obstruction of the meridians and collaterals. Treatment should be to activate blood and remove stasis, reduce swelling and relieve pain. Formulas used include the Harmonizing Qi and Relieving Pain Decoction, Ba Li San, Huoluo Wan, etc. Western medicine can be used for nerve nutrition, such as Coenzyme Q10 injection, oral Mecobalamin tablets, or Adenosine Cobalamin tablets, etc.

　　2. External medicine: Apply external medication to reduce swelling, remove blood stasis, and relieve pain, and at the same time, choose traditional Chinese medicine steaming or hot compress, using such formulas as the Aconitum Lycopsis Decoction.

　　(3) Other Treatments

　　1. Traditional Chinese medicine iontophoresis therapy or physical therapy is one of the effective clinical treatment methods.

　　2. Local anesthesia method: Early on, triamcinolone acetonide 2.5-5mg and lidocaine 2.5-5ml are used for pain point block.

　　(4) Surgical Treatment

　　For those with recurrent attacks and ineffective conservative treatment, surgical treatment can be considered. The patient is placed in a supine position, the affected limb is placed on the table next to the operating table, the forearm is pronated, and the palm is downward. The surgical incision starts from the front of the lateral epicondyle of the humerus, slightly arched downward and backward, and cuts downward between the radial extensor carpi brevis and the total extensor muscle. Pay attention to protect the radial artery and radial nerve during the operation.