Compression du nerf interosseux postérieur au poignet

The posterior interosseous nerve is purely sensory at the level of the wrist. It innervates only the dorsal wrist capsule and intraarticular structures; there is no cutaneous component. Based on anecdotal reports of atypical nerve enlargement after wrist trauma of varying sorts, and of pain improvement after its excision, many hand surgeons consider that this nerve can be compressed by ganglia and other pathologies at the wrist, and that excision of this terminal nerve branch has the potential to provide pain relief, with minimal risk of complications. In this chapter the anatomy of the nerve will be reviewed, along with a summary of the clinical literature used to support the concept of compression of the posterior interosseous nerve as a source of wrist pain. Surgical excision of the posterior interosseous nerve is associated with pain relief in the vast majority of reported cases. There is good evidence that partial wrist denervation, by excision of the terminal part of the posterior interosseous nerve is an effective procedure to reduce the pain associated with intraarticular wrist pathology. However, the incremental benefit of excision of the posterior interosseous nerve in association with ganglion excision, or to treat dorsal wrist pain in the presence of a normal wrist, have not been confirmed by a prospective controlled study. Thus, while the benefit of excision of the posterior interosseous nerve, as a form of partial wrist denervation, to reduce wrist pain caused by arthritis has been clearly demonstrated, the case for a pure compression neuropathy of the posterior interosseous nerve remains to be proven, and the role of posterior interosseous nerve excision in other circumstances remains to be fully established.