Isolated paralysis of the extensor digitorum communis associated with the posterior (Thompson) approach to the proximal radius

Seven patients presented with an isolated extensor digitorum communis (EDC) palsy immediately after undergoing surgery in which the posterior (Thompson) approach to the proximal radius was used. All had normal neurologic examination findings documented prior to surgery. In an attempt to localize this lesion, the authors studied the arborization of the terminal motor branches of the posterior interosseous nerve (PIN) at the distal edge of the supinator. A common innervation pattern to the superficial extensor muscles was observed in 29 of 30 cadaveric limbs. In 10 of 10 specimens, when the EDC was subdivided into its individual bellies, a reproducible pattern emerged: the proximal EDC muscles of the middle and ring fingers were supplied primarily by the recurrent nerve branch(es) and the EDC muscles of the index and little fingers, by separate nerve branches. Consistent with our anatomic findings, perioperative stimulation of the recurrent branch in 1 neurologically intact patient resulted in middle and ring finger extension. Electromyography in 8 normal limbs showed that the middle and ring fingers could be activated together without the index and little fingers in all cases. We believe that these patients with isolated EDC nerve palsy may have sustained an iatrogenic injury to EDC motor branches, distal to the supinator rather than to a PIN fascicle near the proximal supinator.