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.
Citations
The anterior interosseous nerve is the largest branch of the median nerve. The anterior interosseous nerve syndrome is a rare focal neuropathy with typical clinical and electromyographic features. Most commonly reported etiologies include fracture of the forearm and arm, trauma or prolonged pressure on the forearm.
A 26-year-old man was evaluated for weakness of the flexor pollicis longus, the second flexor digitorum profundus and the pronator quadratus muscles that occured following bowling.
We report one case of anterior interosseous nerve syndrome following bowling, which was not related to trauma.
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