0:01

So I'm gonna start out with my first case.

0:04

Um, I love this subject and have, have for years.

0:09

It's got a little bit of neuro

0:11

and a little bit of ortho in it.

0:12

My two favorite things.

0:15

So the first case we're gonna start out with is a

0:21

46-year-old man who had a biceps repair six weeks ago

0:26

and now has the inability to extend the fingers.

0:31

So I'm gonna start out with, uh, I, I mentioned yesterday,

0:36

um, you weren't here, but, you know,

0:38

I have certain projections that I like to use

0:41

for expediency and efficiency.

0:44

And, uh, for instance,

0:45

as we've discussed many times in the wrist,

0:47

I put up the coronals right away.

0:49

When I'm looking for masses, tunnel syndromes, loose bodies.

0:53

I, I always like to have an axial to start with.

0:56

And this is our axial.

0:58

And by the way, the surgery was only about three

1:00

or four weeks, uh, old

1:02

and as you might expect with, um, somebody with, uh,

1:07

difficulty extending the fingers.

1:10

The extensors are a bit emus.

1:13

In fact, the, the deep posterior, uh,

1:15

extensors on the radial side.

1:18

So as you've shown beautifully, that's, that's a tip off

1:21

to the diagnosis.

1:22

And, and this condition has all kinds of,

1:25

of names depending upon where the entrapment occurs.

1:28

Now, what has happened here,

1:30

and this is a known, uh, complication, uh, of this surgery

1:34

is the patient has had a repair of the biceps,

1:38

and they put a bioresorbable anchor through the biceps, uh,

1:42

sorry, through the, uh, through the radius.

1:44

But on the other side,

1:46

they'll usually simply just tie a knot.

1:48

But sometimes to get a better anchor,

1:50

to get better purchase, they'll put this, uh, small, uh,

1:55

plastic object on the other side

1:57

and then pass the sutures through and do some complex tying.

2:01

And in this case, that, that, you know, was met

2:03

with negative results, even though you can't see

2:06

the posterior interosseous nerve,

2:08

it's compressed within the supinator by, by this object.

2:12

Uh, the patient clearly has it.

2:14

Uh, some of the other names that this goes by,

2:16

depending upon where it's compressed,

2:18

I think you mentioned a few of them, the Supinator syndrome,

2:22

the, the Syndrome AROS Arcade.

2:24

And if the sensory portion is involved, uh,

2:27

a little more anteriorly, then you end up with, uh,

2:30

you know, a burning sensation in the upper arm.

2:33

And that's known as, uh, cgia, uh, paraesthetica.

2:37

Um, any comments about this case?

2:40

Yeah, this is a great case.

2:41

I, I think we, um, frequently are getting imaging, uh,

2:45

for postoperative

2:46

or kind of iatrogenic complications of nerves, uh,

2:49

as opposed to kind of those true muscle variants.

2:52

And so they're tough for a lot of reasons, right?

2:55

You get all of this, um, artifact from the surgery itself.

2:58

But this is a great example of using those kind

3:01

of secondary imaging findings, uh, as well as the,

3:04

the clinical history

3:05

to really help land at a diagnosis there.

3:08

So yeah, thank you for sharing

3:09

that. That's a great one. Sure,

3:10

You're welcome. And, and

3:11

you know, this, this nerve kind

3:12

of comes out from the radio Capella area

3:15

and goes underneath the, uh, exits just distal to the ECRB.

3:20

And I'm showing you one

3:21

that's really a compression type example,

3:23

but you, you indicated, uh, properly so that a lot

3:27

of these are repetitive trauma, repetitive friction.

3:30

You see this condition in balloonists conductors, swimmers,

3:34

uh, people that do a lot

3:35

of repetitive motion, overhead motion.

3:38

Um, shall we look at another.