EC Paediatrics

Introduction: Peripheral entrapment neuropathies commonly present as pain and sensory-motor changes in the area innervated by that particular nerve. There are multiple causes of entrapment neuropathies and trauma is one of them. Involvement of the anterior interosseous nerve (AIN) is the most commonly seen entity following supracondylar humerus fractures in children. In the forearm, the motor division of the median nerve is known as AIN. Together with the anterior interosseous artery, the AIN travels deep in the forearm and supplies flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) to the index finger and pronator quadratus (PQ) muscles. The clinical manifestations of AIN compression are seen as a weakness in the thumb and the index finger. This is typically presented as the inability to flex the interphalangeal joints of the thumb and the distal interphalangeal joint of the index finger.

Presentation of Case: A nine-year-old male child from a poor family presented in our pain clinic with right forearm pain along with weakness in the right thumb and index finger, because of which the patient was not able to hold the pen and write in the classroom. There was restricted joint movement at the elbow. The patient gave a history of right-sided supracondylar fracture humerus (Gartland type III with posterior displacement), four and half months back. The fracture was treated with C-arm guided closed reduction and pinning with Kirschner wires under general anesthesia. There was no history of vascular compromise or any other associated nerve involvement. Diagnosis of AIN injury was missed when the child had visited the orthopedic hospital for the initial injury, as the child was extremely anxious, noncooperative, and frightened. Also, there was lot of edema around the elbow joint due to the fracture.

On the basis of detailed history taking and physical examination, the clinical diagnosis of AIN syndrome was made by us. The diagnosis was confirmed after performing different clinical tests including a positive pinch grip test on the affected side. The electrophysiological studies showed typical electromyographic findings. No further investigations were possible because of the poor economic condition of the family. The child was treated with wait and see policy along with physiotherapy, stretching exercises, and rehabilitation. The patient was regularly coming for follow-ups for the next three months. All the complaints of the patient were resolved spontaneously and complete restoration of AIN function was observed within six months of the initial trauma.

Discussion: Understanding the anatomy of the anterior interosseous nerve as well as the etiology of the anterior interosseous syndrome. Primary diagnosis, analysis of sensory-motor involvement and the multimodal treatment approach in children with AIN syndrome. An interdisciplinary and multimodal treatment plan will lead us to an exact diagnosis and this is how the health care providers can help the patient most effectively.

Keywords: Anterior Interosseous Nerve Palsy; Supracondylar Fracture Humerus; Clinical Suspicion; Wait and See

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