雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 49, Issue 2 （March 2021）

Neurological Surgery 脳神経外科 49巻2号（2021年3月発行）

Japanese English

症例

母指または示指のみの屈曲障害を初期症状とした前骨間神経麻痺の2症例 Anterior Interosseous Nerve Palsy with Isolated Flexion Palsy of the Thumb or Index Finger as an Initial Symptom:Two Case Reports 清水曉 ¹ , 望月崇弘 ¹ , 黒田博紀 ¹ , 大澤成之 ¹ , 田中理 ² , 根本充 ³ , 隈部俊宏 ⁴ Satoru SHIMIZU ¹ , Takahiro MOCHIZUKI ¹ , Hiroki KURODA ¹ , Shigeyuki OSAWA ¹ , Osamu TANAKA ² , Mitsuru NEMOTO ³ , Toshihiro KUMABE ⁴ ¹横浜市立脳卒中・神経脊椎センター脳神経外科 ²横浜市立脳卒中・神経脊椎センター臨床検査部 ³北里大学医学部形成外科・美容外科 ⁴北里大学医学部脳神経外科 ¹Department of Neurosurgery, Yokohama Brain and Spine Center ²Clinical Laboratory, Yokohama Brain and Spine Center ³Department of Plastic and Aesthetic Surgery, Kitasato University School of Medicine ⁴Department of Neurosurgery, Kitasato University School of Medicine キーワード： anterior interosseous nerve palsy , incomplete form , misdiagnosis Keyword: anterior interosseous nerve palsy , incomplete form , misdiagnosis pp.452-457

発行日 2021年3月10日 Published Date 2021/3/10

DOI https://doi.org/10.11477/mf.1436204413

PDF(5628KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

Ⅰ．はじめに

　前骨間神経（anterior interosseous nerve：AIN）麻痺は，母指の指節間（interphalangeal：IP）関節と示指の遠位指節間（distal interphalangeal：DIP）関節の屈曲障害を同時に示す完全型と，母指IP関節または示指DIP関節のいずれかの屈曲障害にとどまる不全型に分類される^{3, 9, 12-14）}．これらのうち，2指の症状が揃わない不全型は，認知度が低く看過される傾向がある^{3, 12）}．

　今回われわれは，不全型で発症し完全型に進行した非典型的な経過のため，診断に一考を要したAIN麻痺の2症例を経験したので報告する．

　Case 1：A 73-year-old man who had undergone neurolysis for right cubital tunnel syndrome complained of difficulty using chopsticks. Froment's sign test showed that the interphalangeal（IP）joint of the right thumb that had flexed preoperatively was extended. This finding was considered to indicate recovery from ulnar neuropathy, and the patient was closely followed up. One year later, the patient was unable to push a camera shutter button and was unable to flex the IP joint of the thumb and the distal interphalangeal（DIP）joint of the index finger, a characteristic symptom of anterior interosseous nerve（AIN）palsy. Therefore, the patient underwent AIN neurolysis and subsequently reported slight improvement in his condition.

　Case 2：A 60-year-old woman reported difficulty performing computer mouse clicks with her right hand. As flexing the index finger DIP joint was difficult, a local lesion was suspected, and the patient was closely followed up. One year later, the patient was unable to push the button of a ballpoint pen with her thumb. Extension of the thumb and index finger indicated AIN palsy. The patient refused treatment and was only followed up. The following year, the patient reported that the weakness improved. Simultaneous flexion palsy of the thumb and index finger can lead to a diagnosis of AIN palsy. However, flexion palsy of a single finger in incomplete AIN palsy, as reported here, is often overlooked because of its similarity to the flexor tendon rupture. Awareness regarding this incomplete form of AIN palsy is needed for early and correct diagnosis.