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노뼈막바깥 지방종에 의한 뒤뼈사이신경마비

Posterior Interosseous Nerve Palsy Resulting from Parosteal Lipoma of the Proximal Radius

Article information

J Korean Neurol Assoc. 2020;38(1):68-69
Publication date (electronic) : February 1, 2020
doi : http://dx.doi.org/10.17340/jkna.2020.1.16
Sang Bub Lee, MD, Je Wan Lee, MD, Jung Im Seok, MD
Department of Neurology, Catholic University of Daegu, School of Medicine, Daegu, Korea
이상법, 이제완, 석정임
대구가톨릭대학교 의과대학 신경과학교실
Address for correspondence: Jung Im Seok, MD Department of Neurology, Catholic University of Daegu, School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea Tel: +82-53-650-3440 Fax: +82-53-654-9786 E-mail: jihelpgod@cu.ac.kr
received : August 3, 2019 , rev-recd : October 16, 2019 , accepted : October 16, 2019 .

74세 여자가 오른손의 근력저하로 왔다. 근력저하는 수개월 전에 발생하여 진행하였고, 감각이상은 없었다. 근력검사에서 손가락 신전이 Medical Research Council (MRC) 3, 손목 신전이 MRC 4였다. 신경전도/근전도검사는 오른쪽 뒤뼈사이신경마비에 합당한 소견이었다. 팔꿈치 가쪽에서 시행한 초음파검사에서(Fig. A) 위팔노근아래에 종괴가 있었고, 종괴와 위팔노근사이를 주행하는 뒤뼈사이신경이 손뒤침근(supinator) 근위부에서 단면적이 커졌다가 손뒤침근 내에서는 정상적인 모양과 크기를 보였다(Fig. B, C). 같은 위치의 자기공명영상에서 종괴는 지방종에 합당한 소견이었다(Fig. D, E).

Figure.

(A) The photograph indicates ultrasound probe positioning (lateral side of right elbow). (B, C) Ultrasound reveals a solid mass (arrowheads), PIN (black arrow), and SRN (white arrows under the brachioradialis muscle). (B) Transverse view shows hypoechoic swelling of the PIN just proximal to the supinator muscle. (C) The enlarged nerve normalize in size in the supinator canal. (D, E) T1-weighted MRI shows a well-marginated homogeneous hyperintense mass (asterisk). The appearance is highly suggestive of parosteal lipoma of the radius. PIN (black arrows) and SRN (white arrows) are located between brachioradialis and lipoma. PIN; posterior interosseous nerve, SRN; superficial radial nerve, MRI; magnetic resonance imaging, br; brachioradialis, s; supinator, R; radius.

뼈 주위 지방종이 근위부 노뼈에서 발생하는 경우에 뒤뼈사이신경마비를 유발할 수 있다[1]. 초음파는 말초신경의 국소 이상을 확인할 수 있는 공간 해상도가 높고 자기공명영상은 말초신경 주위의 연부조직 이상이나 종양을 파악할 수 있는 대조 해상도가 높기 때문에 각 검사의 장점을 이용하여 정확한 병터 확인에 도움이 될 수 있다[2].

References

1. Başarir K, Şahin E, Kalem M, Karaca MO, Yildiz Y, Saglik Y. Parosteal lipoma as a rare cause of peripheral neuropathy and local irritation: a report of 12 cases. Acta Orthop Traumatol Turc 2017;51:474–477.
2. Zaidman CM, Seelig MJ, Baker JC, Mackinnon SE, Pestronk A. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology 2013;80:1634–1640.

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Copyright © 2020 Korean Neurological Association

Figure.

Figure.

(A) The photograph indicates ultrasound probe positioning (lateral side of right elbow). (B, C) Ultrasound reveals a solid mass (arrowheads), PIN (black arrow), and SRN (white arrows under the brachioradialis muscle). (B) Transverse view shows hypoechoic swelling of the PIN just proximal to the supinator muscle. (C) The enlarged nerve normalize in size in the supinator canal. (D, E) T1-weighted MRI shows a well-marginated homogeneous hyperintense mass (asterisk). The appearance is highly suggestive of parosteal lipoma of the radius. PIN (black arrows) and SRN (white arrows) are located between brachioradialis and lipoma. PIN; posterior interosseous nerve, SRN; superficial radial nerve, MRI; magnetic resonance imaging, br; brachioradialis, s; supinator, R; radius.