Posterior Interosseous Neuropathy Related to a Loose Distal Biceps Cortical Button: A Case Series

Document Type : CASE REPORT


1 Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

2 Jefferson Health New Jersey, Department of Orthopaedic Surgery, Stratford, New Jersey, USA

3 Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA



Posterior interosseous nerve (PIN) injury is an uncommon yet debilitating complication following distal 
bicep tendon repair. There are case reports of acute intraoperative PIN injury related to retractor 
placement, drill trajectory, and nerve incarceration. We report three cases of delayed PIN neuropath y 
in the setting of a loose cortical button. All patients had resolution of their pain with removal of the 
cortical button and decompression of the radial tunnel. The purpose of this case series is to: 1) highlight 
the possibility of a loose cortical bicep button as the cause of proximal forearm pain and PIN neuropathy 
in the early or late postoperative timeframe; and 2) emphasize the importance of proper surgical 
technique and use of intraoperative fluoroscopy to assure the cortical button is well-fixed and flush with 
the radial shaft.
 Level of evidence: IV


Main Subjects