title: Delayed diagnosed intermuscular lipoma causing a posterior interosseous nerve palsy in a patient with cervical spondylosis: the "priceless" value of the clinical examination in the technological era.
abstract: BACKGROUND
  Posterior interosseous nerve (PIN) palsy may present with various symptoms, and may resemble cervical spondylosis.
  
  
  METHODS
  We report about a 59-year-old patient with cervical spondylosis which delayed the diagnosis of posterior interosseous nerve (PIN) palsy due to an intermuscular lipoma. Initial right hand paraesthesias and clumsiness, together with MR findings of right C5-C6 and C6-C7 foraminal stenosis, misled the diagnostic investigation. The progressive loss of extension of all right hand fingers brought to detect a painless mass compressing the PIN. Electrophysiological studies confirmed a right radial motor neuropathy at the level of the forearm.
  
  
  RESULTS
  Surgical tumor removal and nerve decompression resulted in a gradual motor deficits recovery.
  
  
  CONCLUSIONS
  A thorough clinical examination is paramount, and electrophysiology may differentiate between cervical and peripheral nerve lesions. Ultrasonography and MR offer an effective evaluation of lipomas, which represent a rare cause of PIN palsy. Surgical decompression and lipoma removal generally determine excellent prognoses, with very few recurrences.
authors.forename: R
authors.initials: R
authors.lastname: Colasanti
authors.forename: M
authors.initials: M
authors.lastname: Iacoangeli
authors.forename: A
authors.initials: A
authors.lastname: Di Rienzo
authors.forename: M
authors.initials: M
authors.lastname: Dobran
authors.forename: L
authors.initials: L
authors.lastname: Di Somma
authors.forename: N
authors.initials: N
authors.lastname: Nocchi
authors.forename: M
authors.initials: M
authors.lastname: Scerrati
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D019299:Decompression, Surgical; D003937:Diagnosis, Differential; D005260:Female; D005542:Forearm / Q000294:innervation; D006225:Hand / Q000294:innervation; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000000981:diagnostic imaging; D008067:Lipoma / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000209:etiology* / Q000601:surgery; D009431:Neural Conduction; D009460:Neurologic Examination; D010292:Paresthesia / Q000209:etiology; D011826:Radial Nerve / Q000503:physiopathology*; D012983:Soft Tissue Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D013117:Spinal Cord Compression / Q000209:etiology; D055009:Spondylosis / Q000150:complications* / Q000000981:diagnostic imaging; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging