Anterior interosseous nerve syndrome

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Abstract
A 46-year-old Japanese man experienced sudden-onset left hand weakness upon waking. He had no history of trauma or heavy manual labor. He had been diagnosed with diabetes mellitus 10 years earlier, but never been treated. Physical examination revealed paralysis in the left flexor pollicis and flexor indicis muscles without muscle atrophy. Although Tinel’s sign was negative, he was unable to form ‘O’ sign by using the index finger and thumb of the left hand, which is known as tear drop sign (Figure 1A, arrowhead). Sensory nerve injury symptoms were absent. His blood glucose, serum hemoglobin A1C, and creatinine levels were 274 mg/dl, 11.1% and 2.1 mg/dl, respectively. He was diagnosed with anterior interosseous nerve syndrome as a part of diabetic mononeuropathy, and intensive insulin therapy was initiated. The patient’s symptoms gradually improved, showing full recovery with a perfect ‘OK’ sign at 8-week follow-up (Figure 1B).