Current practice patterns in the diagnosis and management of posterior interosseous nerve and anterior interosseous nerve palsy: a cross-sectional survey of members of the Korean Society for Surgery of Peripheral Nerve

Purpose: Posterior interosseous nerve (PIN) palsy and anterior interosseous nerve (AIN) palsy are uncommon neuropathies with heterogeneous clinical presentations and variable diagnostic and treatment approaches. This study aimed to characterize current practice patterns for diagnosing and managing PIN palsy and AIN palsy among members of the Korean Society for Surgery of Peripheral Nerve (KSSPN).Methods: A cross-sectional, web-based survey was conducted from July 31 to August 10, 2025. The questionnaire assessed respondent demographics, disease classification, diagnostic workup, conservative management, surgical approaches, and treatment preferences for hourglass-like fascicular constriction (HLFC).Results: Ninety-two surgeons completed the survey (response rate, 41.6%). Most respondents (71.0%) considered radial tunnel syndrome and PIN palsy to be distinct entities. Electrodiagnostic studies were the most commonly used diagnostic test (>90%), followed by high-resolution ultrasound and magnetic resonance imaging (approximately 55%). For PIN palsy, the posterior approach was the most preferred surgical technique (34.8%), and the arcade of Frohse was identified as the most common site of compression (39.1%). For AIN palsy, conservative treatment varied; analgesics and nonsteroidal anti-inflammatory drugs were used most often (60.9%). Treatment preferences for HLFC without compressive lesion showed trends toward different approaches between conditions, though the overall difference was not statistically significant (p=0.409), with external neurolysis selected more frequently for PIN palsy (37.7%) and internal neurolysis selected more frequently for AIN palsy (34.8%).Conclusion: Practice patterns for PIN palsy and AIN palsy vary among KSSPN members. In respondents’ management of HLFC, preference distributions differed between the two conditions. These findings underscore the need for further studies to define optimal diagnostic and treatment strategies for PIN palsy and AIN palsy.