What is PINS?
PINS is an uncommon condition in which pressure on the posterior interosseous nerve—part of the radial nerve in the forearm—causes weakness when you try to straighten your fingers or thumb.
Since the nerve primarily controls muscle movement, sensation in the hand usually remains normal.
Key Symptoms
- Difficulty straightening the fingers or thumb (sometimes called “finger drop”)
- Wrist lifts but drifts toward the thumb side
- Dull ache on the outer forearm or around the elbow, often worse with twisting motions
- No tingling, pins-and-needles, or numbness in the hand
Common Causes
- Repetitive twisting jobs or sports (e.g. using a screwdriver, weight-lifting)
- Elbow fractures or dislocations
- Ganglion cysts, lipomas, swollen lymph nodes, or other lumps
- Rheumatoid or other inflammatory arthritis
- Scar tissue after previous surgery in the area
How We Diagnose It
- Physical examination to check strength, wrist position, and any muscle wasting.
- Nerve tests (EMG/NCS) to measure signal speed along the nerve.
- Ultrasound to look for swelling or a mass around the nerve.
- MRI if more detail is needed or to search for hidden causes.
First-Line Treatment (Non-Surgical)
- Rest and avoid constant twisting actions.
- A splint to hold the fingers in a better position while the nerve calms down.
- Anti-inflammatory tablets or a short course of steroid medication for pain and swelling.
- Physiotherapy with gentle stretches, nerve-gliding, and later strength work.
- Injections (steroid or 5 % dextrose) around the nerve if pain or weakness persists.
Most people improve within six to twelve weeks using these measures.
When Surgery is Considered
Surgery may be offered if:
- Weakness or pain has not improved after roughly three months of good non-surgical care, or
- A scan shows a definite lump pressing on the nerve.
During the operation the surgeon releases tight tissue or removes the lump. Gentle movement starts the day after surgery, but heavier work is delayed for six to twelve weeks.
Recovery and Outlook
- Around three-quarters of people recover fully with non-surgical care alone.
- After surgery, strength can keep improving for up to 18 months.
- Early diagnosis and sticking to the exercise programme give the best results.
Everyday Tips
- Take regular breaks from screw-driving or other twisting jobs.
- Use tools with thicker, cushioned handles to reduce strain.
- Do your physiotherapy exercises little and often.
- Contact your clinician promptly if weakness suddenly worsens or you notice a new lump.
Call-to-Action
For personalised advice, surgical consultation or rehabilitation plans, visit www.TheArmDoc.co.uk/PVNS or call 020 3384 5588 to book your appointment today.
Disclaimer: This leaflet is for general guidance only and does not replace personalised medical advice. Always consult a qualified healthcare professional about your own condition.