Long-Term Follow-Up After Posterior Interosseous Neurectomy in a Military Service Member with Chronic Wrist Pain: A Case Report and Review of the Literature

Background Posterior interosseous nerve neurectomy (PINN) has been reported to provide durable pain relief and preserve wrist range of motion (ROM), particularly in active patients. This case report describes a 21-year follow-up after isolated PINN for chronic wrist pain of unclear etiology in a military service member. Case Presentation A 50-year-old right-hand dominant male presented at age 29 with dorsal wrist pain following a training exercise while on active-duty as a Navy SEAL. At the time, conservative management—including NSAIDs, splint immobilization, and physical therapy—failed to relieve symptoms. While the working diagnosis at the time was scapholunate ligament injury, definitive diagnosis via MRI was inconclusive for scapholunate pathology. Tenderness over the scapholunate interval and clinical suspicion led to the decision for diagnostic arthroscopy and simultaneous posterior interosseous neurectomy. The decision to perform posterior interosseous neurectomy was driven by the patient’s desire to preserve wrist ROM and avoid more invasive procedures. At the 21-year follow-up, the patient reported no chronic pain, preserved function, and remained physically active in all desired activities. Physical exam and radiographs showed no signs of scapholunate instability or arthritis. Conclusion This case highlights the potential efficacy of posterior interosseous neurectomy in treating chronic dorsal wrist pain, even when underlying pathology is uncertain. The patient demonstrated excellent long-term pain relief and functional outcomes. Posterior interosseous neurectomy may serve as a valuable motion-preserving option in select patients with refractory wrist pain of unclear origin.