Peripheral Neuropathy Due to Myofascial Therapies are Rare

Reviewed by: James Demetrious, DC, DABCO

Iatrogenic Peripheral Neuropathy

A patient related the history of an injury sustained due to treatment for lateral epicondylitis. His doctor recommended myofascial instrument-assisted soft tissue mobilization (IASTM).

The patient was subjected to vigorous IASTM over the affected lateral epicondyle and proximal extensor tendons. Following this therapy, the patient developed progressively worsening weakness of finger and thumb extensors. The patient denied sensory deficit. 

EMG-NCV confirmed a focal posterior interosseous nerve (PIN) neuropathy. MRI revealed acute edema affecting the PIN at the arcade of Frohse.

With chiropractic care, NSAIDs, therapeutic exercise and the use of a wrist splint, the patient progressively improved without residual deficits during the following month.

Mechanisms of Injury

The posterior interosseous nerve (PIN) is susceptible to external compression and injury. In their new article, Wegiel et al. offer new insight into radial nerve compression, anatomy, and clinical consequences. [1]

In their article, Han et al. describe the clinical manifestations of compressive radial neuropathies. [2]

In addition to IASTM causality, neuropathies have been associated with massage therapy [3, 4] and extracorporeal shockwave therapy (ESWT). [5]

Clinical Risk Management Key Points

The safety and efficacy of myofascial therapies is well-established. Significant adverse effects are rare. Patients may benefit from the following:

  • Clinicians should be aware of the anatomy and susceptibility of superficial peripheral nerves.
  • Clinicians should carefully utilize IASTM, massage therapy and ESWT.
  • Patients should be apprised of the risks/benefits of such procedures.
  • Should a patient experience an adverse event, physicians should make appropriate referrals for diagnostic assessment and care, when necessary.


  1. Wegiel et al. Radial nerve compression: anatomical perspective and clinical consequences. Neurosurgical Review. (2023) 46:53.
  2. Han et al. Clinical Features of Wrist Drop Caused by Compressive Radial Neuropathy and Its Anatomical Considerations. J Korean Neurosurg Soc. 55 (3):148-151, 2014.
  3. Wu et al. Posterior Interosseous Nerve Palsy as a Complication of Friction Massage in Tennis Elbow. American Journal of Physical Medicine & Rehabilitation. 89(8):668-671, 2010.
  4. Suh et al. Case report: Traumatic median neuropathy in the distal forearm after massage therapy. Front Neurol. 2022 Sep 21;13:959919.
  5. Shim et al. Ulnar Neuropathy After Extracorporeal Shockwave Therapy: A Case Report. PMR. 2015 Jun;7(6):667-70.

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The views and opinions expressed in this presentation are solely those of the author. The information is not offered as a standard of care, as research and care evolve. We offer this only to educate and inform. Patients should seek the care of their doctors regarding their conditions.

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