Anatomy of Posterior Antebrachial Cutaneous Nerve Related to the Lateral Epicondyle and Interepicondylar Line

Chodewaratham, Pathidta; Chentanez, Vilai; Agthong, Sithiporn; Huanmanop, Thanasil

doi:10.4067/s0717-95022016000300023

Cited by 4 publications

(12 citation statements)

References 11 publications

(10 reference statements)

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“…This is consistent with two previous studies that found the PABCN emerged from the hiatus at 70 mm and 66 mm from the lateral epicondyle respectively. 9,12…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with two previous studies that found the PABCN emerged from the hiatus at 70 mm and 66 mm from the lateral epicondyle respectively. 9,12 Previous authors have reported the ability of ultrasound to identify peripheral nerves. [13][14][15] In the upper limb, high-frequency ultrasound has been used to identify and block the MABCN and LABCN.…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound-guided posterior antebrachial cutaneous nerve block utilising the ‘fat-filled flat tunnel’: Description of technique and cutaneous sensory block area

Corke

2019

Anaesth Intensive Care

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The aim of the study was to investigate an ultrasound-guided posterior antebrachial cutaneous nerve block based on visualising the nerve within the fat-filled flat tunnel and describe the area of cutaneous sensory loss. A total of 12 healthy volunteers were included in the study. The posterior antebrachial cutaneous nerve was identified within the fat-filled flat tunnel in the upper arm using high-frequency ultrasound. The nerve was blocked using an in-plane needle guidance technique with 1 ml 2% lidocaine. Sensory loss to pinprick was evaluated 15 minutes after performing the block and the cutaneous sensory block area mapped. Ultrasound visualisation of the posterior antebrachial cutaneous nerve in the fat-filled flat tunnel was possible in all volunteers. The median distance of the posterior antebrachial cutaneous nerve to the lateral epicondyle of the elbow was 67.5 (range 54–105) mm. Loss of sharpness sensation to pinprick extended from the posterior aspect of the distal upper arm and posterior forearm to the wrist. The median cutaneous sensory block area was 103 (range 61–341) cm2. Two volunteers had a sensory block over the anterior forearm of 29 and 10 cm2 respectively. This amounted to 11% and 4.5% of the total cutaneous sensory block area. One volunteer had a sensory block over the dorsum of the hand of 39 cm2 (15% of the total cutaneous sensory block area). The results of this study indicate that the fat-filled flat tunnel can be a useful sono-anatomical landmark in identifying the posterior antebrachial cutaneous nerve and may serve as a target for injection. Although sensory block is predominantly confined to the posterior distal arm and forearm, inter-individual variability in the area and distribution was observed. Sensory block in the anterior forearm and dorsum of the hand can occur. The study was prospectively registered at the Australian New Zealand Clinical Trials Registry, identifier ACTRN12618000891224.

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“…This is consistent with two previous studies that found the PABCN emerged from the hiatus at 70 mm and 66 mm from the lateral epicondyle respectively. 9,12…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided posterior antebrachial cutaneous nerve block utilising the ‘fat-filled flat tunnel’: Description of technique and cutaneous sensory block area

Corke

2019

Anaesth Intensive Care

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“…present study is morphologically similar to that of type 2 of Venieratos et al, 10 but with two important differences: (1) after the anastomosis with the MN, the MCN does not emit its terminal branch, the LCNF, (2) we suggest that the part of the cutaneous innervation of the forearm that is made by the LCNF is supplied by the posterior antebrachial cutaneous nerve (PACN), a branch of the radial nerve, providing sensory innervation to the skin of the posterior forearm. 14 Matzi et al 15 reported that, after the separation from the radial nerve, the PACN emerged from the lateral intermuscular septum (LIMS), and immediately pierced the deep fascia after emerging from the LIMS. 16 More distally, its main trunk and branches course in the subcutaneous layer to the posterior forearm, as far as the wrist.…”

Section: Cerda 2014 30mentioning

confidence: 99%

“…14 Data regarding its anatomy remain insufficient, especially regarding its origin and number of branches. 14 The anastomotic variability between the MCN and the MN described in the literature suggest that these anastomoses may be attributed to ontogenetic and phylogenetic factors that influence the formation mechanism of muscles and nerves of the upper limbs during embryonic life. 17,18 Significant variations in nerve patterns may be a result of altered signaling between mesenchymal cells and neuronal growth cones.…”

Section: Cerda 2014 30mentioning

confidence: 99%

“…The knowledge of the formation and of the branching pattern of the terminal branches of the brachial plexus is clinically important in order to avoid iatrogenic PACN injury during surgical procedures at the elbow. 14,22 Portal placement in the elbow arthroscopy could injure the nerve. 23 The PACN injury was diagnosed after the surgical treatment of lateral epicondylitis.…”

Section: Cerda 2014 30mentioning

confidence: 99%

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A Rare Case of Absence of the Lateral Cutaneous Nerve of Forearm: Case Report

et al. 2019

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Introduction Variations in the formation and in the branching pattern of the brachial plexus are common. Numerous anastomotic variations between the musculocutaneous nerve (MCN) and the median nerve (MN) have been reported and could be implicated in a wide range of sensory and motor dysfunctions. Objective To report an uncommon case of an anastomotic variation between the MN and the MCN with a rare absence of the lateral cutaneous nerve of forearm (LCNF). Material and Methods A dissection of a male cadaver was performed at the Morphology Department of the Universidade Federal do Ceará, Fortaleza, state of Ceará, Brazil. The brachial plexus was exposed. Results It was observed that the MCN, after its origin in the lateral fasciculus of the brachial plexus, anastomoses with the MN in the middle third of the arm. It diverges from the most prevalent anatomical pattern, in which the MCN continues to pass distally beneath the brachii biceps, originating the LCNF. In this case, the MCN does not emit its main terminal branch, the LCNF, which innervates the lateral portion of the skin of the forearm. In the present case, the innervation of the lateral portion of the skin of the forearm is provided by radial nerve branches. The reported case has practical implications, since the absence of the LCNF could cause hypoesthesia in the skin of the forearm. Conclusion Thus, the knowledge of the formation and of the branching pattern of the brachial plexus is clinically important for the correct clinical interpretation of the sensory and motor disorders of the upper limbs caused by peripheral nerve injuries, as well as for planning surgical procedures to correct upper limb traumas.

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The Course of Posterior Antebrachial Cutaneous Nerve: Anatomical and Sonographic Study with a Clinical Implication

García-Martínez

Miguel-Pérez

Pérez‐Bellmunt

et al. 2021

IJERPH

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The course of the posterior antebrachial cutaneous nerve (PACN) was studied via ultrasound (US) and dissection. The aim of this study was to reveal the anatomical relationships of PACN with the surrounding structures along its pathway to identify possible critical points of compression. Nineteen cryopreserved cadaver body donor upper extremities were explored via US and further dissected. During US exploration, two reference points, in relation with the compression of the nerve, were marked using dye injection: (1) the point where the RN pierces the lateral intermuscular septum (LIMS) and (2) the point where the PACN pierces the deep fascia. Anatomical measurements referred to the lateral epicondyle (LE) were taken at these two points. Dissection confirmed the correct site of US-guided dye injection at 100% of points where the RN crossed the LIMS (10.5 cm from the LE) and was correctly injected at 74% of points where the PACN pierce the deep fascia (7.4 cm from the LE). There were variations in the course of the PACN, but it always divided from the RN as an only branch. Either ran close and parallel to the LIMS until the RN crossed the LIMS (84%) or clearly separated from the RN, 1 cm before it crossed the LIMS (16%). In 21% of cases, the PACN crossed the LIMS with the RN, while in the rest of the cases it always followed in the posterior compartment. A close relationship between PACN and LIMS, as well as triceps brachii muscle and deep fascia was observed. The US and anatomical study showed that the course of PACN maintains a close relationship with the LIMS and other connective tissues (such as the fascia and subcutaneous tissue) to be present in its pathology and treatment.

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Anatomy of Posterior Antebrachial Cutaneous Nerve Related to the Lateral Epicondyle and Interepicondylar Line

Cited by 4 publications

References 11 publications

Ultrasound-guided posterior antebrachial cutaneous nerve block utilising the ‘fat-filled flat tunnel’: Description of technique and cutaneous sensory block area

Ultrasound-guided posterior antebrachial cutaneous nerve block utilising the ‘fat-filled flat tunnel’: Description of technique and cutaneous sensory block area

A Rare Case of Absence of the Lateral Cutaneous Nerve of Forearm: Case Report

The Course of Posterior Antebrachial Cutaneous Nerve: Anatomical and Sonographic Study with a Clinical Implication

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