Important Anatomical Relationships of the Posterior Interosseous Nerve in the Distal Forearm for Surgical Planning: A Cadaveric Study

Jariwala, Arpit; Krishnan, Balamurali; Soames, Roger; Wigderowitz, C.

doi:10.1055/s-0034-1365828

Cited by 9 publications

(8 citation statements)

References 10 publications

(21 reference statements)

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“…Jariwala et al's (2014) study of Thompson's approach to the forearm noted that the posterior interosseous nerve (PIN) was consistently found in the 4th extensor compartment in all 30 cadavers and noted the proximity of the AIN to PIN. The mean anterior–posterior distance was 0.28 cm (±0.02) between the two nerves.…”

Section: Resultsmentioning

confidence: 99%

“…Grechenig et al (2017) showed these nerves were closest to one another at 8 cm proximal to the RS and a mean 0.84 cm (±0.23) from the ulnar edge of the radius. Jariwala et al (2014) highlighted in their study the proximity of the last motor branch of the PIN to the ulnar head (4.7 cm ± 0.84) and showed the last motor branch of the PIN supplied the extensor indicis in 70% of cases and extensor pollicis longus (EPL) in 30%.…”

Section: Posterior Interosseous Nervementioning

confidence: 97%

“…The PIN was consistently found in the 4th extensor compartment (Jariwala et al, 2014), and the surgeon must also be aware of its proximity to the AIN. The point at which the PIN and AIN were in closest proximity to each other was 8 cm proximal to the RS, on the ulnar side of the forearm (Grechenig et al, 2017).…”

Section: Thompson's Approach To the Distal Forearmmentioning

confidence: 99%

“…Danger and safe zones have been described in the following studies. A study by Jariwala et al (2014) showed that the most proximal part of the ulnar head had a close and consistent relationship with the PIN and its last motor branch. Thus, an incision that is performed too proximal over the ulnar head which diverges from the established approach may put this branch of PIN at risk.…”

Section: Danger and Safe Zones Ulnar Approachmentioning

confidence: 99%

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Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications

Bridgwater,

Mertz,

Brassett

et al. 2023

Clinical Anatomy

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Three commonly used approaches to the forearm in orthopedic surgery are Henry's, Thompson's, and the ulnar approach, each of which has the potential to cause injury to nerves around the wrist. Preserving these nerves is important to prevent complications such as neuroma formation and motor and sensory changes to the hand. We conducted a review of the literature to assess the nerves at risk and whether ‘safe zones’ exist to avoid these nerves. An independent reviewer conducted searches in Embase and MEDLINE of the literature from 2010 to 2020. A total of 68 papers were identified, with 18 articles being included in the review. Multiple nerves were identified as being at risk for each of the approaches described. In the anterior approach, the palmar cutaneous branch of the median nerve (PCBMN) is most at risk of injury. An incision immediately radial to the flexor carpi radialis (FCR) or directly over the FCR is most likely to avoid injury to both superficial branch of the radial nerve (SBRN) and PCBMN. With Thompson's approach, the safest zone for an incision is directly over or slightly radial to Lister's tubercle to avoid injury to SBRN and lateral cutaneous nerve of the forearm. For the ulnar approach, a safe zone was shown to be on the ulnar side of the wrist around the ulnar styloid (US) when the forearm was in supination or a neutral position to avoid injury to the dorsal branch of the ulna nerve (DBUN). Care must be taken around the US due to the density of nerves and the proximity of the last motor branch of the posterior interosseous nerve to the ulnar head. This review highlighted the proximity of nerves to the three most common surgical incisions used to access the forearm. In addition, anatomical variations may exist, and each of the nerves identified as being at risk has multiple branches. Both factors increase the potential of intraoperative damage if the anatomy is not properly understood. The surgeon must adhere carefully to the established approaches to the wrist and distal forearm to minimize damage to nerves and optimize surgical outcomes for the patient.

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Section: Resultsmentioning

confidence: 99%

Section: Posterior Interosseous Nervementioning

confidence: 97%

Section: Thompson's Approach To the Distal Forearmmentioning

confidence: 99%

Section: Danger and Safe Zones Ulnar Approachmentioning

confidence: 99%

See 2 more Smart Citations

Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications

Bridgwater,

Mertz,

Brassett

et al. 2023

Clinical Anatomy

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“…Jariwala et al 20 and Carr and Davis 11 demonstrated that the diameter of PIN increases distally. In our study, some samples might have been collected at slightly different levels, which might have influenced the fascicular area and fiber density measurements.…”

Section: Discussionmentioning

confidence: 99%

Structural Changes in the Posterior Interosseous Nerve from Patients with Wrist Osteoarthritis and Asymptomatic Controls

2020

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Background Posttraumatic morphological changes have been described in the posterior interosseous nerve (PIN) after mild wrist trauma, and it has been suggested that posttraumatic nerve changes may contribute to wrist pain. PIN excision has shown to relieve pain in some patients with wrist osteoarthritis. However, is not known if PINs from osteoarthritic wrist have pathological features. Objective The aim of this study was to investigate whether PINs from osteoarthritic wrists show morphological changes that are not present in healthy wrists. Materials and Methods PINs resected from 15 osteoarthritic wrists were analyzed with light microscopy regarding morphological changes and compared with five asymptomatic controls without osteoarthritis. Results No significant differences in fascicular area, myelinated fiber density or myelinated fiber diameter were found. However, most patients and controls exhibited some degree of pathology, and a few samples from both groups exhibited severe pathological changes. Conclusions Our findings of morphological changes in both patients with osteoarthritis and asymptomatic controls suggest that pathological changes of unknown significance might exist in the general population in the PIN at wrist level. We believe that the observed structural nerve changes in the PIN are unlikely to contribute to the symptoms of pain. Further studies of the normal histological appearance of the terminal PIN are needed. Level of Evidence This is Level II study.

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Patient satisfaction and outcomes of partial wrist denervation in inflammatory arthritis

et al. 2019

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Important Anatomical Relationships of the Posterior Interosseous Nerve in the Distal Forearm for Surgical Planning: A Cadaveric Study

Cited by 9 publications

References 10 publications

Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications

Systematic review of nerves at risk at the wrist in common surgical approaches to the forearm: Anatomical variations and surgical implications

Structural Changes in the Posterior Interosseous Nerve from Patients with Wrist Osteoarthritis and Asymptomatic Controls

Patient satisfaction and outcomes of partial wrist denervation in inflammatory arthritis

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