Innervation of the Elbow Joint and Surgical Perspectives of Denervation: A Cadaveric Anatomic Study

Bekler, Halil; Riansuwan, Kongkhet; Vroeman, Joy C.; McKean, Jason; Wolfe, Valerie M.; Rosenwasser, Melvin P.

doi:10.1016/j.jhsa.2008.01.029

Cited by 16 publications

(18 citation statements)

References 9 publications

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“…3B) and exhibited several branches corresponding to the segment in the proximal forearm. The most proximal of these, the articular branch to the elbow, typically arises at the level of the medial epicondyle (Bekler et al, 2008). The additional branches would be muscular branches to the flexor carpi ulnaris and flexor digitorum profundus.…”

Section: Reinterpreting the Specimen With A Modern Perspectivementioning

confidence: 99%

Intraneural ganglion cyst: A 200‐year‐old mystery solved

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Vincent²,

Wolanskyj

et al. 2008

Clinical Anatomy

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We describe the first reported case of an intraneural ganglion cyst, an ulnar (''cubital'') intraneural cyst, which, on literature review, dated to 1810. For over 80 years, its original brief description by Beauchêne was wrongly attributed to Duchenne, effectively making the reference and specimen inaccessible to scrutiny. Fortunately, the intact cyst had been safely housed in the Musée Dupuytren, Paris, France, thus permitting its examination. Although originally described as a ''serous'' cyst, our present understanding of the anatomy of the ulnar nerve and of peripheral nerve pathology allowed us to reinterpret it as a mucin-filled, elbow-level, ulnar intraneural ganglion cyst. In addition to its description as a fusiform cystic enlargement of the nerve, we documented similar enlargement of a lumen-bearing branch, the articular branch at the level of the elbow. Based on our assessment of the specimen and with a modern perspective, we concluded that the origin of the cyst was from the posteromedial aspect of the elbow joint and that its fluid content, having dissected through a capsular defect, followed the path of the articular branch into the parent ulnar nerve. The purpose of this report is to clarify historical misconceptions regarding the pathogenesis of this controversial entity. Clin. Anat. 21:611-618, 2008. V V C 2008 Wiley-Liss, Inc.

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Section: Reinterpreting the Specimen With A Modern Perspectivementioning

confidence: 99%

Intraneural ganglion cyst: A 200‐year‐old mystery solved

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Vincent²,

Wolanskyj

et al. 2008

Clinical Anatomy

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“…Morrey (2000) also mentioned the presence of a few small articular branches of the median nerve that originate proximal to the motor branches to the pronator teres, radial carpal flexors, and palmaris longus muscles. The proximal articular branch arising from the median nerve was the most constant articular branch reported in the literature (Bekler et al, 2008;Dellon, 2009;Gardner, 1948;Kaplan, 1959;Nourbakhsh et al, 2016;Wilhelm, 1958;Wilhelm, 1996;Wilhelm & Gieseler, 1963). This branch was observed at the level of the distal third of the humerus, traveling medially over the anterior side of the brachialis and penetrating between the brachialis and the humeral head of the pronator teres, to terminate in several small articular branches to the anteromedial capsule.…”

Section: Radial Nervementioning

confidence: 97%

“…This branch was observed at the level of the distal third of the humerus, traveling medially over the anterior side of the brachialis and penetrating between the brachialis and the humeral head of the pronator teres, to terminate in several small articular branches to the anteromedial capsule. The area described is more easily referred to as the area deep to the brachialis muscle (Bekler et al, 2008;Dellon, 2009;Gardner, 1948;Kaplan, 1959;Nourbakhsh et al, 2016;Wilhelm, 1958;Wilhelm, 1996;Wilhelm & Gieseler, 1963). Wilhelm (1958) and De Kesel et al (2012) added several more distal articular branches.…”

Section: Radial Nervementioning

confidence: 99%

“…These arise from muscular branches of the flexor digitorm superficialis, pronator teres, flexor carpi radialis, palmaris longus, and/ or from the anterior interosseus nerve (AIN). However, considerable variability has been reported with respect to the number of articular branches (Bekler et al, 2008;Cavalheiro et al, 2015;Gardner, 1948;Nourbakhsh et al, 2016). An inverse relationship between the extent of median and ulnar nerve contribution to elbow innervation has been reported (Bateman, 1948;Bekler et al, 2008).…”

Section: Radial Nervementioning

confidence: 99%

“…This articular branch first travels on the forms a plexus with median (Gardner, 1948) and/ or ulnar (Wilhelm, 1958) nerves to innervate the anteromedial and lateral capsule, respectively. Owing to the level of the specimen amputation (Bekler et al, 2008) or dissection methods (Cavalheiro et al, 2015), study of the contribution of the musculocutaneous nerve was limited. was that few studies had comprehensively described each of the articular branches' anatomical features through the combination of group of cadaveric dissections.…”

Section: Musculocutaneous Nervementioning

confidence: 99%

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Sensory innervation of the human elbow joint and surgical considerations

et al. 2020

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Based on the currently available literature, total denervation of the elbow joint is considered impossible. However, consensus with respect to the anatomic location of sensory branches is lacking. The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches innervating the elbow joint, as well as the distribution of sensory receptors about its capsule. Four electronic databases were queried, between January 1945 and June 2019. Twenty‐one original articles providing a detailed description of the distribution of sensory receptors about the elbow joint capsule (5) and its articular branches (16) were reviewed. The posterior capsule was found to be primarily innervated by the ulnar and radial nerves via combined articular branches and sensory branches of the medial antebrachial cutaneous nerve. The anterior capsule was found to be primarily innervated by a plexus of articular ramifications from muscular branches of mixed nerves (ulnar, musculocutaneous, radial, and median nerves). A higher density of nociceptors and mechano‐receptors was identified within the posterior and anterior capsules, respectively. Thorough denervation, via the technique proposed herein, is likely to be sufficient in eliminating pain from degenerative conditions of the elbow joint.

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Innervation of the elbow joint: Is total denervation possible? A cadaveric anatomic study

Kesel¹,

Glabbeek²,

Mugenzi³

et al. 2012

Clinical Anatomy

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The aim of this anatomical study was to find out if total denervation of the elbow joint is technically feasible. The endbranches of the brachial plexus of eight fresh-frozen upper arm cadavers were dissected with optical loupe magnification. All major nerves of the upper limb (except the axillary and the medial brachial cutaneous nerve) give some terminal articular endbranches to the elbow. The articular endbranches arise from muscular endbranches, cutaneous endbranches, or arise straight from the main nerves of the brachial plexus. A topographic diagram was made of the different nerves innervating the elbow joint. The ulno-posterior part of the elbow is innervated by the ulnar nerve and some branches of medial antebrachial cutaneous nerve. The radial-posterior part of the elbow is innervated exclusively by the radial nerve. The ulno-anterior part of the elbow is innervated by the median nerve and the musculocutaneous nerve. The radio-anterior part of the elbow is innervated by the radial nerve and the musculocutaneous nerve. These elbow innervation findings are relevant to both anatomical and clinical field as they provide evidence that the total denervation of the elbow joint is impossible. Nevertheless, partial denervation, like denervation of the lateral epicondyle or the ulnar part of elbow, is technically possible.

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Innervation of the Elbow Joint and Surgical Perspectives of Denervation: A Cadaveric Anatomic Study

Cited by 16 publications

References 9 publications

Intraneural ganglion cyst: A 200‐year‐old mystery solved

Intraneural ganglion cyst: A 200‐year‐old mystery solved

Sensory innervation of the human elbow joint and surgical considerations

Innervation of the elbow joint: Is total denervation possible? A cadaveric anatomic study

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