Predicting radial nerve location using palpable landmarks

Abstract

The purpose of this study is to predict the location of radial nerve (RN) utilizing palpable anatomic landmarks. Thirty-four paired upper limbs were dissected. The RN was localized: (1) at the humeral spiral groove (SG), (2) lateral intermuscular septum (LIS), and (3) at its' division into the posterior interosseous nerve (PIN) and radial sensory nerve (RSN). The PIN was located at the anterior aspect of the radial neck (AN). Humeral and radial lengths were measured. The RN traversed the SG, on average, 48% (36%-63%) of humeral length, distal to the greater tuberosity. The RN pierced the LIS, on average, 38% (29%-56%) of humeral length, proximal to the lateral epicondyle (LE). The PIN/RSN division occurred on average 1.0 cm (-11.4 to 3.5) distal to the LE. The PIN crossed the AN, on average, 10% (5%-14%) of radial length, distal to the radial head articular surface.

Radial nerve location at the posterior aspect of the humerus: an anatomic study of 100 specimens

“…Due to the clinical relevance, many anatomic studies have focused on the anatomy of the radial nerve [10][11][12][13][14][15][16]. Carlan et al [15] described the deltoid tuberosity as a potential landmark to determine the location of the radial nerve at the posterior midshaft level of the humerus.…”

A Method to Localize The Radial Nerve Using the ‘Apex Of Triceps Aponeurosis’ as a Landmark

“…Knowledge of the location of the radial nerve during the posterior approach to the humerus, and its relationship with a consistent and reliable anatomic landmark, are major concerns for treating surgeons. Another anatomic landmark is needed to consistently and reliably allow the surgeon to locate the radial nerve during this approach, as described relationships [1,[3][4][5][6][7][12][13][14] of the radial nerve with various osseous landmarks rarely hold true in the clinical setting. Therefore, we compared the distance of the radial nerve from the apex of the triceps aponeurosis among cadavers (having an intact humerus) and patients treated with open reduction and internal fixation for distal third humerus fractures.…”

“…Nevertheless, we describe the relationship of the radial nerve with a proposed soft tissue landmark. Numerous anatomic studies have attempted to establish the relationship of the radial nerve with bony points (lateral epicondyle, medial epicondyle, and angle of acromion) [1,[3][4][5][6][7][12][13][14]. In an anatomic study, Guse and Ostrum [14] reported that the proximal extent of the radial nerve in the spiral groove was 18.1 cm (± 1.1 cm) proximal to the medial epicondyle, whereas the distal extent of the radial nerve in the spiral groove was 12.6 cm (± 1.1 cm) proximal to the lateral epicondyle of the humerus.…”

“…The relationships of the radial nerve with various osseous landmarks did not have any correlative value, with wide interobserver variability, and are difficult for surgeons to access intraoperatively [16]. Based on cadaveric dissections, these studies show that the distance of the lateral epicondyle from the point where the radial nerve leaves the spiral groove distally ranges from 6 cm to 16 cm, whereas the distance of the angle of the acromion from the point where the radial nerve enters the spiral groove ranges from 10 cm to 19 cm [1,[3][4][5][6][7][12][13][14]. Considering the wide range of these proposed anatomic relationships, it may be difficult to localize the radial nerve during the posterior approach to the humerus.…”

“…Some studies have established the anatomic relationship of the radial nerve with various bony landmarks, such as the lateral epicondyle, medial epicondyle, or angle of the acromion [1,[3][4][5][6][7][12][13][14]. Based on cadaveric dissections, these studies show the distance of the lateral epicondyle from the point where the radial nerve leaves the spiral groove distally ranges from 6 cm to 16 cm, whereas the distance of the angle of the acromion from the point where the radial nerve enters the spiral groove ranges from 10 cm to 19 cm.…”