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

Hackl, Michael; Damerow, Deborah; Leschinger, Tim; Scaal, Martin; Müller, Lars Peter; Wegmann, Kilian

doi:10.1007/s00402-015-2300-0

Cited by 19 publications

(22 citation statements)

References 16 publications

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“…Additionally, using embalmed cadaveric specimens may have represented a potential limitation: formalin causes shrinkage and dehydration of soft tissue structures, primarily affecting their neurovascular supply, which may alter anatomical measurements. 8,15,27,28 Moreover, disarticulation of the shoulder joint and dissection of the radial nerve to reach sufficient exposure may have affected the native course of the nerve. 8,15 Therefore, we conducted an in vivo anatomical study based on CTA that we believe overcomes these reported drawbacks associated with the use of cadaveric specimens, and we utilized 3D reconstruction of CT scan images of living subjects to simulate the in situ conditions.…”

Section: Discussionmentioning

confidence: 99%

“…We evaluated the segment where there was direct contact of the radial nerve with the posterior humeral shaft because this segment is reported as the most frequent area of iatrogenic radial nerve injury when using the posterior approach to treat humeral shaft fractures because of the intimate relationship of the radial nerve with the humeral shaft and less mobility. 7 –9,17,18…”

Section: Methodsmentioning

confidence: 99%

“…Little mobility due to this anatomical constraint may lead to an increased risk of nerve injury in the posterior aspect of the humeral shaft when using the posterior approach to treat humeral shaft fractures. 7 –10 Many anatomical studies have sought to define the course of the radial nerve as well as to establish a consistent danger zone of the radial nerve in relation to the various anatomical landmarks of the humerus, such as the deltoid tuberosity, medial/lateral epicondyle, and olecranon fossa. 1,7,9 –15 However, because of the use of cadaveric specimens, the sample size was limited in several studies.…”

Section: Introductionmentioning

confidence: 99%

“…1,7,9 –15 However, because of the use of cadaveric specimens, the sample size was limited in several studies. 7,8…”

Section: Introductionmentioning

confidence: 99%

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Three-dimensional measurement of the course of the radial nerve at the posterior humeral shaft: An in vivo anatomical study

Park

Choi

Kang

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: Iatrogenic radial nerve injury caused by surgical exposure of the humerus is a serious complication. We aimed to describe the course of the radial nerve at the posterior humeral shaft using a three-dimensional (3D) reconstruction technique by utilizing computed tomography (CT) images of living subjects. We hypothesized that the course of the radial nerve in the posterior aspect of the humeral shaft would be reliably established using this technique and the measurements would have satisfactory intraobserver/interobserver reliabilities. Methods: This in vivo anatomical study utilized 652 upper extremity CT angiography images from 326 patients. A 3D modeling of the humerus and radial nerve was performed. We evaluated the segment of the radial nerve that lays directly on the posterior aspect of the humeral shaft and measured its proximal point, mid, and distal points. The shortest distances from the olecranon fossa to these points were defined as R1, R2, and R3, respectively. The relationships between these parameters and humeral length (HL) and transcondylar length (TL) were evaluated, and the intraobserver/interobserver reliabilities of these parameters were measured. Results: The HL was 293.6 mm, and TL was 58.64 mm on average. The R1 measured 159.2 (range 127.1–198.2) mm, R2 was 136.6 (105.7–182.5), and R3 was 112.8 (76.8–150.0) mm on average ( p < .001). The intraobserver/interobserver reliabilities ranged from 0.90 to 0.98. Conclusion: The course of the radial nerve at the posterior aspect of the humeral shaft can be reliably established using the 3D reconstruction technique, and all measurements had excellent intraobserver/interobserver reliability.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…1,7,9 –15 However, because of the use of cadaveric specimens, the sample size was limited in several studies. 7,8…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Three-dimensional measurement of the course of the radial nerve at the posterior humeral shaft: An in vivo anatomical study

Park

Choi

Kang

et al. 2020

J Orthop Surg (Hong Kong)

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“…Hackl et al [22] conducted an anatomic study regarding the course of the radial nerve at the posterior aspect of the humeral shaft. They found the ratio which divides humeral length by distance of the proximal edge of the olecranon fossa to lateral edge of the spiral groove was 3.1±0.31, which was similar to our result (2.98±0.27).…”

Section: Discussionmentioning

confidence: 99%

Optimal Radial Motor Nerve Conduction Study Using Ultrasound in Healthy Adults

Yeo

Kim

et al. 2017

Ann Rehabil Med

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ObjectiveTo obtain reference values, to suggest optimal recording and stimulation site for radial motor nerve conduction study (RmNCS), and to analyze the correlation among RmNCS parameters, demographics and ultrasonography (US) findings.MethodsA total of 55 volunteers participated in this study. We hypothesized that ‘lateral edge of spiral groove (A)’ was the optimal stimulation site, and the ‘largest cross-sectional area (CSA) of extensor indicis proprius (EIP) muscle (B)’ was the optimal recording site. The surface distance between ‘A’ and the lateral epicondyle of the humerus divided by upper arm length, was named the spiral groove ratio. The surface distance between ‘B’ and the ulnar styloid process divided by forearm length, was named the EIP ratio. Using US, we identified these sites, and further conducted RmNCS.ResultsData was collected from 100 arms of the 55 volunteers. Mean amplitude and latency were 5.7±1.1 mV and 5.7±0.5 ms, respectively, at the spiral groove, and velocity between elbow and spiral groove was 73.7±7.0 m/s. RmNCS parameters correlated significantly with height, weight, arm length, and CSA of the EIP muscle. Spiral groove ratio and EIP ratio were 0.338±0.03 and 0.201±0.03, respectively; both values were almost the same, regardless of age, sex and handedness.ConclusionWe established a reference value and standardized method of RmNCS using US. Optimal RmNCS can be conducted by placing the recording electrode 20% (about one-fifth) of forearm length from the ulnar styloid process, and stimulating at 34% (about one-third) of the humeral length from the lateral epicondyle.

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