The anatomy of the anconeus nerve redefined

Maniglio, Mauro; Zaidenberg, Ezequiel Ernesto; Martinez, Ezequiel F.; Zaidenberg, Carlos Rodolfo

doi:10.1177/17531934211061437

Cited by 4 publications

(2 citation statements)

References 15 publications

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“…Maniglio et al [21] revised the anatomy of the anconeus branch in 15 elbows, and their results are well comparable to our topographical results in a larger collective. The anconeus branch separated from the radial nerve at mean 16.4 cm from the lateral epicondyle, which is similar to our mean of 17.7 cm measured from the olecranon.…”

Section: Discussionsupporting

confidence: 87%

Lateral para-olecranon approach: surgical guide and anatomical considerations to the anconeus branch: is there a nerve-free zone?

Plecko

Schwarz²,

Hohenberger³

et al. 2022

Eur J Trauma Emerg Surg

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Purpose In the last decades, total elbow arthroplasty, elbow osteosynthesis and revision surgery have been more popularized. The study aimed to assess the course of the anconeus branch of the radial nerve in relation to two variations of the lateral para-olecranon approach, considering iatrogenic nerve injuries. Methods The study consisted of 120 upper extremities from 60 Thiel-embalmed human specimens. Two randomized versions of the lateral para-olecranon approach (centrally orientated: P1 and laterally orientated: P2) were performed. The olecranon and the intersection points to the anconeus branch of the radial nerve were determined as anatomical landmarks. The measurements were assessed by two independent observers. Differences were analyzed using the Student’s t test; associations were computed with the Pearson correlation (r). An alpha of 0.05 (p) and a confidence interval of 95% were set. Results The intersection points averaged 12.3 cm (SD 1.8, range 8.2–16.8) for P1 versus 5.5 cm (SD 1.4, range 3.0–9.2) for P2 (p ≤ 0.001). Statistically significantly higher values for male and longer humeral specimens were revealed (all values: p < 0.05). Comparison of left and right sides yielded no difference. Excellent inter-rater agreements were found (ICC = 0.902, range 0.860–0.921). A correlation was evaluated between the humeral length and the distances in both approaches (P1: r = 0.550, p < 0.001, P2: r = 0.669, p < 0.001). Conclusion The data presented here allow preservation of the anconeus branch. The P1 forms a potential advantage by owing a broader safe zone. Using the centrally orientated approach seems to provide adequate nerve protection during surgery for one of the motor branches for extension of the elbow joint and might result in improved postoperative benefits.

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Section: Discussionsupporting

confidence: 87%

Lateral para-olecranon approach: surgical guide and anatomical considerations to the anconeus branch: is there a nerve-free zone?

Plecko

Schwarz²,

Hohenberger³

et al. 2022

Eur J Trauma Emerg Surg

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“…Additionally, there were no mentions of notable anconeus denervation nor functional deficits in the retrospective series of PCNF-BrEpi surgical denervation by Rose et al and Dellon, and neither reports explicitly identified or isolated the PCNF-BrA as part of their surgical techniques [ 1 , 12 ]. In addition, there is a discrepancy regarding the motor innervation to the anconeus, as described by Maniglio et al, who describe the anconeus nerve (a direct branch off the trifurcation point of the distal radial nerve) to supply the motor innervation to the anconeus and do not mention or identify PCNF-BrA [ 13 ]. Provided these inconsistencies regarding the motor supply to the anconeus, and given the anconeus is an accessory muscle for elbow extension, the potential denervation by inadvertent PCNF-BrA injury likely has minimal-to-no functional consequence.…”

Section: Discussionmentioning

confidence: 99%

Novel Ultrasound-Guided Radiofrequency Ablation of the Epicondylar Branch of the Posterior Cutaneous Nerve of the Forearm for Recalcitrant Lateral Epicondylosis

Umapathy,

Miller,

Chen

2024

Cureus

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This report describes a novel technique for the treatment of recalcitrant lateral epicondylosis (LE) by radiofrequency ablation (RFA) of the epicondylar branch of the posterior cutaneous nerve of the forearm (PCNF-BrEpi). Here, we describe two patients suffering from recalcitrant LE who were treated with ultrasound-guided RFA of the PCNF-BrEpi in the outpatient pain clinic setting. Patient follow-up was made at eight weeks, five months, and seven months. Numerical pain rating (NPR) for pain and Upper Extremity Functional Index-15 (UEFI-15) were obtained at baseline and at each of the follow-ups. Both patients reported significant improvement in their pain and function quickly. RFA may be a viable treatment option for recalcitrant LE. Larger comparative trials and further investigation are needed to establish results in comparison to conventional treatments and to validate RFA as a treatment option in recalcitrant LE.

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Anconeus and pronation: a palpatory and ultrasonographic study

Canoso,

Murillo-González,

Mérida-Velasco

et al. 2024

Surg Radiol Anat

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Purpose Depending on its axis, pronation varies from the radius rotation around the steady ulna to the reciprocal adduction of the radius and abduction of the ulna. While there is no question that pronator teres is a central pronation agonist, anconeus’s role is not settled. The current investigation comparing palpation and ultrasonography in these two muscles during pronation along the axis capitulum-second digit evolved from a serendipitous finding in a clinical anatomy seminar. Methods Single-hand palpation and two-transducer ultrasonography over anconeus and pronator teres were used on ten normal subjects to investigate their contraction during pronation around the capitulum-second digit axis. These studies were done independently and blind to the results of the other. The statistical analysis between palpation and ultrasonography was performed with Cohen’s kappa coefficient and the χ2 test. Results On palpation, on resisted full pronation, anconeus contracted in 8/10 subjects and pronator teres in 10/10 subjects. Without resistance, the corresponding ratios were 5/10 and 9/10. On two-transducer ultrasonography, the comparable ratios were 7/10 and 10/10, and 3/10 and 10/10. A fair concordance (Cohen’s kappa = 0.21) between palpation and ultrasonography in detecting the simultaneous status of anconeus and pronator teres during resisted full pronation. Anatomic dissection illustrated the elements involved. Conclusions Plain palpation confirmed by ultrasonography showed the simultaneous contraction of anconeus and pronator teres during resisted pronation in most of the studied subjects. The study suggests that palpation can be helpful in directly studying muscle activity during movement.

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The anatomy of the anconeus nerve redefined

Cited by 4 publications

References 15 publications

Lateral para-olecranon approach: surgical guide and anatomical considerations to the anconeus branch: is there a nerve-free zone?

Lateral para-olecranon approach: surgical guide and anatomical considerations to the anconeus branch: is there a nerve-free zone?

Novel Ultrasound-Guided Radiofrequency Ablation of the Epicondylar Branch of the Posterior Cutaneous Nerve of the Forearm for Recalcitrant Lateral Epicondylosis

Anconeus and pronation: a palpatory and ultrasonographic study

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