The anconeus muscle revisited: double innervation pattern and its clinical implications

Jiménez-Díaz, V.; Aragonés, P.; García-Lamas, Lorena; Laakso, R. Barco; Quinones, Sara; Konschake, Marko; Gemmell, Carolina; Sañudo, José Ramón; Cecilia-López, D.

doi:10.1007/s00276-021-02750-5

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…We observed a transverse direct distance to the olecranon of 1.1 cm at mean in our collective, which showed an adequate distance to the olecranon. Jiménez-Díaz et al [24] reported a comparable horizontal distance of 1.7 cm at mean between the lateral epicondyle and the entry point into the anconeus muscle in 90° flexion of the elbow joint.…”

Section: Discussionmentioning

confidence: 90%

“…We found additionally equivalent results with a mean intersection point of 12.3 cm (P1) and 5.5 cm (P2) from the olecranon to the anconeus branch with regard to the described approaches. Jiménez-Díaz et al [24] reported a high-frequency double-innervation pattern from a branch of the posterior interosseous nerve to the anconeus muscle, which was present in 70.4% of their sample. The entry point of this accessory branch was always observed distal and medial to the lateral epicondyle.…”

Section: Discussionmentioning

confidence: 93%

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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: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 93%

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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show abstract

“…The anconeus muscle is a fan shaped triangular muscle that originates from the posterosuperior aspect of the LE to be inserted in the posterolateral surface of the proximal ulna [ 4 , 15 ]. The triceps–anconeus muscle innervated mainly by the radial nerve, which is liable to be damaged during posterior elbow approaches [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

A modified trans-anconeus approach to facilitate fixation of a posterior radial head fracture: a cadaveric feasibility study

et al. 2023

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Fixation of radial head fracture with minimally invasive posterior approach remains a significant challenge. The aim of this study was to determine the feasibility of trans-anconeus posterior elbow approach and to observe lateral ulnar collateral ligament (LUCL) in extended elbows. This cadaveric study was performed in twenty upper limbs of fresh fixed adult male cadavers. An oblique incision was made in the middle segment of anconeus until the lateral ligament complex and the joint capsule had been revealed. A deep dissection was explored to observe the anatomical relationship of the LUCL to the anconeus. Measurements of the LUCL were recorded while the elbow was fully extended. The mean distance between the edge of the radial head and the proximal insertion of the LUCL was 13.3 mm (11.5-16.2 mm); the mean distance between the edge of the radial head and the distal insertion of the LUCL was 20.9 mm (19.2-23.4 mm); the distance between the edge of the radial head and the distal edge of the annular ligament was 11.2 mm (8.22-11.7 mm). By estimate correlation of the previous measurements, the direct and accessible way to expose the posterolateral articular capsule of the elbow joint was through a window in medial 2/3 of the middle segment of anconeus muscle. These trans-anconeus approach is useful. It provides good visualization, facilitates applying the implants, and lessens the risk of radial nerve injury. Awareness of the anatomy is mandatory to avoid injury of LUCL.

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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 anconeus muscle revisited: double innervation pattern and its clinical implications

Cited by 6 publications

References 21 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?

A modified trans-anconeus approach to facilitate fixation of a posterior radial head fracture: a cadaveric feasibility study

Anconeus and pronation: a palpatory and ultrasonographic study

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