The Innervation Pattern of the Radial Nerve at the Elbow and in the Forearm

Abstract

Sixty paired cadaver forearms were dissected to examine the distribution of the radial nerve branches to the muscles at the elbow and forearm. Emphasis was placed on the innervation of the extensor carpi radialis brevis and the supinator muscles because of discrepancies in the literature concerning these muscles. The most common branching pattern (from proximal to distal) was to brachioradialis, extensor carpi radialis longus, superficial sensory, extensor carpi radialis brevis, supinator, extensor digitorum/extensor carpi ulnaris, extensor digiti minimi, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus and extensor indicis. The branch to extensor digitorum and extensor carpi ulnaris came off as a common stem often with the branch to extensor digiti minimi. The branch to the ECRB muscle was noted to arise from the posterior interosseous nerve in 45%, superficial sensory nerve in 25% and at the bifurcation of the posterior interosseous and superficial sensory nerves in 30% of specimens. The supinator had an average of 2.3 branches from the posterior interosseous nerve (range 1-6). The branches to the supinator showed a wide variability proximal to and within the supinator.

Radial tunnel syndrome: results of surgical decompression by a postero-lateral approach

“…It is important to consider the variability of the pattern of radial nerve innervation at the distal level, as we have been able to observe in our study [1,11,12]. This explains the three pareses of the common finger extensors seen in our patients caused by excessive distal dissections.…”

“…Radial tunnel syndrome (RTS) is a painful syndrome in the proximal forearm area caused by compression of the posterior interosseous nerve (PIN), the motor branch of the radial nerve, at forearm level [1][2][3][4][5][6][7][8]. It is sometimes called resistant epicondylitis because it has been confused on multiple occasions with epicondylitis resistant to medical and surgical treatment and because of the interrelation between both pathologies [3,6,7,9].…”

Anatomic pattern of the terminal branches of posterior interosseous nerve

“…Although some studies focused on the order of the terminal branches of the PIN (Sunderland, 1978;Abrams et al, 1997;Branovacki et al, 1998), others were related to the terminal sensory branch of the PIN (Dellon and Seif, 1978;Carr and Davis, 1985;Waters and Schwartz, 1993;Elgafy et al, 2000a). The anatomic location of the terminal sensory branch of the PIN is constant in the deep radial aspect of the fourth dorsal compartment and is generally used as a donor graft for digital nerve repairs, or during denervation of painful wrist problems.…”

An Anomalous Pattern of Superficial Branch of Radial Nerve: A Cadaveric Case Report

“…Moreover, a nearly similar variation as stated in this present case study was noticed many years ago. The incidence of the superficial branch of radial nerve supply to ECRB has been reported as 56%, 48% and 25% respectively (al-Qattan, 1996;Branovacki et al, 1998;Salsbury, 1938). However, the present case variation has previously never been reported in the literature.…”