Transfer of the Radial Nerve Branches for the Treatment of the Anterior Interosseous Nerve Lesion: An Anatomical Study

Abstract

Objective:This anatomical study aimed to analyze the possibility of transferring the radial nerve branches destined to the brachioradialis (BR), extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), and supinator (SM) muscles to innervate the AIN.Methods:Ten limbs from five male cadavers were prepared by intra-arterial injection of a solution of 10% glycerol and formalin.Results:The presence of only one branch to the BR muscle was noted in 7 limbs and two branches were noted in three limbs. In two members of a common trunk with branch to the ECRL. In eight cases, we identified one branch for the ERLC and two branches in two cases. We identified only one branch for the ECRB, while in six limbs, two branches were noted, penetrating the muscular body at two different points. We identified at least two branches innervating the supinator muscle. The AIN was detached from the median nerve distal to the intercondylar line of the humerus. In seven limbs, it originated from the nervous fascicles of the posterior region of the median nerve and from the posterolateral fascicles in three limbs. The flexor pollicis longus and flexor digitorum profundus muscles received more than one branch of the AIN in all limbs.Conclusion:The radial nerve branches for the ECRL, ECRB, and supinator muscles can be transferred directly to the AIN or to one of its branches after intraneural dissection, without tension even in elbow movements. Level of Evidence IV; Case series.

Selective transfer of nerve to supinator to restore digital extension in central cord syndrome: An anatomical study and a case report

“…In all specimens, two branches were identified emerging radially and ulnarly from the PIN to enter the supinator. In previous reports, the authors have identified, in a small percentage of dissections, a single branch emerging from the PIN, which subsequently divided to innervate the superficial and deep heads of the supinator muscle (Bertelli et al, 2009; Matavelli et al, 2019). The myelinated fiber counts averaged 401 and 398 for NS and EDC, respectively, a ratio of 1:1.…”

Surgical Technique: Brachioradialis to Extensor Carpi Radialis Longus and Brevis Nerve Transfers for Tetraplegia

“…There is consistently only one ECRB branch that arises from the radial nerve further distal to ECRL, on average 11.8 mm distal to the bicondylar line. 10,11 In our single case using BR-ECRB nerve transfer, distal to proximal internal neurolysis of the fascicle supplying ECRB from its distal branch point was needed to achieve coaptation to BR branch.…”

“…The branches to BR arise on average 58.3 mm proximal to the bicondylar line (i.e., the line between the medial and lateral epicondyles) and entered the muscle on average 40.1 mm proximal to the bicondylar line. 10 One cadaveric study found 1 to 2 BR branches (1 branch 70% of limbs, 2 branches 30% of limbs), 11 whereas another cadaveric study found 1 to 4 BR branches (1 branch 10%, 2 branches 70%, 3 branches 10%, 4 branches 10%). 10 The branches to ECRL are distal to those of the BR, arising on average 34.6 mm proximal to the bicondylar line and entering the muscle on average 8.4 mm proximal to the bicondylar line.…”

“…10 In 70% to 80% of limbs, there is only one ECRL branch, and in 20% to 30% there are 2 ECRL branches. 10,11 Because of this anatomy whereby both BR and ECRL branches arise from the radial nerve in the distal upper arm, Waxweiler et al 10 found that BR to ECRL coaptation could be performed in all specimens in a tension-free manner without intraneural dissection.…”

“…The branches to ECRL are distal to those of the BR, arising on average 34.6 mm proximal to the bicondylar line and entering the muscle on average 8.4 mm proximal to the bicondylar line 10 . In 70% to 80% of limbs, there is only one ECRL branch, and in 20% to 30% there are 2 ECRL branches 10,11 . Because of this anatomy whereby both BR and ECRL branches arise from the radial nerve in the distal upper arm, Waxweiler et al 10 found that BR to ECRL coaptation could be performed in all specimens in a tension-free manner without intraneural dissection.…”