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Anatomic landmarks for the radial tunnel.

Ron Hazani1, Nitin J Engineer, Arian Mowlavi

  • 1Division of Plastic and Reconstructive Surgery, School of Medicine, University of Louisville, Louisville, KY, USA. ronmdsurg@hotmail.com

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Summary

Identifying the posterior interosseous nerve (PIN) is crucial for radial tunnel syndrome treatment. Anatomical landmarks like the radial head and wrist provide reliable guides for locating the PIN and deep branch of the radial nerve (DBRN).

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Area of Science:

  • Anatomy
  • Orthopedic Surgery
  • Nerve Surgery

Background:

  • The posterior interosseous nerve (PIN), the deep branch of the radial nerve (DBRN), is challenging to locate within the radial tunnel.
  • Accurate identification of the PIN and DBRN is essential for diagnosing and treating radial tunnel syndrome.
  • Anatomical landmarks can aid in surgical procedures involving the radial nerve, such as injections and decompression.

Purpose of the Study:

  • To identify reliable anatomical landmarks for locating the posterior interosseous nerve (PIN) within the radial tunnel.
  • To establish precise measurements for the entry and exit points of the deep branch of the radial nerve (DBRN) and PIN relative to the supinator muscle.
  • To facilitate diagnosis and treatment of radial tunnel syndrome through improved anatomical understanding.

Main Methods:

  • Dissection of 18 cadaveric arms to identify anatomical landmarks for PIN localization.
  • Utilized the proximal radial edge of the radial head and the mid-width of the wrist as key landmarks.
  • Measured the proximal and distal edges of the supinator muscle from the radial head and documented the DBRN's course.

Main Results:

  • The PIN exits the superficial supinator muscle at an average of 7.4 cm distal to the radial head.
  • The PIN follows a longitudinal path from the radial head to the wrist's mid-width.
  • The DBRN courses obliquely within the supinator muscle towards the biceps tendon.

Conclusions:

  • The radial head and dorsal wrist's mid-width serve as predictable landmarks for the PIN's course and location.
  • The DBRN enters the supinator muscle approximately 3.5 cm distal to the radial head.
  • The PIN is predicted to exit the supinator muscle at approximately 7.5 cm distal to the radial head, aiding surgical planning.