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Posterior interosseous nerve localization within the proximal forearm - a patient normalized parameter.

Srinath Kamineni1, Crystal R Norgren1, Evan M Davidson1

  • 1Srinath Kamineni, Elbow Shoulder Research Centre, Department of Orthopaedics and Sports Medicine, University of Kentucky, Lexington, KY 40506, United States.

World Journal of Orthopedics
|May 6, 2017
PubMed
Summary

This study introduces a patient-normalized parameter for locating the posterior interosseous nerve (PIN) in the forearm. This method aids in precise anatomical localization for diagnostic and surgical procedures.

Keywords:
Posterior interosseous nerveRadial nerveRadial tunnel syndromeSupinator syndromeTransepicondylar distance

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Area of Science:

  • Anatomy
  • Orthopedics
  • Surgical Navigation

Background:

  • Accurate localization of the posterior interosseous nerve (PIN) is crucial for effective diagnosis, injections, and surgical interventions in the forearm.
  • Existing anatomical references may lack patient-specific normalization, potentially leading to inaccuracies in clinical practice.

Purpose of the Study:

  • To establish a "patient-normalized" parameter for reliably locating the PIN in the proximal forearm.
  • To correlate the nerve's position with easily measurable anatomical landmarks across different forearm rotations.

Main Methods:

  • Dissection of 63 cadaveric upper extremities to identify the PIN's path after emerging from the supinator muscle.
  • Measurement of the transepicondylar distance (TED) and the PIN's distance from the lateral epicondyle in neutral, pronated, and supinated forearm positions.
  • Statistical analysis using the Wilcoxon-Mann-Whitney test for inter-observer and intra-observer reliability and side-to-side comparison.

Main Results:

  • The PIN's position relative to the TED varied significantly with forearm rotation: 100% TED in pronation, 84% TED in neutral, and 72% TED in supination.
  • Predictive accuracy for PIN localization was highest in supination, with 90.47%-95.23% of specimens within 2 cm of the position-specific percentage of TED.
  • A statistically significant difference (P=0.0357) was observed between the TED measurements of the right and left sides.

Conclusions:

  • A "patient-normalized" parameter, based on the TED, effectively localizes the PIN's crossing point relative to the lateral epicondyle and radial styloid.
  • This parameter offers improved accuracy for clinical applications, including diagnosis, targeted injections, and surgical approaches to the PIN.
  • The findings highlight the importance of forearm rotation in PIN localization and suggest potential side-specific anatomical variations.