Relation of radial nerve to superficial bony and soft tissue landmarks- a cadaveric study

Authors

  • Renu Gupta Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
  • Ashish Kumar Nayyar Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
  • Surajit Ghatak Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20221795

Keywords:

Iatrogenic injury, Humerus, Triceps aponeurosis, Olecranon process

Abstract

Background: Prevention of iatrogenic nerve injury during humerus fracture surgery would be of prodigious importance. Several methods were used to ease this type of injury but no flawless result is at hand. Therefore, this study was designed to predict the location of the radial nerve (RN) by bony as well as soft tissue landmarks and also identify the safe zone for RN in arm.

Methods: Fifty upper limbs belonging to 25 cadavers with no macroscopic deformity of their elbow joint were dissected for the study. RN was dissected in the spiral groove of the humerus and measurements were taken from different anatomical landmarks.

Results: There was no bilateral asymmetry as well as no statistical difference was observed in male and female measurements. The mean distance between olecranon to spiral groove 16.91±0.18 cm, olecranon to entry in Intermuscular septum 10.65±0.16 cm, triceps aponeurosis to RN in spiral groove 2.50±0.06 cm, medial epicondyle to upper margin of spiral groove 17.01±0.09 cm and lateral epicondyle to lower margin of spiral groove 10.97±0.12 cm was observed.

Conclusions: Understanding the zone of danger of humerus provide more safety during surgical intervention of humerus by predicting the location of RN by different bony and soft tissue landmarks.

References

Samardzic M, Grujicic D, Milinkovic ZB. Radial nerve lesions associated with fractures of the humeral shaft. Injury. 1990;21:220e2

Wang JP, Shen WJ, Chen WM, Huang CK, Shen YS, Chen TH. Iatrogenic radial nerve palsy after operative management of humeral shaft fractures. J Trauma. 2009;66:800e3.

DeFranco MJ, Lawton JN. Radial nerve injuries associated with humeral fractures. J Hand Surg. 2006;31A:655e63.

Shao YC, Harwood P, Growtz MRW, Limb D, Giannoudis PV. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg (Br). 2005;87-B:1647e52.

Claessen FMAP, Peters RM, Verbeek DO, Helfet DL, Ring D. Factors associated with radial nerve palsy after operative treatment of diaphyseal humeral shaft fractures. J Shoulder Elbow Surg. 2015;24:307e11.

Standring S. Gray’s Anatomy: the anatomical basis of clinical practice. 1st ed. Edinburg: Churchill Livingstone/ Elsevier. 2016;783.

Arora S, Goyal A. The relationship of the radial nerve with the “apex of triceps aponeurosis”. J Orthop Trauma. 2013;27:e125e6.

Chaudhry T, Noor S, Maher B, Bridger J. The surgical anatomy of the radial nerve and the triceps aponeurosis. Clin Anat. 2010;23:222e6.

Cox CL, Riherd D, Tubbs RS, Bradley E, Lee DH. Predicting radial nerve location using palpable landmarks. Clin Anat. 2010;23:420e6.

Fleming P, Lenehan B, Sankar R, Folan-Curran J, Curtin W. One third, two-thirds: relationship of the radial nerve to the lateral intermuscular septum in the arm. Clin Anat. 2004;17:26e9.

Gerwin M, Hotchkiss RN, Weiland AJ. Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve. J Bone Joint Surg Am. 1996;78:1690e5.

Guse TR, Ostrum RF. The surgical anatomy of the radial nerve around the humerus. Clin Orthop Relat Res. 1995;320:149e53.

Van Sint Jan S, Nguyen Van D, Rooze M. Quantified relationships of the radial nerve with the radial groove and selected humeral landmarks. Surg Radiol Anat. 2008;30:627e31.

Uhl RL, Larosa JM, Sibeni T, Martino LJ. Posterior approaches to the humerus: when should you worry about the radial nerve? J Orthop Trauma. 1996;10(5):338-40.

Carlan D, Pratt J, Patterson JMM, Weiland AJ, Boyer MI, Gelberman RH. The radial nerve in the brachium: an anatomic study in human cadavers. J Hand Surg Am. 2007;32:1177-82.

Arora S, Goel N, Cheema GS, Batra S, Maini L. A method to localize the radial nerve using the ‘Apex of Triceps Aponeurosis’ as a landmark. Clin Orthop Relat Res. 2011;469:2638-44.

Prasad M, Isaac B, Samuel P. Anatomic Landmarks to Identify the Radial Nerve during the Posterior Approach of the Humerus: A Cadaveric Study. J Clin Diagnostic Res. 2018;12(11):AC01-4.

Demirkale I, Imamoglu H, Selim S. Localisation of the radial nerve at the spiral groove: A new technique. J Orthop Translation. 2019;16:85-90.

Seigerman DA, Chou EW, Yoon RS, Lu M, Frank MA, Gaines LC et al. Identification of the radial nerve during the posterior approach to the humerus: a cadaveric study. J Orthop Trauma. 2012;26:226-8.

Downloads

Published

2022-06-28

How to Cite

Gupta, R., Nayyar, A. K., & Ghatak, S. (2022). Relation of radial nerve to superficial bony and soft tissue landmarks- a cadaveric study. International Journal of Research in Medical Sciences, 10(7), 1503–1507. https://doi.org/10.18203/2320-6012.ijrms20221795

Issue

Section

Original Research Articles