Triceps and cutaneous radial nerve branches investigated via an axillary anterior arm approach: new findings in a fresh-cadaver anatomical study

2021 ◽  
pp. 1-10
Author(s):  
Jayme A. Bertelli ◽  
Mayur Sureshlal Goklani ◽  
Neehar Patel ◽  
Elisa Cristiana Winkelmann Duarte
Keyword(s):  
Radial Nerve ◽  
Latissimus Dorsi ◽  
Cutaneous Nerve ◽  
Posterior Surface ◽  
Motor Branch ◽  
Medial Head ◽  
Triceps Muscle ◽  
Fresh Cadaver ◽  
New Findings ◽  
Lateral Head

OBJECTIVE The authors sought to describe the anatomy of the radial nerve and its branches when exposed through an axillary anterior arm approach. METHODS Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery. RESULTS Via the anterior arm approach, all triceps muscle heads could be dissected and individualized. The radial nerve overlaid the latissimus dorsi tendon, bounded by the axillar artery on its superior surface, then passed around the humerus, together with the lower lateral arm and posterior antebrachial cutaneous nerve, between the lateral and medial heads of the triceps. No triceps motor branch accompanied the radial nerve’s trajectory. Over the latissimus dorsi tendon, an antero-inferior bundle, containing all radial nerve branches to the triceps, was consistently observed. In the majority of the dissections, a single branch to the long head and dual innervations for the lateral and medial heads were observed. The triceps long and proximal lateral head branches entered the triceps muscle close to the latissimus dorsi tendon. The second branch to the lateral head stemmed from the triceps lower head motor branch. The triceps medial head was innervated by the upper medial head motor branch, which followed the ulnar nerve to enter the medial head on its anterior surface. The distal branch to the triceps medial head also originated near the distal border of the latissimus dorsi tendon. After a short trajectory, a branch went out that penetrated the medial head on its posterior surface. The triceps lower medial head motor branch ended in the anconeus muscle, after traveling inside the triceps medial head. The lower lateral arm and posterior antebrachial cutaneous nerve followed the radial nerve within the torsion canal. The lower lateral brachial cutaneous nerve innervated the skin over the biceps, while the posterior antebrachial cutaneous nerve innervated the skin over the lateral epicondyle and posterior surface of the forearm. The average numbers of myelinated fibers were 926 in the long and 439 in the upper lateral head and 658 in the upper and 1137 in the lower medial head motor branches. CONCLUSIONS The new understanding of radial nerve anatomy delineated in this study should aid surgeons during reconstructive surgery to treat upper-limb paralysis.

Triceps Motor Nerve Branches as a Donor or Receiver in Nerve Transfers

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONS333-ONS339 ◽  
Author(s):  
Jayme A. Bertelli ◽  
Marcos A. Santos ◽  
Paulo R. Kechele ◽  
Marcos F. Ghizoni ◽  
Hamilton Duarte
Keyword(s):  
Radial Nerve ◽  
Latissimus Dorsi ◽  
Motor Nerve ◽  
Nerve Transfer ◽  
Motor Branch ◽  
Medial Head ◽  
Nerve Transfers ◽  
Axillary Region ◽  
Long Head ◽  
Lateral Head

AbstractObjective:The pattern of triceps innervation is complex and, as yet, has not been fully elucidated. The purposes of this study were 1) to clarify the anatomy of the triceps motor branches, and 2) to evaluate their possible uses as a donor or receiver for nerve transfer.Methods:The radial nerve and its motor and cutaneous branches were bilaterally dissected from the axilla and posterior arm regions of 10 embalmed cadavers.Results:A single branch innervates the triceps long head, whereas double innervation was identified for the lateral and medial heads. The upper branch to the lateral head originated from the radial nerve, whereas the lower branch to the lateral head stemmed from the lower medial head motor branch, which ultimately innervated the anconeus muscle. Both the long head and the upper medial head motor branches originated in the axillary region in the vicinity of the latissimus dorsi tendon.Conclusion:Each of the triceps’ motor branches might be used as a donor for transfer. The triceps long head motor branch should be used preferentially when the intention is to establish triceps reinnervation.

scholarly journals Surgical Implications of Innervation Pattern of the Triceps Muscle: A Cadaveric Study

2018 ◽  
Vol 10 (03) ◽  
pp. 139-142 ◽  
Author(s):  
Prashant Chaware ◽  
John Santoshi ◽  
Manmohan Patel ◽  
Mohtashim Ahmad ◽  
Bertha Rathinam
Keyword(s):  
Radial Nerve ◽  
Axillary Nerve ◽  
Nerve Supply ◽  
Upper Limbs ◽  
Innervation Pattern ◽  
Medial Head ◽  
Triceps Muscle ◽  
Muscle Transfers ◽  
Long Head ◽  
Lateral Head

AbstractThe innervation pattern of triceps is complex and not fully comprehended. Anomalous innervations of triceps have been described by various authors. We have attempted to delineate the nerve supply of the triceps and documented the anomalous innervations of its different heads. The brachial plexus and its major branches (in the region of the axilla and arm) and triceps were dissected in 36 embalmed cadaver upper limbs. Long head received one branch from radial nerve in 31 (86%) specimens. Four (11%) specimens received two branches including one that had dual innervation from the radial and axillary nerves, and one (3%) specimen had exclusive innervation from a branch of the axillary nerve. Medial head received two branches arising from the radial nerve in 34 (94%) specimens. One (3%) specimen received three branches from the radial nerve whereas one (3%) had dual supply from the radial and ulnar nerves. Lateral head received multiple branches exclusively from the radial nerve, ranging from 2 to 5, in all (100%) specimens. Knowledge of the variations in innervation of the triceps would not only help the surgeon to avoid inadvertent injury to any of the nerve branches but also offers new options for nerve and free functional muscle transfers.

scholarly journals Spinal accessory nerve to triceps muscle transfer using long autologous nerve grafts for recovery of elbow extension in traumatic brachial plexus injuries

2018 ◽  
Vol 129 (4) ◽  
pp. 1041-1047 ◽  
Author(s):  
Liselotte F. Bulstra ◽  
Nadia Rbia ◽  
Michelle F. Kircher ◽  
Robert J. Spinner ◽  
Allen T. Bishop ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Radial Nerve ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Elbow Extension ◽  
Motor Branch ◽  
Spinal Accessory ◽  
Triceps Muscle ◽  
Long Head ◽  
Grade 3

OBJECTIVEReconstructive options for brachial plexus lesions continue to expand and improve. The purpose of this study was to evaluate the prevalence and quality of restored elbow extension in patients with brachial plexus injuries who underwent transfer of the spinal accessory nerve to the motor branch of the radial nerve to the long head of the triceps muscle with an intervening autologous nerve graft and to identify patient and injury factors that influence functional triceps outcome.METHODSA total of 42 patients were included in this retrospective review. All patients underwent transfer of the spinal accessory nerve to the motor branch of the radial nerve to the long head of the triceps muscle as part of their reconstruction plan after brachial plexus injury. The primary outcome was elbow extension strength according to the modified Medical Research Council muscle grading scale, and signs of triceps muscle recovery were recorded using electromyography.RESULTSWhen evaluating the entire study population (follow-up range 12–45 months, mean 24.3 months), 52.4% of patients achieved meaningful recovery. More specifically, 45.2% reached Grade 0 or 1 recovery, 19.1% obtained Grade 2, and 35.7% improved to Grade 3 or better. The presence of a vascular injury impaired functional outcome. In the subgroup with a minimum follow-up of 20 months (n = 26), meaningful recovery was obtained by 69.5%. In this subgroup, 7.7% had no recovery (Grade 0), 19.2% had recovery to Grade 1, and 23.1% had recovery to Grade 2. Grade 3 or better was reached by 50% of patients, of whom 34.5% obtained Grade 4 elbow extension.CONCLUSIONSTransfer of the spinal accessory nerve to the radial nerve branch to the long head of the triceps muscle with an interposition nerve graft is an adequate option for restoration of elbow extension, despite the relatively long time required for reinnervation. The presence of vascular injury impairs functional recovery of the triceps muscle, and the use of shorter nerve grafts is recommended when and if possible.

scholarly journals Superficial radial nerve–lateral antebrachial cutaneous nerve anatomic variation

2013 ◽  
Vol 4 (1) ◽  
pp. 70-74 ◽  
Author(s):  
Eduardo R. Davidovich ◽  
Osvaldo J. M. Nascimento
Keyword(s):  
Radial Nerve ◽  
Anatomic Variation ◽  
Cutaneous Nerve ◽  
Superficial Radial Nerve

scholarly journals Surgically relevant anatomy of the axillary and radial nerves in relation to the latissimus dorsi tendon in variable shoulder positions: A cadaveric study

2019 ◽  
Vol 12 (1) ◽  
pp. 24-30
Author(s):  
Stephen Gates ◽  
Brian Sager ◽  
Garen Collett ◽  
Avneesh Chhabra ◽  
Michael Khazzam
Keyword(s):  
Internal Rotation ◽  
Nerve Injury ◽  
Radial Nerve ◽  
Latissimus Dorsi ◽  
External Rotation ◽  
Axillary Nerve ◽  
Dynamic Nature ◽  
Iatrogenic Nerve Injury ◽  
Relationship Of ◽  
The Relationship

Background The purpose of this study was to define the relationship of the axillary and radial nerves, particularly how these are affected with changing arm position. Methods Twenty cadaveric shoulders were dissected, identifying the axillary and radial nerves. Distances between the latissimus dorsi tendon and these nerves were recorded in different shoulder positions. Positions included adduction/neutral rotation, abduction/neutral rotation for the axillary nerve, adduction/internal rotation, adduction/neutral rotation, adduction/external rotation, and abduction/external rotation for the radial nerve. Results Width of the latissimus tendon at its humeral insertion was 29.3 ± 5.7 mm. Mean distance from the latissimus insertion to the axillary nerve in adduction/neutral rotation was 24.2 ± 7.1 mm, the distance increased to 41.1 ± 9.8 mm in abduction/neutral rotation. Mean distance from the latissimus insertion to the radial nerve was 15.3 ± 5.5 mm with adduction/internal rotation, 25.8 ± 6.9 mm in adduction/neutral rotation, and 39.5 ± 6.8 mm in adduction/external rotation. Mean distance increased with abduction/external rotated 51.1 ± 7.4 mm. Conclusions Knowing the axillary and radial nerve locations relative to the latissimus dorsi tendon decreases the risk of iatrogenic nerve injury. Understanding the dynamic nature of these nerves related to different shoulder positions is critical to avoid complications.

A New Technique for Endoscopic Carpal Tunnel Decompression

1995 ◽  
Vol 20 (4) ◽  
pp. 465-469 ◽  
Author(s):  
T. M. TSAI ◽  
T. TSURUTA ◽  
S. A. SYED ◽  
H. KIMURA
Keyword(s):  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Glass Tube ◽  
New Technique ◽  
Motor Branch ◽  
Flexor Retinaculum ◽  
Fresh Cadaver ◽  
Custom Made ◽  
Portal Technique

A new one-portal technique for endoscopic carpal tunnel release (ECTR) is introduced with its clinical results. The incision is made at the palmar aspect of file hand. A custom-made glass tube with a groove is inserted, and under endoscope observation, a meniscus knife is pushed forward along the groove to release the flexor retinaculum. This new technique has been studied in ten fresh cadaver hands and used in 123 patients' hands. Results of the cadaver study showed that the flexor retinaculum was released completely in all ten hands. No injuries to tendons, nerves, or arteries were noted. In one case the cotton tip was lost from the stick. All clinical releases were performed uneventfully except for three cases of neuropraxia of the digital nerve of the radial side of the ring finger, one laceration of the motor branch of the median nerve, one mild infection, one loss of cotton tip from the cotton swab stick, and one case of chipping of the glass tube. The case with the laceration of the motor branch of the median nerve occurred early in the series and required the conventional open incision to repair the nerve. The cases with loss of cotton from the stick and chipping of the tube also required a conventional incision to remove the cotton and glass chip. Advantages of this one-portal technique with the glass tube include less scar tenderness than with two-portal techniques, decreased risk of injury to the superficial palmar arch and ulnar nerve because of the distal approach, a view of pathology in the carpal tunnel through the glass tube, and confirmation of release of the flexor retinaculum.

Cubital Tunnel Syndrome Caused by Abnormal Insertion of Triceps Brachii Muscle

1994 ◽  
Vol 19 (1) ◽  
pp. 38-39 ◽  
Author(s):  
S. MATSUURA ◽  
T. KOJIMA ◽  
Y. KINOSHITA
Keyword(s):  
Clinical Course ◽  
Cubital Tunnel Syndrome ◽  
Medial Epicondyle ◽  
Cubital Tunnel ◽  
Triceps Brachii ◽  
Medial Head ◽  
Triceps Muscle ◽  
Triceps Brachii Muscle ◽  
Tunnel Syndrome ◽  
Operative Findings

Some cases of cubital tunnel syndrome are caused by anatomical abnormalities such as the epitrochleo-anconeus muscle or snapping and bulkiness of the medial head of the triceps brachii muscle. We report a rare cause of cubital tunnel syndrome that has not been reported previously. It was caused by an abnormal insertion of the medial head of the triceps muscle into the medial epicondyle. The clinical course and operative findings are described.

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