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The course of the median and radial nerve across the elbow: an anatomic study

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Nerve transection has been described as complication of arthroscopic elbow arthrolysis. Therefore, the goal of this study was to define bony landmarks for intraoperative orientation regarding the location of the median and radial nerve.

Methods

In 22 formalin-fixated upper extremities, the radial and median nerves were dissected and marked with respect to their native course. A 3D X-ray scan was performed. The distances of the radial nerve to the radial head (R1), the capitulum (R2), and its lateral border (RC) were measured. The location of the radial nerve in relation to the transversal diameter of the humeral condyle (HC) was calculated. Similarly, the distances of the median nerve to the trochlea (M1), the medial border of the trochlea (M2), and its relation to HC were calculated.

Results

The mean value for R1 was 8 mm (±2.9 mm), for R2 was 11.3 mm (±3.8 mm), and for RC was 10.6 mm (±5.1 mm). RC/HC averaged 24 % (±11 %). M1 averaged 11.7 mm (±5.2 mm), and M2 was 2.4 mm (±4.1 mm). M2/HC averaged 6 % (±9 %).

Conclusions

The radial nerve is located ventral to the central third of the capitulum. The median nerve lies ventral to the medial quarter of the humeral condyle. When performing arthroscopic arthrolysis, this information should be kept in mind during anterior capsulectomy.

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References

  1. Kodde IF, van Rijn J, van den Bekerom MP, Eygendaal D (2013) Surgical treatment of post-traumatic elbow stiffness: a systematic review. J Shoulder Elb Surg 22(4):574–580. doi:10.1016/j.jse.2012.11.010

    Article  Google Scholar 

  2. Cefo I, Eygendaal D (2011) Arthroscopic arthrolysis for posttraumatic elbow stiffness. J Shoulder Elb Surg 20(3):434–439. doi:10.1016/j.jse.2010.11.018

    Article  Google Scholar 

  3. Schmidt T, Stangl R (2013) Indikationen, Komplikationen und Ergebnisse der Ellenbogenarthroskopie. Obere Extremität 8(4):220–225. doi:10.1007/s11678-013-0231-3

    Article  Google Scholar 

  4. Haapaniemi T, Berggren M, Adolfsson L (1999) Complete transection of the median and radial nerves during arthroscopic release of post-traumatic elbow contracture. Arthroscopy 15(7):784–787

    Article  CAS  PubMed  Google Scholar 

  5. Park JY, Cho CH, Choi JH, Lee ST, Kang CH (2007) Radial nerve palsy after arthroscopic anterior capsular release for degenerative elbow contracture. Arthroscopy 23(12):1360 e1–1360 e3. doi:10.1016/j.arthro.2006.11.021

    Article  Google Scholar 

  6. Ruch DS, Poehling GG (1997) Anterior interosseus nerve injury following elbow arthroscopy. Arthroscopy 13(6):756–758

    Article  CAS  PubMed  Google Scholar 

  7. Thomas MA, Fast A, Shapiro D (1987) Radial nerve damage as a complication of elbow arthroscopy. Clin Orthop Relat Res 215:130–131

    PubMed  Google Scholar 

  8. Omid R, Hamid N, Keener JD, Galatz LM, Yamaguchi K (2012) Relation of the radial nerve to the anterior capsule of the elbow: anatomy with correlation to arthroscopy. Arthroscopy 28(12):1800–1804. doi:10.1016/j.arthro.2012.05.890

    Article  PubMed  Google Scholar 

  9. Henry AK (1927) Complete exposure of the radius. Exposures of long bones and other surgical methods. John Wright & Sons Ltd, Bristol, pp 9–12

    Google Scholar 

  10. Ozturk A, Kutlu C, Taskara N, Kale AC, Bayraktar B, Cecen A (2005) Anatomic and morphometric study of the arcade of Frohse in cadavers. Surg Radiol Anat 27(3):171–175. doi:10.1007/s00276-005-0321-z

    Article  PubMed  Google Scholar 

  11. Dexel J, Kasten P (2013) Arthroskopie des Ellenbogens. Obere Extremität 8(1):2–8. doi:10.1007/s11678-013-0201-9

    Article  Google Scholar 

  12. Reddy AS, Kvitne RS, Yocum LA, Elattrache NS, Glousman RE, Jobe FW (2000) Arthroscopy of the elbow: a long-term clinical review. Arthroscopy 16(6):588–594. doi:10.1053/jars.2000.8953

    Article  CAS  PubMed  Google Scholar 

  13. Elfeddali R, Schreuder MH, Eygendaal D (2013) Arthroscopic elbow surgery, is it safe? J Shoulder Elb Surg 22(5):647–652. doi:10.1016/j.jse.2013.01.032

    Article  Google Scholar 

  14. Kelly EW, Morrey BF, O’Driscoll SW (2001) Complications of elbow arthroscopy. J Bone Jt Surg Am 83-A(1):25–34

    CAS  Google Scholar 

  15. Marti D, Spross C, Jost B (2013) The first 100 elbow arthroscopies of one surgeon: analysis of complications. J Shoulder Elb Surg 22(4):567–573. doi:10.1016/j.jse.2012.12.001

    Article  Google Scholar 

  16. Nelson GN, Wu T, Galatz LM, Yamaguchi K, Keener JD (2013) Elbow arthroscopy: early complications and associated risk factors. J Shoulder Elb Surg 23(2):273–278. doi:10.1016/j.jse.2013.09.026

    Article  Google Scholar 

  17. Small NC (1988) Complications in arthroscopic surgery performed by experienced arthroscopists. Arthroscopy 4(3):215–221

    Article  CAS  PubMed  Google Scholar 

  18. Lynch GJ, Meyers JF, Whipple TL, Caspari RB (1986) Neurovascular anatomy and elbow arthroscopy: inherent risks. Arthroscopy 2(3):190–197

    Article  CAS  PubMed  Google Scholar 

  19. Miller CD, Jobe CM, Wright MH (1995) Neuroanatomy in elbow arthroscopy. J Shoulder Elb Surg 4(3):168–174

    Article  CAS  Google Scholar 

  20. Diliberti T, Botte MJ, Abrams RA (2000) Anatomical considerations regarding the posterior interosseous nerve during posterolateral approaches to the proximal part of the radius. J Bone Jt Surg Am 82(6):809–813

    CAS  Google Scholar 

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Conflict of interest

No benefits of any kind have been received related to the subject of this article.

Ethical approval

This study has been approved by the ethical committee of the University of Cologne (approval number 13-219).

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Authors and Affiliations

  1. Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany

    Michael Hackl, Sebastian Lappen, Lars P. Müller & Kilian Wegmann

  2. Clinic for Shoulder Surgery, Bad Neustadt/Saale, Germany

    Klaus J. Burkhart

  3. Department of Anatomy I, University of Cologne, Cologne, Germany

    Wolfram F. Neiss

Authors
  1. Michael Hackl
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  2. Sebastian Lappen
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  3. Klaus J. Burkhart
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  4. Wolfram F. Neiss
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  5. Lars P. Müller
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  6. Kilian Wegmann
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Correspondence to Michael Hackl.

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Hackl, M., Lappen, S., Burkhart, K.J. et al. The course of the median and radial nerve across the elbow: an anatomic study. Arch Orthop Trauma Surg 135, 979–983 (2015). https://doi.org/10.1007/s00402-015-2228-4

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  • DOI: https://doi.org/10.1007/s00402-015-2228-4

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