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The proximal humeral attachment of the lateral head of the triceps brachii: a cadaveric study and potential site for radial nerve compression

  • Original Article - Neurosurgical Anatomy
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Abstract

Background

Knowledge of potential compression sites of peripheral nerves is important to the clinician and surgeon alike. One anatomical location for potential compression of the radial nerve, which is rarely mentioned in the literature, is at the proximal humeral attachment of the lateral head of the triceps brachii at the level of the proximal spiral groove. As no anatomical studies have been devoted to this band, the present study was conducted.

Methods

Ten adult fresh-frozen cadavers were dissected and the lateral head’s attachment onto the posterior humerus evaluated for a band. This anatomy and its relation to the radial nerve during range of motion of the elbow and forearm were evaluated.

Results

A band was found on 15 of 20 arms. On five sides, the band was comprised of grossly muscle fibers of the lateral head of the triceps brachii and was not tendinous. The bands were crescent-shaped, straight, and duplicated on nine, five, and one arm, respectively. The length of the bands ranged from 1.1 to 2.2 cm (mean 1.54 cm). The width of the bands ranged from 0.5 to 1.1 cm (mean 0.8 cm). With elbow extension and the forearm in neutral, all bands were lax. With elbow extension and the forearm supinated, the bands became tauter less the muscular bands. In elbow extension and with the forearm in supination, the bands became most taut less the muscular bands.

Conclusions

The presence of a fibrous band extending from the lateral head of the triceps brachii is common and should be among the differential diagnoses of anatomical sites for potential proximal radial nerve compression when other more common locations are ruled out.

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Acknowledgments

The authors would like to thank those who donated their body for the advancement of medical education and research.

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Authors and Affiliations

  1. Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada

    Skyler Jenkins, Stephen Bordes, Marios Loukas & R. Shane Tubbs

  2. Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland

    Łukasz Olewnik

  3. Department of Normal and Clinical Anatomy, Medical University of Lodz, Lodz, Poland

    Robert Haładaj

  4. Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA

    Joe Iwanaga, Aaron S. Dumont & R. Shane Tubbs

  5. Department of Anatomy, University of Warmia and Mazury, Olsztyn, Poland

    Marios Loukas

  6. Department of Neurosurgery, Ochsner Health System, New Orleans, LA, USA

    C. J. Bui & R. Shane Tubbs

  7. Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA

    R. Shane Tubbs

Authors
  1. Skyler Jenkins
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  2. Stephen Bordes
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  3. Łukasz Olewnik
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  4. Robert Haładaj
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  5. Joe Iwanaga
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  6. Marios Loukas
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  7. Aaron S. Dumont
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  8. C. J. Bui
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  9. R. Shane Tubbs
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Corresponding author

Correspondence to Joe Iwanaga.

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The authors declare that they have no conflict of interest.

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Comments

The article by Jenkins et al. explores a rare site of potential entrapment of the radial nerve in the mid-arm. The authors conducted a cadaveric study to describe the anatomy of the radial nerve and a band formed by the lateral head of the triceps brachii. A great effort was made in dissecting twenty upper extremity limbs to thoroughly investigate this site of possible compression and describe useful anatomic considerations at this site.

Spontaneous entrapment of the radial nerve in the mid-arm is rare. Compression by fibrous or tendinous arches of the lateral head of the triceps in patients after strenuous activity was introduced by Lotem and Manske [2, 3] (Figure 1). Other spontaneous causes of radial nerve lesions exist, such as the hourglass deformity with constriction bands (torsion) of the radial nerve which has been thought to be associated with an inflammatory nature. More commonly, the radial nerve is compressed related to positioning such is in the case of Saturday Night Palsy or after trauma (typically in the spiral groove).

This discussion of a potential predisposing anatomical site for radial nerve pathology by a band of the lateral triceps in the arm parallels that of the arcade of Frohse (superior part of the superficial layer of the supinator muscle) and the posterior interosseous nerve (PIN) in the proximal forearm. Much has been written about the PIN lesions at this location in relationship to spontaneous entrapment, compression by a mass (ganglion cyst or lipoma), or following trauma. The occurrence of PIN palsy in patients with a history of forearm rotation has been discussed and that excess pronation can increase pressure on the nerve at the arcade of Frohse [1]. Inflammatory lesions of the PIN at this site also have been increasingly reported.

This article provides a strong foundation for clinicians to understand and correlate with clinical experiences. Additional pathoanatomical studies and case reports correlating the anatomy (i.e., fibrous or tendinous edge) and pathology as confirmed with magnetic resonance imaging or ultrasound abnormalities and increased pressures (with simulated motion or activity), will help elucidate clinical compression of the radial at this location in spontaneous and posttraumatic cases.

Nikhil Murthy,

Robert J. Spinner,

Rochester, MN, USA

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This article is part of the Topical Collection on Neurosurgical Anatomy

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Jenkins, S., Bordes, S., Olewnik, Ł. et al. The proximal humeral attachment of the lateral head of the triceps brachii: a cadaveric study and potential site for radial nerve compression. Acta Neurochir 163, 615–618 (2021). https://doi.org/10.1007/s00701-020-04527-y

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  • DOI: https://doi.org/10.1007/s00701-020-04527-y

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