Skip to main content

Advertisement

Log in

Ulnar Nerve Innervation to Triceps: A Cadaveric Study and a Technical Note on Partial Triceps to Biceps Transfer

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

The loss of elbow flexion is a routinely encountered problem in clinical practice. There is no literature on ulnar nerve innervation to triceps in addition to the radial nerve which is dual nerve innervation to triceps in the Indian population. We intend to study the incidence of ulnar nerve innervation to the medial head of triceps in Indian population and also the clinical feasibility of transfer of long and medial head of triceps tendon to biceps around the medial aspect of humerus.

Materials and Methods

A cross-sectional study was conducted using 32 fresh-frozen skeletally mature cadavers of Indian origin. The possible contribution of the ulnar nerve to medial head of triceps in addition to the radial nerve was recorded. The arm length, the distance where the ulnar nerve pierces the medial intermuscular septum from medial epicondyle; the distance of the ulnar nerve fascicle from the medial epicondyle was also measured.

Results

The incidence of ulnar nerve innervation to the medial head of triceps was 43.8%. Mean arm length was 29.13 cm. Mean distance where the ulnar nerve pierced the medial intermuscular septum from medial epicondyle was 9.93 cm. Mean distance of the ulnar nerve branch to the triceps from medial epicondyle was 8.01 cm.

Conclusion

This study reveals the presence of dual nerve innervation to triceps in 43.8% of the Indian population. The clinical implication would be to look for the possible contribution of the ulnar nerve fascicle to the medial head of triceps, which will help us to include the medial head along with the long head of triceps while performing partial triceps-to-biceps tendon transfer, and the other use would be as a donor fascicle when performing a nerve transfer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Rühmann O, Schmolke S, Gossé F, Wirth CJ. Transposition of local muscles to restore elbow flexion in brachial plexus palsy. Injury 2002;33:597–609.

    Article  PubMed  Google Scholar 

  2. Jain DK, Bhardwaj P, Venkataramani H, Sabapathy SR. An epidemiological study of traumatic brachial plexus injury patients treated at an Indian centre. Indian J Plast Surg 2012;45:498–503.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Berger A, Hierner R, Becker MH. Secondary operation for elbow flexion reconstruction after brachial plexus lesion. Orthopade 1997;26:643–50.

    PubMed  Google Scholar 

  4. Hovnanian AP. Latissimus dorsi transplantation for loss of flexion or extension at the elbow; a preliminary report on technic. Ann Surg 1956;143:493–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Marshall RW, Williams DH, Birch R, Bonney G. Operations to restore elbow flexion after brachial plexus injuries. J Bone Joint Surg Br 1988;70:577–82.

    Article  CAS  PubMed  Google Scholar 

  6. Schottstaedt ER, Larsen LJ, Bost FC. Complete muscle transposition. J Bone Joint Surg Am 1955;37-A: 897–918.

    Article  CAS  PubMed  Google Scholar 

  7. Hierner R, Berger A. Pectoralis major muscle transfer for reconstruction of elbow flexion in post traumatic brachial plexus lesions. Oper Orthop Traumatol 2009;21:126–40.

    Article  PubMed  Google Scholar 

  8. Lim AY, Pereira BP, Kumar VP. The long head of the triceps brachii as a free functioning muscle transfer. Plast Reconstr Surg 2001;107:1746–52.

    Article  CAS  PubMed  Google Scholar 

  9. Hoang PH, Mills C, Burke FD. Triceps to biceps transfer for established brachial plexus palsy. J Bone Joint Surg Br 1989;71:268–71.

    Article  CAS  PubMed  Google Scholar 

  10. Steindler A. Operative treatment of paralytic conditions of the upper extremity. J Orthop Surg 1919;1:608–19.

    Google Scholar 

  11. Chen WS. Restoration of elbow flexion by modified steindler flexorplasty. Int Orthop 2000;24:43–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Ishida O, Sunagawa T, Suzuki O, Ochi M. Modified steindler proceudre for the treatment of brachial plexus injuries. Arch Orthop Trauma Surg 2006;126:63–5.

    Article  PubMed  Google Scholar 

  13. Bunnell S. Restoring flexion to the paralytic elbow. J Bone Joint Surg Am 1951;33-A:566–71.

    Article  CAS  PubMed  Google Scholar 

  14. Carroll RE, Hill NA. Triceps transfer to restore elbow flexion. A study of fifteen patients with paralytic lesions and arthrogryposis. J Bone Joint Surg Am 1970;52:239–44.

    Article  CAS  PubMed  Google Scholar 

  15. Haninec P, Szeder V. Reconstruction of elbow flexion by transposition of pedicled long head of triceps brachii muscle. Acta Chir Plast 1999;41:82–6.

    CAS  PubMed  Google Scholar 

  16. Naidu S, Lim A, Poh LK, Kumar VP. Long head of the triceps transfer for elbow flexion. Plast Reconstr Surg 2007;119:45e–7e.

    Article  PubMed  Google Scholar 

  17. Bekler H, Wolfe VM, Rosenwasser MP. A cadaveric study of ulnar nerve innervation of the medial head of triceps brachii. Clin Orthop Relat Res 2009;467:235–8.

    Article  PubMed  Google Scholar 

  18. Miguel-Perez MI, Combalia A, Arandes JM. Abnormal innervation of the triceps brachii muscle by the ulnar nerve. J Hand Surg Eur 2010;35:430–1.

    Article  CAS  Google Scholar 

  19. Loukas M, Bellary SS, Yüzbaşioğlu N, Shoja MM, Tubbs RS, Spinner RJ, et al. Ulnar nerve innervation of the medial head of the triceps brachii muscle: A cadaveric study. Clin Anat 2013;26:1028–30.

    Article  PubMed  Google Scholar 

  20. Pascual-Font A, Vazquez T, Marco F, Sañudo JR, Rodriguez-Niedenführ M. Ulnar nerve innervation of the triceps muscle: Real or apparent? An anatomic study. Clin Orthop Relat Res 2013;471:1887–93.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Contreras MG, Warner MA, Charboneau WJ, Cahill DR. Anatomy of the ulnar nerve at the elbow: Potential relationship of acute ulnar neuropathy to gender differences. Clin Anat 1998;11:372–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Darshan Kumar A Jain.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jain, D.K.A., Kumar, S.T. & Shetty, N. Ulnar Nerve Innervation to Triceps: A Cadaveric Study and a Technical Note on Partial Triceps to Biceps Transfer. JOIO 53, 353–356 (2019). https://doi.org/10.4103/ortho.IJOrtho_440_17

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ortho.IJOrtho_440_17

Keywords

Navigation