The course and branching pattern of the deep branch of the radial nerve in relation to the supinator muscle in fetus elbow

VARIATIONS OF THE STRUCTURE, TOPOGRAPHY, BLOOD SUPPLY AND INNERVATION OF THE BRACHIORADIALIS IN HUMAN FETUS

OBJECTIVE

The aim of the research was to establish the features of age-related and individual anatomical variability of the brachioradialis, its blood supply, and innervation options.

PATIENTS AND METHODS

Materials and methods: The study of the variant anatomy of the brachioradialis and its vascular and nervous structures was carried out on 25 preparations of human fetuses of 4-7 months, 81.0-270.0 mm parietal-coccygeal length (PCL) using macromicroscopic preparation, injection vessels, and morphometry.

RESULTS

Results: Spindle-like (56%) and round (24%) shapes of the brachioradialis were found in most of the studied fetuses; its elongated flat (12%) and triangular (8%) forms occur less often. In a fetus of 185.0 mm TKD, the right brachioradialis consisted of two separate parts: upper and lower, which were connected at the level of the middle of the forearm into a common short muscle belly. In another human fetus of 220.0 mm TKD, the right brachioradialis also consisted of two separate parts - upper and lower, triangular in shape, but separated by a pronounced horizontal gap.

CONCLUSION

Conclusions: The features of the fetal anatomy of the brachioradialis are established: its variability and bilateral asymmetry of shape and size, variability of the places of origin and attachment, etc. In individual human fetuses, the brachioradialis consists of two separate parts that have special topographical relationships. The area of the greatest concentration of both extra- and intramuscular nerves and arteries is the upper and middle third of the brachioradialis. In the area of the forearm, the course of radial vascular-nerve formations is determined by the brachioradialis.

Ultrasound of the Radial Nerve: A Pictorial Review

This pictorial review focuses on the ultrasound (US) appearance of the normal and pathological radial nerve (RN) and its branches and provides tips with which to locate them and avoid misinterpretation of normal findings. A wide range of our pathological cases are reviewed and presented to help in familiarizing the reader with common and uncommon clinical scenarios that affect the RN and its main branches.

The arcade of Frohse: a systematic review and meta-analysis

PURPOSE

The structure of the proximal margin of the superficial layer of the supinator muscle is of high interest to many researches. Its tendinous appearance, called the arcade of Frohse, may be clinically important because of its close relationship to the deep branch of the radial nerve passing beneath it and is considered to be the cause of several syndromes. Given the importance of this structure, we aimed to provide a comprehensive and evidence-based review with meta-analytic techniques.

MATERIALS AND METHODS

The meta-analysis was performed in adherence to the PRISMA guidelines. Three medical databases were searched in order to identify all potentially eligible articles. Included studies were assessed for quality and the extracted morphological and morphometric data from the relevant articles was analyzed with the use of random effects meta-analysis.

RESULTS

A total of 20 studies were included into this meta-analysis. The pooled prevalence of the arcade of Frohse was calculated to be 66% within the adult population and 0% in the fetuses. Other variations regarding the arcade of Frohse were identified as very rare. Analysis of the morphometric parameters revealed the average proportions to be 23.22 mm for the length, 11.05 mm for the width and the mean thickness is 0.67 mm.

CONCLUSIONS

The arcade of Frohse is a commonly found structure in adults and thoughtful knowledge of its texture and morphology is especially useful in neurology, neurosurgery, orthopedics, trauma surgery and hand surgery, because it is considered to be the most common source of compression for the deep branch of the radial nerve.

The supinator muscle: anatomical bases for deep branch of the radial nerve entrapment

PURPOSE

Our goals were to carry out an anatomical description of the internal architecture of the supinator muscle in order to describe potentially compressive structures for the deep branch of the radial nerve (DBRN) and to establish reference landmarks for the surgical treatment of radial tunnel syndrome.

METHODS

Thirty upper limbs were dissected. The pennation angle of proximal and distal arcades of the supinator to the radial shaft axis was measured. Possible compressive structures of both superficial and deep heads of supinator were recorded. Proximal and distal arcades of the superficial layer of the supinator were classified according to their fiber content as tendinous, musculo-tendinous, muscular or membranous. The distances of superficial layer of the supinator muscle to the humeroradial joint line and lateral epicondyle were measured.

RESULTS

Pennation angle was 33.6° (±4.2°) for the superficial layer and 50.2° (±6.6°) for the deep layer. The difference was statistically significant (p < 0.0001). The proximal arcade was purely tendinous in 20 cases (66.7 %). The distal arcade was mainly tendinous or musculo-tendinous (70 %). The average distance between the lateral epicondyle and the proximal arcade was 41.6 mm. We did not find any other potentially compressive structure within DBRN course between both layers.

CONCLUSION

Our anatomical results about pennation angle could be used as a basis for a thorough functional study about the supinator. Both proximal and distal arcades appeared as the two zones ables to compress the DBRN. Their localization should help the surgeon for the DBRN neurolysis.

Anatomical association between wrist extensor musculature and topographical pain sensitivity maps of the elbow area

OBJECTIVE

High-density topographical sensitivity maps have been developed to visualize nonuniformity deep tissue pain sensitivity in, for example, lateral epicondylitis (LE). The aim of this cadaveric study was to determine the anatomical association between the topographical sensitivity maps over the elbow area and wrist extensor musculature.

METHODS

A topographical pressure sensitivity map consisting of 12 points forming a 3 × 4 matrix: 4 points in the superior part, 4 points in the middle, and 4 points in the lower part around the lateral epicondyle was marker on a 50-year embalmed cadaver. Color marker pins were inserted into each point. Pins were removed during the process of dissection, but the small holes created by their removal assured accurate relocation.

RESULTS

Progressive dissection revealed that points 1 to 4 (superior line) were placed over the musculotendinous junction and belly of the extensor carpi radialis brevis (ECRB) muscle, points 6 to 8 (middle line) were placed over the musculotendinous junction and belly of the extensor digitorum communis muscle, and points 9 to 12 (inferior line) were located over the musculotendinous junction and belly of the extensor carpi ulnaris muscle. It was also observed that the superficial branch of the radial nerve runs between the belly of the ECRB and extensor digitorum communis muscles.

CONCLUSIONS

This study confirmed that anatomical location previously assumed supporting the important wrist extensor muscles, particularly the ECRB, in patients with LE as depicted by pressure pain sensitivity maps. This study also suggests a potential role of the superficial branch of the radial nerve in LE.