A lateral approach to the distal humerus following identification of the cutaneous branches of the radial nerve

• Published in: Journal of bone and joint surgery. British volume Vol. 91; no. 4; pp. 552 - 556
• Main Authors: HANNOUCHE, D, BALLIS, R, RAOULD, A, NIZARD, R. S, MASQUELET, A. C
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.04.2009; British Editorial Society of Bone & Joint Surgery
• Edition: British volume
• Subjects: Aged; Aged, 80 and over; Arm - anatomy & histology; Arm - innervation; Biological and medical sciences; Diseases of the osteoarticular system; Female; Forearm - anatomy & histology; Forearm - blood supply; Humans; Humerus - anatomy & histology; Humerus - surgery; Male; Medical sciences; Orthopedic Procedures - methods; Orthopedic surgery; Radial Nerve - anatomy & histology; Skin - innervation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Orthopedic surgery; Cutaneous nerve; Treatment; Radial nerve; Lateral; Surgical approach; Identification; Humerus
• ISSN: 0301-620X; 2049-4394; 2044-5377; 2049-4408
• DOI: 10.1302/0301-620X.91B4.21296

We describe a lateral approach to the distal humerus based on initial location of the superficial branches of the radial nerve, the inferior lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm. In 18 upper limbs the superficial branches of the radial nerve were located in the subcutaneous tissue between the triceps and brachioradialis muscles and dissected proximally to their origin from the radial nerve, exposing the shaft of the humerus. The inferior lateral cutaneous nerve of the arm arose from the radial nerve at the lower part of the spiral groove, at a mean of 14.2 cm proximal to the lateral epicondyle. The posterior cutaneous nerve of the forearm arose from the inferior lateral cutaneous nerve at a mean of 6.9 cm (6.0 to 8.1) proximal to the lateral epicondyle and descended vertically along the dorsal aspect of the forearm. The size and constant site of emergence between the triceps and brachioradialis muscles constitute a readily identifiable landmark to explore the radial nerve and expose the humeral shaft.