Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Aug 4;5(3):147-151.
doi: 10.1055/s-0037-1605388. eCollection 2017 Sep.

Distance of the Posterior Interosseous Nerve from the Radial Head during Elbow Arthroscopy: An Anatomical Study

Paolo Arrigoni  1   2 , Davide Cucchi  1   3 , Enrico Guerra  4 , Alessandro Marinelli  4 , Alessandra Menon  1   2 , Pietro Simone Randelli  1   2 , Luigi Adriano Pederzini  5 ; SIGASCOT Upper Limb Committee
Affiliations

Distance of the Posterior Interosseous Nerve from the Radial Head during Elbow Arthroscopy: An Anatomical Study

Paolo Arrigoni et al. Joints. .

Abstract

Purpose The aims of this study were to measure the distance of the posterior interosseous nerve (PIN) from the radial head (RH) and its variations with forearm movements. Methods Five fresh frozen cadaver specimens were dissected under arthroscopy. An anterior capsulectomy extended to the entire lateral compartment was performed. The need of soft tissue dissection to isolate the nerve in the extracapsular space was recorded. The distance between the nerve and the anterior part of the RH was then measured with a graduated caliper inserted via the midlateral portal with the forearm in neutral position, full pronation, and full supination. Results The PIN was identifiable in all the specimens. In four cases, it was surrounded by a thick layer of adipose tissue, and further dissection was necessary to isolate it. Damage of the PIN during dissection occurred in one case, in which the proximal part of the nerve was accidentally cut. In three of the remaining cases, an increased distance was measured with the forearm in supination, as compared with neutral and full pronation position. Conclusion This anatomical study suggests that in most of the cases, the PIN does not lay just extracapular at the level of the radiocapitellar joint, but is surrounded by a thick layer of adipose tissue. Furthermore, its distance from the RH appears to increase with forearm supination. This position could increase the safe working space between RH and PIN. Clinical Relevance Knowledge of PIN position in relation to the anterior elbow capsule and its changes with forearm movements can help reduce the iatrogenic injuries during elbow arthroscopy.

Keywords: cadaver; elbow arthroscopy; nerve injury; posterior interosseous nerve.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Arthroscopic measurement of the distance between the anterior part of the RH and the posterior interosseous nerve (asterisk) with a graduated caliper inserted through the midlateral portal. Arrowhead indicates capitellum. RH; radial head.
Fig. 2
Fig. 2
The posterior interosseous nerve (asterisk) is separated from the anterolateral elbow capsule by a thick layer of adipose tissue, which is retracted by a probe inserted through the posterolateral portal. Arrowhead indicates capitellum. RH, radial head.
See this image and copyright information in PMC

References

    1. Daurka J, Chen A, Akhtar K, Kamineni S. Tardy posterior interosseous nerve palsy associated with radial head fracture: a case report. Cases J. 2009;2(01):22. - PMC - PubMed
    1. Erra C, De Franco P, Granata G et al.Secondary posterior interosseous nerve lesions associated with humeral fractures. Muscle Nerve. 2016;53(03):375–378. - PubMed
    1. Van Geertruyden J P, Vico P G. Iatrogenic posterior interosseous nerve palsy following an elbow fracture. Acta Orthop Belg. 1996;62(04):222–224. - PubMed
    1. Saldua N, Carney J, Dewing C, Thompson M. The effect of drilling angle on posterior interosseous nerve safety during open and endoscopic anterior single-incision repair of the distal biceps tendon. Arthroscopy. 2008;24(03):305–310. - PubMed
    1. Lo E Y, Li C S, Van den Bogaerde J M. The effect of drill trajectory on proximity to the posterior interosseous nerve during cortical button distal biceps repair. Arthroscopy. 2011;27(08):1048–1054. - PMC - PubMed