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Important anatomical relationships of the posterior interosseous nerve in the distal forearm for surgical planning: a cadaveric study.

ABSTRACT: A thorough knowledge of the anatomy of the terminal branch of the posterior interosseous nerve (PIN) and its relationship to the anterior interosseous nerve (AIN) is essential in facilitating regional anesthetic blocks and planning surgical exposures for wrist surgery and arthrodesis of wrist and proximal row carpectomy. This cadaveric study focused on the anatomy and course of the PIN and its anatomical relationships at the distal forearm. Thirty embalmed cadaver forearms were dissected using microsurgical techniques. A structured pro forma was used to collect data. The PIN was consistently found in the fourth extensor compartment in all specimens. The last motor branch was given off 46.9 ± 8.4 mm (mean ± standard deviation) from the most proximal part of the ulnar head. The AIN was found lying consistently on the anterior aspect of the interosseous membrane, being on average 2.8 ± 0.2 mm (mean ± standard deviation) from the PIN. This knowledge will facilitate the planning of diagnostic and therapeutic procedures associated with the wrist.

SUBMITTER: Jariwala A

PROVIDER: S-EPMC3922858 | biostudies-other | 2014 Feb

REPOSITORIES: biostudies-other

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Posterior interosseous nerve palsy after closed proximal forearm fractures.

Project description:Although rare, posterior interosseous nerve (PIN) palsy can occur in patients with a closed proximal forearm fracture and may present in a delayed fashion after initial trauma. In this case series, three cases of posterior interosseous nerve (PIN) injury following proximal forearm fractures are presented and discussed. Our literature search yielded six studies concerning PIN injury in radial head/neck fractures and proximal forearm fractures. Out of a total of 8 patients, 7 patients were treated non-operatively and in one patient a PIN release was performed. One patient was lost to follow-up, all other 7 patients showed successful recovery. A treatment algorithm for PIN palsy after proximal forearm fractures is provided. Based on our experience and what we found in literature, it seems safe to treat PIN palsies conservatively.

| S-EPMC6719290 | biostudies-literature

Locating the anterior interosseous nerve in relation to the surgically relevant landmarks of the forearm: A cadaveric study.

Project description:BackgroundThis study emphasizes locating the anterior interosseous nerve (AIN) related to its level of origin, number, and lengths of its muscular branches and relation to surgically important landmarks such as the bi-epicondylar line, pronator teres, and Gantzer muscles.MethodsThe study was undertaken at a private Medical school in south India during 2019-20. The level of origin of AIN was measured from the bi-epicondylar line and its length was measured up to the upper border of the pronator quadratus using 44 cadaveric upper limbs. The number of branches given to flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) was quantified and their lengths were measured.ResultsThe nerve originated at a mean distance of 41.56 mm from the bi-epicondylar line. In 12 upper limbs, FDP received two branches and in two limbs, it received three branches. In 13 upper limbs, FPL received two branches from AIN. It was observed that the muscular branches for FDP were shorter than those for FPL. Gantzer muscle was observed in 18 (40%) specimens and was found superficial to the nerve.ConclusionThe muscular branches of AIN had a variable pattern of innervation. Multiple muscular branches to the FPL and FDP were observed in the upper 2/3rds of the forearm. These branches to FPL and FDP would aid as a source of nerve grafting and nerve transfer in the cases of upper extremity nerve palsies.

| S-EPMC8521140 | biostudies-literature

Reconstruction of posterior interosseous nerve injury following biceps tendon repair: case report and cadaveric study.

Project description:Surgical repair of distal biceps tendon rupture is a technically challenging procedure that has the potential for devastating and permanently disabling complications. We report two cases of posterior interosseous nerve (PIN) injury following successful biceps tendon repair utilizing both the single-incision and two-incision approaches. We also describe our technique of posterior interosseous nerve repair using a medial antebrachial cutaneous nerve graft (MABC) and a new approach to the terminal branches of the posterior interosseous nerve that makes this reconstruction possible. Finally, we advocate consideration for identification of the posterior interosseous nerve prior to reattachment of the biceps tendon to the radial tuberosity.

| S-EPMC2686781 | biostudies-other

Persistent anterior interosseous nerve palsy following forearm crutch use.

Project description:A 43-year-old man presented with weakness of the interphalageal joint of his right thumb following the use of forearm crutches. On examination he was unable to oppose his thumb and index finger to form the 'ok' sign. Nerve conduction showed anterior interosseous nerve (AIN) damage along its path to the flexor pollicis longus. The patient was managed conservatively with little clinical improvement seen at 4?months. AIN palsies are very rare and account for <1% of all upper limb lesions. Although AIN palsies resulting from other causes such as surgery and blunt trauma are more common, we report the second case of AIN palsy following crutch use, and the first case in which clinical identification was confirmed using electrodiagnosis. Usual clinical practice recommends a prolonged period of conservative management with surgical management withheld for a minimum of 12?months. Correct crutch fitting and early identification of signs of associated injuries are of paramount importance.

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Distal radius malunion and forearm rotation: a cadaveric study.

Project description:Background Malunions following distal radius fractures are common, with shortening, translation, and rotation occurring. The patients frequently lose forearm rotation, but there is no data to indicate whether this is due to mechanical misalignment between the radius and the ulna or to contracture of the soft tissues. Material and Methods Seven fresh cadaveric specimens were used to determine the loss of forearm rotation with varying simulated distal radius fracture malalignment patterns. Uniplanar malunion patterns consisting of dorsal tilt, radioulnar translation, or radial shortening were simulated by creating an osteotomy at the distal end of the radius. Description of Technique By orienting the distal fragment position using an external fixator and maintaining the position with wedges and a T-plate, varying degrees of malunion of the distal radius could be simulated. Rotation of the forearm was produced by fixing the elbow in a flexed position and applying a constant torque to the forearm using deadweights. Forearm rotation was measured with a protractor. Results Dorsal tilt to 30° and radial translation to 10 mm led to no significant restriction in forearm pronation or supination ranges of motion. A 5-mm ulnar translation deformity resulted in a mean 23% loss of pronation range of motion. Radial shortening of 10 mm reduced forearm pronation by 47% and supination by 29%. Conclusion Because a severe osseous misalignment was required to produce a significant loss in rotation, contracture of the soft tissues is most likely the cause of the loss of rotation in most cases.

| S-EPMC3922873 | biostudies-other

Nerve ultrasound identifies abnormalities in the posterior interosseous nerve in patients with proximal radial neuropathies.

Project description:The radial nerve and posterior interosseous nerve (PIN) are prone to injury at multiple sites. Electrodiagnostic (EDx) studies may only identify the most proximal lesion. Nerve ultrasound could augment EDx by visualizing additional pathology.This investigation was a retrospective examination of ultrasound and EDx from 26 patients evaluated for posterior cord/radial/PIN lesions.Eighteen of 26 patients had abnormalities on EDx (15 radial, 2 PIN, 1 posterior cord). Ultrasound identified 15 of 18 (83%) of the EDx abnormalities and provided additional diagnostic information. In 6 of 15 (40%) patients with EDx evidence of radial neuropathy, ultrasound identified both radial nerve enlargement and additional, unsuspected PIN enlargement (53% to 339% enlarged vs. unaffected side). Ultrasound also identified: nerve (dis)continuity at the trauma site (n = 8); and nerve tumor (n = 2; 1 with normal EDx).In radial neuropathy, ultrasound often augments EDx studies and identifies a second lesion in the PIN. Further studies are required to determine the etiology and significance of this additional distal pathology.

| S-EPMC5925758 | biostudies-literature

The utility of ultrasound in showing a unique cause of posterior interosseous nerve syndrome.

Project description: Not available

| S-EPMC5730911 | biostudies-literature

Hyalinization of interosseous membrane of forearm: A case report.

Project description: Not available

| S-EPMC6823687 | biostudies-literature

The Myth of Median Nerve in Forearm and Its Role in Double Crush Syndrome: A Cadaveric Study.

Project description:Purpose: This study aims to histologically compare the median nerve in the arm, forearm, and wrist, to help understand how cervical radiculopathy in a double crush phenomenon causes distal nerve dysfunction at the carpal tunnel and median nerve with concurrent absence of symptoms at the forearm. Methods: The study was performed on 12 fresh cadaveric upper limbs free from any injury or operation. Male cadavers in the age range of 35-40 years were used. The dissection of the median nerve and the histological examination of the specimens from the arm, forearm, and wrist were conducted to evaluate variations in the epineurium thickness (μm), perineurium thickness (μm), number of fascicles per nerve trunk, area percent of myelin covering, and area percent of neurolemmal sheath. Results: Morphometric and statistical results of the cadaveric median nerve trunk revealed that the mean epineurium and perineurium thickness measured in H&E-stained sections in the forearm were significantly greater than those in the arm and wrist specimens. Further, the mean percent area of the myelin covering in the forearm was significantly lower than that in the arm and wrist specimens in the sections stained with osmium oxide (p < 0.001). There were, however, no significant differences in the neurolemmal sheath among the arm, forearm, and wrist specimens in the silver-stained sections. Conclusion: The histological differences explained the high concomitant occurrence of carpal tunnel syndrome (CTS) and cervical radiculopathy and the concurrent absence of symptoms at the forearm. Hence, we suggest cautious evaluation of patients with upper limb symptoms, since the management of these conditions requires a different approach.

| S-EPMC8490666 | biostudies-literature

Composite Anatomical Variations between the Sciatic Nerve and the Piriformis Muscle: A Nepalese Cadaveric Study.

Project description:Piriformis syndrome is a rare syndrome which is one of the main causes of nondiscogenic sciatica causing severe low back pain due to entrapment of sciatic nerve either by the hypertrophy or by inflammation of the piriformis muscle. We have carried out dissection in 20 Nepalese cadavers. Out of 40 dissected gluteal regions, 37 exhibited typical appearance of sciatic nerve, piriformis muscle, and their relations resembling type-a, whereas 3 gluteal regions showed composite structural variations resembling type-b and type-c based on Beaton and Anson's classification. Knowledge pertaining to such variations will be helpful during a surgical intervention in the gluteal region and in turn reduces the risk of injuring these nerves which are more susceptible to damage. Our study reports such variations in Nepalese population which will be helpful during evaluation of the pain induction in various test positions and also useful for analysis of the range of the neurological deficiency in sciatic nerve neuropathies. The present study also explains the basis of the unsuccessful attempt of the sciatic nerve block during popliteal block anaesthesia.

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