Surgical Implications of Innervation Pattern of the Triceps Muscle: A Cadaveric Study

Chaware, Prashant; Santoshi, John Ashutosh; Patel, Manmohan; Ahmad, Mohtashim; Rathinam, Bertha

doi:10.1055/s-0038-1660771

Cited by 6 publications

(6 citation statements)

References 15 publications

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“…Al-Meshal and Gilbert 12 observed dual innervation of the triceps long head in 2 of their 22 specimens. Contrary to other studies, 13,14 we were unable to identify the triceps long head motor branch stemming from the axillary nerve or posterior cord. In studies by de Sèze et al, 15 the triceps long head was never innervated by the radial nerve.…”

Section: Discussioncontrasting

confidence: 99%

Triceps and cutaneous radial nerve branches investigated via an axillary anterior arm approach: new findings in a fresh-cadaver anatomical study

Bertelli

Goklani

Patel

et al. 2022

Journal of Neurosurgery

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OBJECTIVE The authors sought to describe the anatomy of the radial nerve and its branches when exposed through an axillary anterior arm approach. METHODS Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery. RESULTS Via the anterior arm approach, all triceps muscle heads could be dissected and individualized. The radial nerve overlaid the latissimus dorsi tendon, bounded by the axillar artery on its superior surface, then passed around the humerus, together with the lower lateral arm and posterior antebrachial cutaneous nerve, between the lateral and medial heads of the triceps. No triceps motor branch accompanied the radial nerve’s trajectory. Over the latissimus dorsi tendon, an antero-inferior bundle, containing all radial nerve branches to the triceps, was consistently observed. In the majority of the dissections, a single branch to the long head and dual innervations for the lateral and medial heads were observed. The triceps long and proximal lateral head branches entered the triceps muscle close to the latissimus dorsi tendon. The second branch to the lateral head stemmed from the triceps lower head motor branch. The triceps medial head was innervated by the upper medial head motor branch, which followed the ulnar nerve to enter the medial head on its anterior surface. The distal branch to the triceps medial head also originated near the distal border of the latissimus dorsi tendon. After a short trajectory, a branch went out that penetrated the medial head on its posterior surface. The triceps lower medial head motor branch ended in the anconeus muscle, after traveling inside the triceps medial head. The lower lateral arm and posterior antebrachial cutaneous nerve followed the radial nerve within the torsion canal. The lower lateral brachial cutaneous nerve innervated the skin over the biceps, while the posterior antebrachial cutaneous nerve innervated the skin over the lateral epicondyle and posterior surface of the forearm. The average numbers of myelinated fibers were 926 in the long and 439 in the upper lateral head and 658 in the upper and 1137 in the lower medial head motor branches. CONCLUSIONS The new understanding of radial nerve anatomy delineated in this study should aid surgeons during reconstructive surgery to treat upper-limb paralysis.

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Section: Discussioncontrasting

confidence: 99%

Triceps and cutaneous radial nerve branches investigated via an axillary anterior arm approach: new findings in a fresh-cadaver anatomical study

Bertelli

Goklani

Patel

et al. 2022

Journal of Neurosurgery

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“…The cadaveric study shed some light to increase the safety and the utility of this approach; 1- It is better to leave 2 cm at least from superior margin during anconeus incision as the present cadaveric study (in twelve specimens) showed connection between the medial head of the triceps and anconeus. Also, it could be at risk in cutting the nerve to anconeus because it branches from the radial nerve of the medial head of triceps at the anconeus superior margin [ 17 ]. 2- It is better to plan splitting of the anconeus muscle in the medial 2/3 of the middle segment.…”

Section: Discussionmentioning

confidence: 99%

A modified trans-anconeus approach to facilitate fixation of a posterior radial head fracture: a cadaveric feasibility study

et al. 2023

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Fixation of radial head fracture with minimally invasive posterior approach remains a significant challenge. The aim of this study was to determine the feasibility of trans-anconeus posterior elbow approach and to observe lateral ulnar collateral ligament (LUCL) in extended elbows. This cadaveric study was performed in twenty upper limbs of fresh fixed adult male cadavers. An oblique incision was made in the middle segment of anconeus until the lateral ligament complex and the joint capsule had been revealed. A deep dissection was explored to observe the anatomical relationship of the LUCL to the anconeus. Measurements of the LUCL were recorded while the elbow was fully extended. The mean distance between the edge of the radial head and the proximal insertion of the LUCL was 13.3 mm (11.5-16.2 mm); the mean distance between the edge of the radial head and the distal insertion of the LUCL was 20.9 mm (19.2-23.4 mm); the distance between the edge of the radial head and the distal edge of the annular ligament was 11.2 mm (8.22-11.7 mm). By estimate correlation of the previous measurements, the direct and accessible way to expose the posterolateral articular capsule of the elbow joint was through a window in medial 2/3 of the middle segment of anconeus muscle. These trans-anconeus approach is useful. It provides good visualization, facilitates applying the implants, and lessens the risk of radial nerve injury. Awareness of the anatomy is mandatory to avoid injury of LUCL.

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“…In this context, it is important to have the knowledge about anatomical variations in the innervation of triceps brachii. This will prevent inadvertent iatrogenic injury and also provides new modalities for the free functional nerve and muscle transfers for the triceps brachii (11). Ulnar collateral nerve (UCN) runs along with the UN, but it is a branch of RN (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

An Anatomical Perspective of Ulnar Collateral Nerve with Reference to Nerve and Muscle Transfer Surgery

Jiji

Joy

Murlimanju

et al. 2020

Muscle Ligaments and Tendons J

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Background. The purpose was to analyze the prevalence, origin, course and termination of the ulnar collateral nerve in anatomical samples from Indian population. Methods. The present study included 68 adult human cadaveric embalmed upper limbs. The sex of these upper limbs were not known. The initial segment of radial nerve was meticulously dissected in the specimens to observe the ulnar collateral nerve. The digital Vernier caliper was used for the measurements which were performed in this study. The data was given in millimeter and expressed as mean ± SD. Results. The ulnar collateral nerve was observed in 57 (83.8%) of our specimens. It originated in the axilla in 35 cases (61.4%), at the brachio-axillary angle in 13 (22.8%) and in the arm in 9 cases (15.8%) respectively. The termination of ulnar collateral nerve by piercing deep into the triceps muscle happened 101.9 ± 4 mm above the medial epicondyle of humerus. The origins of muscular branch to long head of triceps muscle and ulnar collateral nerve were located 44.7 ± 3.7 mm and 66.7 ± 4.4 mm away from the bifurcation of posterior cord respectively. Conclusions. The present study suggests higher frequency of ulnar collateral nerve in sample Indian population. Ulnar collateral nerve can be used to re-innervate the muscles in case of brachial plexus injuries. Our study provides information about the detailed morphology and topography of the ulnar collateral nerve. The detailed knowledge can help the orthopedic surgeons during the procedures like muscle transfer, nerve transfer and nerve grafting.

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Surgical Implications of Innervation Pattern of the Triceps Muscle: A Cadaveric Study

Cited by 6 publications

References 15 publications

Triceps and cutaneous radial nerve branches investigated via an axillary anterior arm approach: new findings in a fresh-cadaver anatomical study

Triceps and cutaneous radial nerve branches investigated via an axillary anterior arm approach: new findings in a fresh-cadaver anatomical study

A modified trans-anconeus approach to facilitate fixation of a posterior radial head fracture: a cadaveric feasibility study

An Anatomical Perspective of Ulnar Collateral Nerve with Reference to Nerve and Muscle Transfer Surgery

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