Relationships Between the Posterior Interosseous Nerve and the Supinator Muscle: Application to Peripheral Nerve Compression Syndromes and Nerve Transfer Procedures

Abstract

Background and Study Aims Little information can be found in the literature regarding the relationships of the posterior interosseous nerve (PIN) while it traverses the supinator muscle. Because compression syndromes may involve this nerve at this site and researchers have investigated using branches of the PIN to the supinator for neurotization procedures, the authors' aim was to elucidate information about this anatomy.

Materials and Methods Dissection was performed on 52 cadaveric limbs to investigate branching patterns of the PIN within the supinator muscle.

Results On 29 sides, the PIN entered the supinator muscle as a single nerve and from its medial side provided two to four branches to the muscle. On 23 sides, the nerve entered the supinator muscle as two approximately equal-size branches that arose from the radial nerve on average 2.2 cm from the proximal edge of this muscle. In these cases, the medial of the two branches terminated on the supinator muscle, and the lateral branch traveled through the supinator muscle; in 13 specimens, it provided additional smaller branches to the supinator muscle. The length of PIN within the supinator muscle was 4 cm on average, and the diameter of its branches to the supinator muscle ranged from 0.8 to 1.1 mm. In 10 specimens, the PIN left the supinator muscle before the most distal aspect of the muscle. In two specimens with a single broad PIN, muscle fibers of the supinator muscle pierced the PIN as it traveled through it.

Conclusion This knowledge of the anatomy of the PIN as it passes through the supinator muscle may be useful to neurosurgeons during decompressive procedures or neurotization.

Keywords

anatomy - compression - neurosurgery - peripheral nerve - upper limb

• References

• 1 Tatar I, Kocabiyik N, Gayretli O, Ozan H. The course and branching pattern of the deep branch of the radial nerve in relation to the supinator muscle in fetus elbow. Surg Radiol Anat 2009; 31 (8) 591-596
• 2 Duquin TR, Chavan PR, Bisson LJ. Innervation of the supinator muscle and its relationship to two-incision distal biceps tendon repair: an anatomic study. Clin Anat 2010; 23 (4) 413-419
• 3 Carfi J, Ma DM. Posterior interosseous syndrome revisited. Muscle Nerve 1985; 8 (6) 499-502
• 4 Bowen TL, Stone KH. Posterior interosseous nerve paralysis caused by a ganglion at the elbow. J Bone Joint Surg Br 1966; 48 (4) 774-776
• 5 Change LW, Gowans JDC, Granger CV, Millender LH. Entrapment neuropathy of the posterior interosseous nerve of the forearm. J Bone Joint Surg 1966; 48: 770-773
• 6 Ozturk A, Kutlu C, Taskara N, Kale AC, Bayraktar B, Cecen A. Anatomic and morphometric study of the arcade of Frohse in cadavers. Surg Radiol Anat 2005; 27 (3) 171-175
• 7 Agnew DH. Bursal tumour producing loss of power of forearm. Am J Med Sci 1863; 46: 404-405
• 8 Riffaud L, Morandi X, Godey B , et al. Anatomic bases for the compression and neurolysis of the deep branch of the radial nerve in the radial tunnel. Surg Radiol Anat 1999; 21 (4) 229-233
• 9 Russell SM. Examination of Peripheral Nerve Injuries: An Anatomical Approach. New York: Thieme; 2006
• 10 Woltman HW, Learmonth JR. Progressive paralysis of the nervus interosseous dorsalis. Brain 1934; 57: 25-31
• 11 Pecina MM, Krmpotic-Nemanic J, Markiewitz AD. Tunnel Syndromes: Peripheral Nerve Compression Syndromes. 3rd ed. Boca Raton, FL: CRC Press; 2001
• 12 Thomas SJ, Yakin DE, Parry BR, Lubahn JD. The anatomical relationship between the posterior interosseous nerve and the supinator muscle. J Hand Surg Am 2000; 25 (5) 936-941
• 13 Tubbs RS, Salter EG, Wellons III JC, Blount JP, Oakes WJ. Superficial surgical landmarks for identifying the posterior interosseous nerve. J Neurosurg 2006; 104 (5) 796-799
• 14 Roles NC, Maudsley RH. Radial tunnel syndrome: resistant tennis elbow as a nerve entrapment. J Bone Joint Surg Br 1972; 54 (3) 499-508
• 15 Bertelli JA, Kechele PR, Santos MA, Besen BA, Duarte H. Anatomical feasibility of transferring supinator motor branches to the posterior interosseous nerve in C7-T1 brachial plexus palsies. Laboratory investigation. J Neurosurg 2009; 111 (2) 326-331
• 16 Dong Z, Gu YD, Zhang CG, Zhang L. Clinical use of supinator motor branch transfer to the posterior interosseous nerve in C7-T1 brachial plexus palsies. J Neurosurg 2010; 113 (1) 113-117
• 17 Sponseller PD, Engber WD. Double-entrapment radial tunnel syndrome. J Hand Surg Am 1983; 8 (4) 420-423
• 18 Bergman RA, Thompson SA, Afifi AK , et al. Compendium of Human Anatomic Variation. Baltimore: Urban & Schwarzenberg; 1984
• 19 Sunderland S. Nerves and Nerve Injuries. 2nd ed. New York: Churchill Livingstone; 1978