The anatomical relationship between the posterior interosseous nerve and the supinator muscle

doi:10.1053/jhsu.2000.16360

The Journal of Hand Surgery

Volume 25, Issue 5, September 2000, Pages 936-941

https://doi.org/10.1053/jhsu.2000.16360 Get rights and content

Understanding the anatomical relationships in the region of the supinator muscle is crucial in limiting surgical morbidity. The course, length, and muscular innervations of the posterior interosseous nerve, as well as a detailed dissection of the supinator muscle, were described and recorded in 31 specimens from 16 adult cadavers. In our study, the radial nerve bifurcated into the posterior interosseous nerve and superficial radial nerve 8.0±1.9 cm distal to the lateral intermuscular septum. The bifurcation of the radial nerve occurred 3.6±0.7 cm proximal to the leading edge of the supinator, with the posterior interosseous nerve exiting the supinator muscle 3.8±0.9 cm distal to the proximal margin. The arcade of Frohse was membranous in 68% of our specimens and tendinous in 32%. The supinator had one semicircular head or layer in 71% of specimens and 2 distinct heads or layers, as defined by diverging muscle fibers, in 29%. With 2 heads, or layers, the superficial layer extended to the lateral epicondyle while the deep layer extended to the ulna, below the radial notch.

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Location of the posterior interosseous nerve in relation to common lateral approaches to the elbow
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The risk of posterior interosseous nerve (PIN) injury during surgical approaches to the lateral elbow varies depending on the chosen approach, level of dissection, and rotational position of the forearm. Previous studies evaluated the trajectory of the PIN in specific surgical applications to reduce iatrogenic nerve injuries. The goal of this study is to examine the location of the PIN using common lateral approaches with varying forearm rotation.
The Kaplan, extensor digitorum communis (EDC) split, and Kocher approaches were performed on 18 cadaveric upper extremity specimens. Measurements were recorded with a digital caliper from the radiocapitellar (RC) joint and the lateral epicondyle to the point where the PIN crosses the approach in full supination, neutral, and full pronation with the elbow at 90°. The ratio of the nerve’s location in relation to the entire length of the radius was also evaluated to account for different-sized specimens.
The PIN was not encountered in the Kocher interval. For Kaplan and EDC split, with the forearm in full supination, the mean distance from the lateral epicondyle to the PIN was 52.0 ± 6.1 mm and 59.1 ± 5.5 mm, respectively, and the mean distance from the RC joint to the PIN was 34.7 ± 5.5 mm and 39.3 ± 4.7 mm, respectively; with the forearm in full pronation, the mean distance from the lateral epicondyle to the PIN was 63.3 ± 9.7 mm and 71.4 ± 8.3 mm, respectively, and the mean distance from the RC joint to the PIN was 44.2 ± 7.7 mm and 51.1 ± 8.7 mm, respectively.
The PIN is closer to the lateral epicondyle and RC joint in the Kaplan than EDC split approach and is not encountered during the Kocher approach. The PIN was not encountered within 26 mm from the RC joint and 39 mm from the lateral epicondyle in any approach and forearm position and is generally safe from iatrogenic injury within these distances.
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The role of the coronoid process in elbow instability has been established. When necessary, coronoid fixation can be challenging. Placing fixation perpendicular to the fracture requires achieving a trajectory as close as possible to the midline axis of the proximal ulna, either from anterior to posterior or vice versa. The aim of this study was to determine whether coronoid exposure—and the ability to place fixation from anterior to posterior—is improved via a lateral extensor–splitting approach with forearm supination, that is, the “spin move,” with progressive stages of lateral elbow instability.
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The posterior interosseus nerve (PIN) may be encountered when using the extensile extensor digitorum communis (EDC)-splitting approach to the elbow. An accurate means of estimating its location remains elusive. The purpose of this investigation is to identify whether the methods described in previous studies can be improved upon to more accurately estimate the PIN's location using the transepicondylar distance (TED).
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In method A, the mean TED was 63.4 ± 6.1 mm. Of the 6 measurements, the TED was most correlated to the actual distance to the PIN from the LE in pronation (68.3 ± 7.3 mm; R² = 0.266). The median difference between the estimated and actual distances was −5.6 mm (−19.3 mm to 7.6 mm). In method B, the mean TED was 68.4 ± 8.7 mm, and the mean measured distance from the LE in pronation was 68.7 ± 9.4 mm. The TED closely correlated with the measured distance to the PIN (R² = 0.95, P < .001). The mean difference between the estimated and actual distances was ±2.0 mm (range −4.0 mm to 2.0 mm), significantly more precise than method A (P = .007).
Using a tape measure, the TED predicted the PIN’s location within a mean ±2 mm in pronation along an axis from the LE to Lister’s tubercle, using an EDC-splitting approach. This technique is simple and comparatively more accurate than those used previously.
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^*: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

¹: From the Department of Orthopaedic Surgery, Hamot Medical Center, Erie, PA.

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The anatomical relationship between the posterior interosseous nerve and the supinator muscle*

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

Posterior interosseous nerve paralysis caused by fibrous band compression at the supinator muscle: a report of four cases

Acta Orthop Scand

Compression of the radial nerve by the triceps muscle: a case report

J Bone Joint Surg

Radial palsy following muscular effort: a nerve compression syndrome possibly related to a fibrous arch of the lateral head of the triceps

J Bone Joint Surg

Entrapment and compression neuropathies