Anatomy of the anterior interosseous innervation of the pronator quadratus: evaluation of structures at risk in the single dorsal incision wrist denervation technique.
OBJECTIVE
Patients with chronic wrist pain often are treated with wrist denervation, which typically involves transecting both the anterior interosseous nerve (AIN) and the posterior interosseous nerve. A single dorsal incision approach is an improvement over the more traditional multiple-incision technique. The purpose of our study was to describe the branches of the AIN to the pronator quadratus and evaluate the risk of denervation with the single dorsal incision technique.


METHODS
Twelve fresh-frozen cadaver forearms were dissected. The branches of the AIN to the pronator quadratus were identified and the individual branch points were measured from the articular edge of the distal radius. Wrist denervation was then performed on each specimen through the single dorsal incision (as suggested by Berger).


RESULTS
There were an average of 3 branches from the AIN to the pronator quadratus. All forearms had at least 1 branch to the pronator quadratus more proximal to the distal end of the dorsal skin incision; however, in only 2 of the forearms was the most proximal branch more than 2 cm proximal to the distal end of the dorsal skin incision.


CONCLUSIONS
Wrist denervation through the recommended single dorsal incision poses a serious risk for completely denervating the pronator quadratus. Therefore the resection of the AIN must be performed close to the distal margin of the pronator quadratus.
Lin
David L
DL
Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, Washington, DC, USA. david.lin@na.amedd.army.mil
Lenhart
Martha K
MK
Farber
Gerald L
GL
D003714:Denervation; D004210:Dissection; D005542:Forearm / Q000294:innervation* / Q000601:surgery; D006225:Hand / Q000294:innervation* / Q000601:surgery; D006801:Humans; D009121:Muscle Denervation; D018482:Muscle, Skeletal / Q000294:innervation* / Q000601:surgery; D010525:Peripheral Nerves / Q000033:anatomy & histology* / Q000601:surgery; D011403:Pronation / Q000502:physiology*; D012307:Risk Factors; D014953:Wrist / Q000294:innervation* / Q000601:surgery