Innervation of the elbow joint and surgical perspectives of denervation: a cadaveric anatomic study.
OBJECTIVE
Peripheral articular denervation has been proposed as an alternative treatment for degenerative arthritis. It shows particular promise in the elbow because the joint is non-weight bearing and easily exposed. Accurate knowledge of peripheral neuroanatomy is required for future denervation surgeries, yet very few studies focus on the articular branches of the ulnar, median, and radial nerves that provide elbow capsule innervation.


METHODS
Twenty-three upper limbs from skeletally mature fresh-frozen cadavers were used for dissection of the ulnar, median, and radial nerves. The presence, number, location, and diameter of articular branches to the elbow capsule were recorded.


RESULTS
The ulnar nerve typically supplied 1 to 2 large branches to the elbow capsule (range, 0-4). In the 3 specimens with a greater number, a thinner diameter was noted (<1 mm compared with 1.2 mm). The median nerve contributed an average of 1.3 branches (range, 0-4) and showed an inverse ratio with the ulnar nerve contribution. The posterior interosseous nerve contributed a range of 0 to 4 branches, arising at 5 mm to 2 mm after bifurcation of the radial nerve.


CONCLUSIONS
Most previous upper-extremity nerve studies have failed to fully characterize the contributions of all 3 major nerves to capsular innervation. We have thoroughly documented the articular branching patterns of all 3 major nerves and show that all 3 may contribute branches to the capsule.
Bekler
Halil
H
Department of Orthopaedic Surgery, Trauma Training Center, Columbia University, New York Orthopaedic Hospital, Columbia Presbyterian-Medical Center, New York, NY, USA. hibekler@yeditepe.edu.tr
Riansuwan
Kongkhet
K
Vroemen
Joy C
JC
Vroeman
Joy C
JC
McKean
Jason
J
Wolfe
Valerie M
VM
Rosenwasser
Melvin P
MP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D003714:Denervation / Q000379:methods*; D004210:Dissection; D004551:Elbow Joint / Q000294:innervation* / Q000601:surgery; D006801:Humans; D008475:Median Nerve / Q000033:anatomy & histology*; D008875:Middle Aged; D011826:Radial Nerve / Q000033:anatomy & histology*; D014459:Ulnar Nerve / Q000033:anatomy & histology*