title: Identification of the radial nerve during the posterior approach to the humerus:  a cadaveric study.
abstract: OBJECTIVE
  Identification of the radial nerve is necessary during the posterior approach to the humerus in an effort to maintain its integrity. Other than anatomic descriptions of the radial nerve with respect to osseous structures, there are few superficial intraoperative landmarks along the course of the traditional triceps-splitting approach to provide facile nerve identification. The objective of this study was to determine the reliability of using the anatomic intersection of the long and lateral heads of the triceps and the triceps aponeurosis as a superficial reference point for radial nerve identification during the posterior approach to the humerus.
  
  
  METHODS
  Thirty adult human cadaver upper extremities as 15 matched pairs were used. Systematic identification and measurement from the point of intersection between the long and lateral heads of the triceps and the triceps aponeurosis to the distal most aspect of the radial nerve as it coursed the posterior humerus at its midaxial point was performed and recorded.
  
  
  RESULTS
  Mean distance was found to measure 39.0 ± 2.1 mm (range, 36-44 mm), approximating a fixed distance, two finger breadths proximal to our identified point of intersection. Statistical analysis between the two matched pair groups yielded no significant difference in measured distances (P = 0.88).
  
  
  CONCLUSIONS
  Our group has identified the point of intersection among three landmarks forming a point of intersection. This point is the confluence of the long and lateral heads of the triceps and the triceps aponeurosis. This serves as a visualized anatomic reference point during the posterior surgical exposure to the humerus and can be used to identify the radial nerve as it courses the posterior humerus.
authors.affiliation: Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Seigerman
authors.forename: Edward W
authors.initials: EW
authors.lastname: Choung
authors.forename: Richard S
authors.initials: RS
authors.lastname: Yoon
authors.forename: Michael
authors.initials: M
authors.lastname: Lu
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Frank
authors.forename: L C D R Robert J
authors.initials: LC
authors.lastname: Gaines
authors.forename: Frank A
authors.initials: FA
authors.lastname: Liporace
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D006801:Humans; D006811:Humerus / Q000033:anatomy & histology* / Q000601:surgery*; D008297:Male; D008953:Models, Anatomic; D011826:Radial Nerve / Q000033:anatomy & histology* / Q000601:surgery*