title: Anatomical Study of the Surgical Approaches to the Radial Tunnel.
abstract: OBJECTIVE
  To provide a cadaveric analysis of 3 surgical approaches (anterior, anterolateral, posterior) used for decompression of the posterior interosseous nerve within the radial tunnel. The aim of the study was to determine whether the number of compression sites visualized and safely released differed between approaches. We hypothesized that no single approach is adequate for visualization of all key compression sites.
  
  
  METHODS
  Thirty fresh-frozen cadaveric specimens were used to perform 10 anterior, 10 anterolateral, and 10 posterior approaches to the radial tunnel. For each approach, key anatomical structures and the 5 documented anatomical sites of nerve compression that were clearly visualized within the surgical exposure were recorded. The portion of the supinator that was directly visualized in each approach was released. A second window was then created to expose the remaining uncut portion of the supinator. Measurements were taken from each specimen.
  
  
  RESULTS
  Statistical analysis demonstrated that the anterior and anterolateral approaches were best for visualizing the fibrous bands of the radial head, the leash of Henry, the origin of the extensor carpi radialis brevis, and the arcade of Frohse. The posterior approach was best for visualizing the distal border of the supinator. The relative uncut supinator distance varied with approach. The anterior approach left a larger relative uncut portion than the posterior approach.
  
  
  CONCLUSIONS
  No single approach was adequate for complete visualization and release of all compression points of the radial tunnel. In cases of radial tunnel release, complete visualization of the posterior interosseous nerve compression sites is best achieved through multiple windows.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
authors.forename: Ekaterina Y
authors.initials: EY
authors.lastname: Urch
authors.affiliation: Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
authors.forename: Zina
authors.initials: Z
authors.lastname: Model
authors.affiliation: Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Wolfe
authors.affiliation: Division of Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY. Electronic address: lees@hss.edu.
authors.forename: Steve K
authors.initials: SK
authors.lastname: Lee
mesh_terms: D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000601:surgery*; D020425:Radial Neuropathy / Q000601:surgery*
keywords: Anatomy; nerve compression; posterior interosseous nerve; radial nerve; radial tunnel