title: Targeted Muscle Reinnervation of the Brachium: An Anatomic Study of Musculocutaneous and Radial Nerve Motor Points Relative to Proximal Landmarks.
abstract: OBJECTIVE
  Targeted muscle reinnervation (TMR) offers enhanced prosthetic use by harnessing additional neural control from unused nerves in the amputated limb. The purpose of this study was to document the location and number of motor end plates to each muscle commonly used in TMR in the brachium relative to proximally based bony landmarks.
  
  
  METHODS
  We dissected 18 matched upper limbs (9 fresh-frozen cadavers). The locations of each of the nerves' muscular insertions into the medial biceps and brachialis were measured relative to the anterolateral tip of the acromion. The terminal branches to the lateral triceps were measured relative to the posterolateral tip of the acromion. Both the number of branches and the location of the muscular insertions were documented. Common descriptive statistics were used to describe the data.
  
  
  RESULTS
  There was a median of 2 branches to the medial biceps located 19.6 cm from the anterolateral tip of the acromion (range, 15-25 cm). There was a median of 3.5 branches to the brachialis located 24.2 cm from the anterolateral tip of the acromion (range, 19-27.5 cm). There was a median of 2.5 branches to the lateral triceps located 21.6 cm from the posterolateral tip of the acromion (range, 11-29 cm). The mean distances to the primary branch muscle and the number of smaller branches were not significantly different when compared by sex or side.
  
  
  CONCLUSIONS
  Motor points for the medial biceps, brachialis, and lateral triceps can be identified reliably using proximal landmarks in targeted muscle reinnervation.
  
  
  CONCLUSIONS
  The data obtained from this study may assist the surgeon in localizing the nerve branches and muscular insertions for the commonly used muscles for TMR of the brachium.
authors.affiliation: Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Renninger
authors.affiliation: Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA.
authors.forename: Vanna J
authors.initials: VJ
authors.lastname: Rocchi
authors.affiliation: Department of Orthopedic Surgery, Southern California Permanente Medical Group, San Diego, CA. Electronic address: ltkroonen@mac.com.
authors.forename: Leo T
authors.initials: LT
authors.lastname: Kroonen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D059925:Anatomic Landmarks; D001186:Artificial Limbs; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation*; D009138:Musculocutaneous Nerve / Q000033:anatomy & histology*; D011826:Radial Nerve / Q000033:anatomy & histology*; D034941:Upper Extremity / Q000294:innervation*
keywords: Prosthetics; musculocutaneous; radial; targeted muscle reinnervation