title: Surgical Anatomy of the Radial Nerve at the Elbow and in the Forearm: Anatomical Basis for Intraplexus Nerve Transfer to Reconstruct Thumb and Finger Extension in C7 - T1 Brachial Plexus Palsy.
abstract: BackgroundC7 - T1 palsy results in complete loss of finger motion and poses a surgical challenge. This study investigated the anatomy of the radial nerve in the elbow and forearm and the feasibility of intraplexus nerve transfer to restore thumb and finger extension.MethodsThe radial nerves were dissected in 28 formalin-fixed upper extremities. Branching pattern, length, diameter, and number of myelinated fibers were recorded.ResultsCommonly, the branching pattern (from proximal to distal) was to the brachioradialis, extensor carpi radialis longus, superficial sensory proximal to the lateral epicondyle, extensor carpi radialis brevis, supinator, extensor digitorum communis, extensor digiti minimi, extensor carpi ulnaris, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, and extensor indicis distal to the lateral epicondyle.ConclusionsBranches to the brachioradialis, extensor carpi radialis longus, and supinator can be transferred to the posterior interosseous nerve to restore hand movement in patients with C7 - T1 brachial plexus palsies; the supinator branch is probably the best choice in this regard.
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Dong
authors.affiliation: Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Chun-Lin
authors.initials: CL
authors.lastname: Zhang
authors.affiliation: Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Yu-Dong
authors.initials: YD
authors.lastname: Gu
mesh_terms: D020516:Brachial Plexus Neuropathies; D002102:Cadaver; D004550:Elbow / Q000294:innervation* / Q000473:pathology; D005260:Female; D005385:Fingers / Q000294:innervation; D005542:Forearm / Q000294:innervation* / Q000473:pathology; D006801:Humans; D008297:Male; D016067:Nerve Transfer / Q000379:methods*; D011826:Radial Nerve / Q000033:anatomy & histology* / Q000473:pathology / Q000601:surgery; D019651:Plastic Surgery Procedures; D013933:Thumb / Q000294:innervation