Triceps aponeurosis and deltoid tuberosity as a landmarks for radial nerve dissection: a cadaveric study

TL;DR

This study identifies the triceps aponeurosis and deltoid tuberosity as reliable landmarks for locating the radial nerve during surgery, reducing the risk of nerve injury.

Contribution

The study introduces new soft tissue and bony landmarks for radial nerve dissection in posterior humeral approaches.

Findings

The average distance between the triceps aponeurosis apex and the radial nerve was 40.3 mm.

The radial nerve was consistently located posteriorly at the mid-axial level of the distal deltoid tuberosity.

These landmarks are especially useful when traditional cues are obscured by fractures.

Abstract

The radial nerve, originating from the posterior cord of the brachial plexus, traverses the posterior humerus. Incidences of radial nerve injury have been noted following surgical interventions like fracture fixation and exploration in this area. There's a paucity of literature detailing soft tissue anatomical cues for radial nerve dissection. This study aimed to identify reliable soft tissue and bony landmarks (triceps aponeurosis and deltoid tuberosity) that can be of substantial importance in dissecting the radial nerve and reducing iatrogenic nerve injury utilizing the posterior approach.

Thirty-two fresh-frozen cadaver specimens underwent dissection using a posterior triceps-splitting approach to expose the radial nerve. The distance between the apex of the triceps aponeurosis and the radial nerve was measured, alongside noting the radial nerve's position relative to the deltoid tuberosity.

Of the cadavers, 78% were female, and 22% were male, with a mean age of 76 (range: 62-85). The average distance between the aponeurosis apex and the radial nerve was 40.3 mm (range: 28-60). The radial nerve was consistently found in all specimens, situated posteriorly at the humerus's mid-axial level at the distal part of the deltoid tuberosity.

The triceps aponeurosis and distal deltoid tuberosity serve as reliable and practical landmarks for dissecting and exploring the radial nerve during posterior humeral approaches. These landmarks prove especially valuable when fractures obscure conventional anatomical cues.

Figures