Anatomic Course of the Superficial Branch of the Radial Nerve in the Wrist and Its Location in Relation to Wrist Arthroscopy Portals: A Cadaveric Study

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• 作者：Ayhan Kı ; lı ; ç ; Aysin Kale ; Ahmet Usta ; Fuat Bilgili ; Yavuz Kabukç ; uoğ ; lu ; Sami Sö ; kü ; cü
• 关键词：Radial nerve ; Anatomic study ; Wrist arthroscopy ; Portal
• 刊名：Arthroscopy: The Journal of Arthroscopic & Related Surgery
• 出版年：2009
• 出版时间：November 2009
• 年：2009
• 卷：25
• 期：11
• 页码：1261-1264
• 全文大小：837 K

文摘

Purpose

The aim of this study was to assess the course of the superficial branch of the radial nerve (SBRN) at the level of the wrist and its branches in relation to wrist arthroscopy portals.

Methods

Dissections were performed on 11 hands from 6 cadavers in the section starting from the point where the SBRN begins to emerge and ending at the terminal branches of the dorsal hand. The distribution of the SBRN, the distance from the superficial branch to the dorsal portals used in wrist arthroscopy, and the distance from the superficial branch to the anatomic determinants (styloid process of the radius, Lister tubercle) were studied.

Results

At the level of the wrist, the nerve bifurcated into 2 branches in 8 of 11 wrists (73 % ) and into 3 branches in 3 of 11 wrists (27 % ). The mean distance from the SBRN where it was first detected proximal to the Lister tubercle was 73 mm. The mean distance between the styloids was 52 mm; the distance between the Lister tubercle and styloid process of the radius was 23 mm. At the wrist level, the distance from the branch closest to the radial side to the Lister tubercle was 28 mm (L-D1), 21 mm (L-D2/3), and 7 mm (RS-D1). The distance of the closest nerve branch to the 3-4 portal was 9 mm. The distances of the other portals were 5 mm (1-2RMC–D1), 8 mm (1-2RMC–D2/3), 8 mm (1-2P–D1), and 9 mm (1-2P–D2/3).

Conclusions

The limited size of the area where portals can be positioned and the anatomic variations between individuals are major obstacles in developing a guideline for reducing the risk of SBRN injury in wrist arthroscopy.

Clinical Relevance

Great care must be taken when using the 1-2 portal. We suggest making a skin-only incision for this portal and then using blunt dissection to help prevent injury to the SBRN.