Radial nerve-anatomy

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Transcript of Radial nerve-anatomy

  • 1.Radial Nerve Anatomy Episode 1

2. Radial Nerve Originates as the terminal branch of theposterior cord of the brachial plexus: roots from C5, 6, 7, 8, & T1. Largest branch of brachial plexus 3. Cutaneous Innervation Posterior cutaneous nerve of arm Inferior lateral cutaneous nerve of arm Posterior cutaneous nerve of forearm Superficial branch of radial nerve 4. Motor Innervation Muscular branches of radial nerve aboveelbow: Triceps Anconeus Brachoradialis ECRL 5. Motor Innervation Muscular Branches below elbow: ECRB (varied innervation: superficial or PIN) Supinator PIN: Superficial EDC, ECU,, EDM Deep APL, EPL, EPB, EI 6. Course of Radial Nerve 7. Course of Radial Nerve Largest terminal branch of posterior cord Enters posterior aspect of humerus through lowertriangular interval Teres major (superior) Long head triceps (medial) Humerus (lateral) Gives posterior cutaneous nerve of arm in axilla 8. Course of Radial Nerve Comes to lie in distal part of spiral groove withprofundi brachii artery Beneath lateral head of triceps and proximal to origin of medial head Gives branches to triceps, anconeus and inferiorlateral cutaneous nerve of arm Through lateral intermuscular septum 10-12cmabove lateral epicondyle 9. Course of Radial Nerve In anterior compartment of arm lies betweenbrachialis and brachioradialis 1-3 accessory branches to brachialis Large branch to BR (sometimes this branch givenby superficial radial below elbow) ECRL generally innervated proximal to elbowjoint 10. Course of Radial Nerve Enters the forearm anterior to lateral epicondyle More specifically over articulation between capitulum and radial head ECRB innervated distal to elbow joint either PIN orsuperficial branch At some point 3cm above or below divides into: Superficial radial PIN 11. Course of Superficial Radial Nerve Runs over supinator,PT and FDS Lies under BR with radial artery on its ulnar side from1/3 of the way down forearm Passes posteriorly through tendon of BR proximal toradial styloid Passes over tendons of snuffbox Terminates as cutaneous branches to dorsum ofhand and lateral 3.5 digits short of nailbeds 12. Posterior Interosseous Nerve Gains access to posterior forearm by divingposterior and laterally through ligament ofFrohse and the interval between the twoheads of supinator Arcade of Frohse is a fibrous arch originatinglateral epicondyle superior part of superficiallayer of supinator German Anatomist, Fritz Frohse (1871-1916) 13. Posterior Interosseous Nerve After exiting the supinator divides into deepand superficial muscular branches Superficial EDC, ECU, EDM Deep APL, EPL, EPB, EI 14. Radial Nerve Compression Sites PIN As it traverses the radial tunnel it encounters 4sites of compression Radial tunnel syndrome entrapment neuropathy 15. Radial Tunnel Syndrome1. Fibrous bands Tight fibrous bands anterior to radial head at entrance oftunnel1. Arcade of Frohse Most common1. Leash of Henry Radial recurrent vx that fan out over radial nn1. Medial border of ECRB 16. Cheiralgia paresthetica Described by Robert Wartenberg 1932 Superficial radial nerve neuritis Wartenberg Syndrome Causes: Trauma, iatrogenic, compression (muscle anomalies,fascial bands, thrombosis radial recurrent artery, tumour,haemorrhage) Symptoms: Dysaesthesia over distribution 17. Radial Nerve Palsy Causes: Fractures esp humerus, Monteggia Penetrating injury/trauma Saturday Night Palsy Crutches Iatrogenic tumour 18. Episode IIRadial Nerve Tendon Transfers