Identification of Radial Nerve in Relationship to Deltoid Tuberosity and Brachioradialis

Document Type: RESEARCH PAPER

Authors

1 Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA

2 University of Nevada, Reno School of Medicine, Division of Orthopaedic Surgery, Las Vegas, NV, USA

Abstract

Background: Several studies have identified the radial nerve in arm using different anatomic landmarks, however, a
controversy remains. Deltoid tuberosity (DT) and brachioradialis (BR) are reproducible landmarks that can be used to
identify the radial nerve (RN) during fracture surgery.
Methods: Dissection of RN was carried out in 17 fresh frozen adult cadavers. Using a calibrated caliper, we measured
the distance between DT and the origin of BR. The distance between DT and where RN becomes lateral in its relationship
with the humerus (DT-RN) and the distance between RN and BR (RN-BR) were subsequently measured. The ratio of
DT-RN to DT-BR was calculated to see where the nerve lies in relationship to DT-BR.
Results: Average DT-BR was 81.8 (±14.86) mm, average DT-RN was 48.9 (± 7.83) mm, and average RN-BR was 33.0
(± 10.16) mm. RN was always found posterior to DT and was never found in the proximal third of DT-BR. The nerve
was found in the middle third of DT-BR in 14 of 17 cadavers (82.4 %) and in the distal third in 3 out of 17 cadavers
(17.6%). 16 of 17 cadavers (94%) had radial nerve in the distal half of DT-BR.
Conclusion: Using the anatomic relationships between RN, DT, and the origin of BR, identification of RN is easily
reproducible. These two structures can serve as the stationary landmarks during fracture surgery to find the radial
nerve, which can be found in the distal 2/3 of the distance between the deltoid tuberosity and the origin of brachioradialis.
Level of evidence: V

Keywords

Main Subjects


1. Shah JJ, Bhatti NA. Radial nerve paralysis associated
with fractures of the humerus. A review of 62 cases.
Clin Orthop Relat Res. 1983; 172(1):171-6.
2. Sonneveld GJ, Patka P, van Mourik JC, Broere G.
Treatment of fractures of the shaft of the humerus
accompanied by paralysis of the radial nerve. Injury.
1987; 18(6):404-6.
3. Carroll EA, Schweppe M, Langfitt M, Miller AN,
Halvorson JJ. Management of humeral shaft fractures.
J Am Acad Orthop Surg. 2012; 20(7):423-33.
4. Walker M, Palumbo B, Badman B, Brooks J, Van
Gelderen J, Mighell M. Humeral shaft fractures: a
review. J Shoulder Elbow Surg. 2011; 20(5):833-44.
5. Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis
PV. Radial nerve palsy associated with fractures of the
shaft of the humerus: a systematic review. J Bone Joint
Surg Br. 2005; 87(12):1647-52.
6. Carlan D, Pratt J, Patterson JM, Weiland AJ, Boyer MI,
Gelberman RH. The radial nerve in the brachium:
an anatomic study in human cadavers. J Hand Surg.
2007; 32(8):1177-82.

7. Hoppenfeld S, Buckley R. Surgical exposures in
orthopaedics: the anatomic approach. 4th ed.
Philadelphia: Lippincott Williams & Wilkins; 2009.
8. Gerwin M, Hotchkiss RN, Weiland AJ. Alternative
operative exposures of the posterior aspect of the
humeral diaphysis with reference to the radial nerve.
J Bone Joint Surg Am. 1996; 78(11):1690-5.
9. Cox CL, Riherd D, Tubbs RS, Bradley E, Lee DH.
Predicting radial nerve location using palpable
landmarks. Clin Anat. 2010; 23(4):420-6.
10. Bono CM, Grossman MG, Hochwald N, Tornetta P 3rd.
Radial and axillary nerves. Anatomic considerations
for humeral fixation. Clin Orthop Relat Res. 2000;
373(1):259-64.
11. Fleming P, Lenehan B, Sankar R, Folan-Curran J, Curtin
W. One-third, two-thirds: relationship of the radial
nerve to the lateral intermuscular septum in the arm.
Clin Anat. 2004; 17(1):26-9.
12. Seigerman DA, Choung EW, Yoon RS, Lu M, Frank
MA, Gaines LC, et al. Identification of the radial nerve
during the posterior approach to the humerus: a

cadaveric study. J Orthop Trauma. 2012; 26(4):226-8.
13. Uhl RL, Larosa JM, Sibeni T, Martino LJ. Posterior
approaches to the humerus: when should you worry
about the radial nerve? J Orthop Trauma. 1996;
10(5):338-40.
14. Chaudhry T, Noor S, Maher B, Bridger J. The
surgical anatomy of the radial nerve and the triceps
aponeurosis. Clin Anat. 2010; 23(2):222-6.