Abstract
AIM
To provide a "patient-normalized" parameter in the proximal forearm.
METHODS
Sixty-three cadaveric upper extremities from thirty-five cadavers were studied. A muscle splitting approach was utilized to locate the posterior interosseous nerve (PIN) at the point where it emerges from beneath the supinator. The supinator was carefully incised to expose the midpoint length of the nerve as it passes into the forearm while preserving the associated fascial connections, thereby preserving the relationship of the nerve with the muscle. We measured the transepicondylar distance (TED), PIN distance in the forearm's neutral rotation position, pronation position, supination position, and the nerve width. Two individuals performed measurements using a digital caliper with inter-observer and intra-observer blinding. The results were analyzed with the Wilcoxon-Mann-Whitney test for paired samples.
RESULTS
In pronation, the PIN was within two confidence intervals of 1.0 TED in 95% of cases (range 0.7-1.3 TED); in neutral, within two confidence intervals of 0.84 TED in 95% of cases (range 0.5-1.1 TED); in supination, within two confidence intervals of 0.72 TED in 95% of cases (range 0.5-0.9 TED). The mean PIN distance from the lateral epicondyle was 100% of TED in a pronated forearm, 84% in neutral, and 72% in supination. Predictive accuracy was highest in supination; in all cases the majority of specimens (90.47%-95.23%) are within 2 cm of the forearm position-specific percentage of TED. When comparing right to left sides for TEDs with the signed Wilcoxon-Mann-Whitney test for paired samples as well as a significance test (with normal distribution), the P-value was 0.0357 (significance - 0.05) indicating a significant difference between the two sides.
CONCLUSION
This "patient normalized" parameter localizes the PIN crossing a line drawn between the lateral epicondyle and the radial styloid. Accurate PIN localization will aid in diagnosis, injections, and surgical approaches.
Document Type
Article
Publication Date
4-18-2017
Digital Object Identifier (DOI)
https://doi.org/10.5312/wjo.v8.i4.310
Repository Citation
Kamineni, Srinath; Norgren, Crystal R.; Davidson, Evan M.; Kamineni, Ellora P.; and Deane, Andrew S., "Posterior Interosseous Nerve Localization Within the Proximal Forearm - a Patient Normalized Parameter" (2017). Orthopaedic Surgery and Sports Medicine Faculty Publications. 11.
https://uknowledge.uky.edu/orthopaedicsurgery_facpub/11
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Notes/Citation Information
Published in World Journal of Orthopedics, v. 8, issue 4, p. 310-316.
©The Author(s) 2017.
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