Lateral Antebrachial Cutaneous Nerve Research Articles

Cutaneous innervation of the distal forearm and hand — Minimizing complication rate by defining danger zones for surgical approaches

BackgroundThe aim of this study was to investigate the course of the lateral, medial and posterior antebrachial cutaneous nerves, the superficial branch of the radial nerve, the dorsal branch of the ulnar nerve and the palmar branches of the median and ulnar nerve and to determine their relationship to osseous and tendinous landmarks in order to define danger zones for open and arthroscopic approaches in this region. MethodsThe cutaneous nerves were dissected on 20 embalmed forearms and hands of anatomical specimens. The position and distribution of nerves and landmarks were measured at pre-determined positions. After statistical analysis danger zones were defined. ResultsBased on the course of the subcutaneous nerves, specific danger zones were defined for the palmar, the dorsal, the radial and the ulnar region of the distal forearm, wrist and hand. For the palmar and dorsal regions, specific recommendations for surgical approaches were made, approaches at the ulnar and radial aspect were considered being at high risk for nerve injury. ConclusionsThe method presented in this study allows the distinction of danger-zones for surgical approaches considering both normal and aberrant courses of cutaneous nerves, including all cutaneous nerves in the distal forearm, wrist and hand. Converting absolute measurements into relative numbers allowed to eliminate proportional differences in morphology and could help guide surgeons to estimate the course of cutaneous nerves in this area, thus helping to avoid iatrogenic nerve injury.

Selective Thumb Carpometacarpal Joint Denervation for Painful Arthritis: Clinical Outcomes and Cadaveric Study.

To determine the innervation pattern to the thumb carpometacarpal (CMC) joint and assess the safety and efficacy of selective joint denervation for the treatment of pain and impairment associated with thumb CMC arthritis. Cadaveric dissections were performed in 10 fresh upper extremities to better define the innervation patterns to the CMC joint and guide the surgical approach for CMC joint denervation. Histologic confirmation of candidate nerves was performed with hematoxylin and eosin staining. Results from a series of 12 patients with symptomatic thumb CMC arthritis who underwent selective denervation were retrospectively evaluated to determine the safety and efficacy of this treatment approach. Differences in preoperative and postoperative measurements of grip and key-pinch strength as well as subjective reporting of symptoms were compared. Nerve branches to the thumb CMC joint were found to arise from the lateral antebrachial cutaneous nerve (10 of 10 specimens), the palmar cutaneous branch of the median nerve (7 of 10 specimens), and the radial sensory nerve (4 of 10 specimens). With an average follow-up time of 15 months, 11 of 12 patients (92%) reported complete or near-complete relief of pain. Average improvements in grip and lateral key-pinch strength were 4.1 ± 3.0 kg (18% ± 12% from baseline) and 1.7 ± 0.5 kg (37% ± 11% from baseline), respectively. One patient experienced the onset of new pain consistent with a neuroma that resolved with steroid injection. All patients were released to light activity at 1 week after surgery, and all activity restrictions were lifted by 6 weeks after surgery. Selective denervation of the CMC joint is an effective approach to treat pain and alleviate impairment associated with CMC arthritis. The procedure is well tolerated, with faster recovery as compared with trapeziectomy. Branches arising from the lateral antebrachial cutaneous nerve, palmar cutaneous branch of the median nerve, and radial sensory nerve can be identified and resected with a single-incision Wagner approach. Therapeutic V.

Optimal surgical approach for the treatment of Quervains disease: A surgical-anatomical study.

AIMTo determine which of the common used incision techniques has the lowest chance of iatrogenic damage to the nerves which at risk are the superficial branch of the radial nerve (SBRN) and the Lateral Antebrachial Cutaneous Nerve (LABCN).METHODSTwenty embalmed arms were dissected and the course of the SBRN and the LABCN in each individual arm was marked and the distance between the two branches of the SBRN at the location of the First Extensor Compartment (FEC) was measured. This data was used as input in a visualization tool called Computer Assisted Anatomy Mapping (CASAM) to map the course of the nerves in each individual arm.RESULTSThis image visualizes that in 90% of the arms, one branch of the SBRN crosses the FEC and one branch runs volar to the compartment. The distance between the two branches was 7.8 mm at the beginning of the FEC and 10.2 mm at the end. Finally the angle of incision at which the chance of damage to the nerves is lowest, is 19.4 degrees volar to the radius.CONCLUSIONCASAM shows the complexity of the course of the SBRN over the FEC. None of the four widely used incision techniques has a significantly lower chance of iatrogenic nerve damage. Surgical skills are paramount to prevent iatrogenic nerve damage.

The free flap from the superficial palmar branch of radial artery innervated by the lateral cutaneous nerve of the forearm repair the defects of finger pulp

Objective To explore the outcomes of free flap from the radial artery superficial palmar branch (RASP) innervated by the lateral cutaneous nerve of the forearm for repairing the defects of finger pulp. Methods From April, 2013 to February, 2015, 20 fingers in 20 cases were treated with free flap from RASP innervated by the later-al cutaneous nerve of the forearm. The area of flap was from 1.8 cm×2.0 cm to 2.0 cm×4.0 cm. Postoperative follow up was done termly. Results All 20 flaps survived. All cases were followed-up for 7-20 months(averag, 12 months). The flaps appeared well with good texture. The two-point discrimination was from 7 mm to 12 mm, and graded with S3 and S3+ sensation.There was little scar noted at the donor site in the wrist.There was no influence of hand and wrist func-tion. Conclusion The method of using free flap from SASP innervated by the lateral cutaneous nerve of the forearm to repair the defects of finger pulp has good clinical effect. Key words: Free flap; Superficial palmar branch, radial artery; Lateral cutaneous nerve of the forearm; Finger; Injury

The anatomy of forearm free flap phalloplasty for transgender surgery.

Transgender surgeries are becoming more frequent and visual interpretation of anatomy is essential for both surgeons and patients. Since the forearm free flap phalloplasty was introduced in 1984, it has been known to provide reliable cosmetic and functional results for transitioning men compared with phalloplasty by different flaps. Surgical text descriptions were enhanced by the creation of new anatomic illustrations. The forearm free flap consists of the anterior forearm skin, subcutaneous tissue, fascia containing the radial artery as the perforator and its venae comitantes, cephalic and basilic veins, and lateral and medial antebrachial cutaneous nerves are demonstrated in relation to the surgically derived flap. Song's forearm free flap phalloplasty requires two surgical stages with a three-month interval between the stages: prelamination of a neourethra and construction of a neophallus. The neophallus created by forearm flap phalloplasty is reported to achieve acceptable aesthetical and psychological satisfaction, appropriate size and shape, and satisfying sexual intercourse. Despite increasing experiences in gender confirming surgery with modifications made by many authors, urethral complications including fistula and/or stricture formation are the leading causes of reoperation. The poor esthetic outcome of the forearm donor site and a decrease in rigidity of the neophallus are the main limitations. Illustrations of anatomy help inform surgical choice and understanding of risks and benefits by patients. The anatomy of the free forearm flap phalloplasty supports creation of a neophallus for transsexual anatomy revision. Clin. Anat. 31:145-151, 2018. © 2017 Wiley Periodicals, Inc.

Vascular branches from cutaneous nerve of the forearm and hand: Application to better understanding raynaud's disease.

Cutaneous nerves have branches called vascular branches (VBs) that reach arteries. VBs are thought to be involved in arterial constriction, and this is the rationale for periarterial sympathectomy as a treatment option for Raynaud's disease. However, the branching patterns and distribution areas of the VBs remain largely unclear. The aim of the present study was to investigate the anatomical structures of the VBs of the cutaneous nerves. Forty hands and forearms were examined to assess the branching patterns and distribution areas of the VBs of the superficial branch of the radial nerve (SBRN), the lateral antebrachial cutaneous nerve (LACN), the medial antebrachial cutaneous nerve (MACN), and the palmar cutaneous branch of the ulnar nerve (PCUN). VBs reaching the radial and ulnar arteries were observed in all specimens. The branching patterns were classified into six types. The mean distance between the radial styloid process and the point where the VBs reached the radial artery was 34.3 ± 4.8 mm in the SBRN and 38.5 ± 15.8 mm in the LACN. The mean distance between the ulnar styloid process and the point where the VBs reached the ulnar artery was 60.3 ± 25.9 mm in the MACN and 43.8 ± 26.0 mm in the PCUN. This study showed that the VBs of the cutaneous nerves have diverse branching patterns. The VBs of the SBRN had a more limited distribution areas than those of the other nerves. Clin. Anat. 31:734-741, 2018. © 2017 Wiley Periodicals, Inc.

Analysis of 784 Surgically Treated Distal Biceps Tendon Ruptures

The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, two-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and re-operation rate. To examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multi-specialty, integrated healthcare system. Retrospective cohort study of distal biceps tendon repairs performed from January 1, 2008 through December 31, 2015. The repair methods were classified as: two-incision approach using bone tunnel-suture fixation, or anterior single incision approach. Anterior single incisions were further classified according to the fixation method: cortical button alone, cortical button and interference screw, or suture anchors alone. Patient demographics, surgeon characteristics, surgical outcomes, and complications were analyzed for all repair types. Of the 784 repairs that met our inclusion criteria, 639 (81.5%) were single incision approaches. When comparing two-incision and single incision repairs, there was a significantly higher rate of posterior interosseous nerve palsy (3.4% vs. 0.8% respectively, P: 0.010), heterotopic bone formation (7.6% vs 2.7%, respectively. P: 0.004), and re-operations (8.3% vs 2.3%, respectively. P<0.001). When excluding lateral antebrachial cutaneous nerve palsies, there was no significant difference in the overall nerve palsies between single incision and two-incision (5.8% vs. 6.9%, respectively, P: 0.612). The overall rate of tendon re-rupture was 1.9% (single incision: 1.6%, two-incision: 2.8%, P: 0.327). The overall rate of post-operative wound infection was 1.5% (single incision: 1.3%, two-incision: 2.8%, P: 0.182). The average time from surgery to release from medical care was 14.4 weeks (single incision: 14.0 weeks, two-incisions: 16.0 weeks, P: 0.286). Patients treated with cortical button + interference screw were released significantly sooner than other single incision repair types (13.1±8.01 weeks, P: 0.011). There were no significant differences in rates of motor neuropraxia, infection, re-rupture, re-operation in regards to surgeon’s years of practice, fellowship training, or case volume. The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, two-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and re-operation rate. Surgeon’s years of practice, fellowship training, and case volume do not affect the rate of major complications.

Post-operative Complications Following Distal Biceps Tendon Repairs: A Prospective Study

Ownership Interest: Matador Medical, Dimension Orthotics LLC, Wright Medical (Beredjiklian) The reported incidence of post-operative complications following distal biceps tendon repairs (DBTR) has been largely determined by retrospective and small prospective studies.1-4 We hypothesized that a large prospective cohort study of DBTRs performed at our institution would demonstrate similar complication rates. All patients undergoing a primary DBTR by a surgeon from our institution were followed prospectively. The repair technique, post-operative protocol, and follow-up intervals were determined by the individual surgeons’ protocols. At each visit, the surgeon evaluated the patient for any complication, which included infection, wound dehiscence, sensory nerve injury, motor nerve injury, heterotopic ossification, re-rupture, and others. Demographic and surgical data was collected. Descriptive statistics were performed. Sixty patients (59 male, 1 female) underwent 60 distal biceps repairs by 25 orthopaedic surgeons over the course of 6 months. The mean age of the patients was 47 years (Range: 28 - 62), and the mean Body Mass Index (BMI) was 32 (Range: 23 to 54). Surgical techniques included one-incision tension-slide (33 cases), two-incision Modified Boyd Anderson (26 cases), and one-incision suture anchor (1 case). The average time to surgery was 2.9 weeks (Median: 2, Range: 0.5 - 10), the average post-operative length of immobilization was 1.5 weeks (Range: 0 - 4), and the average follow-up was 12 weeks (Range: 6 - 27). The overall complication rate was 23%. There were 14 sensory nerve injuries: 8 lateral antebrachial cutaneous nerves, 2 superficial radial nerves, 1 non-specific hand numbness, and 3 non-specific forearm numbness. Thirteen of 14 sensory nerve injuries occurred with single-incision techniques (38% of one-incision cases vs 4% of two-incision cases). While there was not a single infection, 1 patient had wound blisters, and 1 patient developed olecranon bursitis. Finally, 1 patient re-ruptured his biceps tendon, which required revision surgery. •Patients treated with a one-incision technique have a higher rate of complication than those treated with a two-incision technique.•Sensory nerve injury, specifically to the lateral antebrachial cutaneous nerve, is the most common complication.•The prospective incidence of complications is similar to that obtained retrospectively and reported in the literature.

Lateral Antebrachial Cutaneous Nerve as a Donor Source for Digital Nerve Grafting: A Concept Revisited.

Objective:The main objective of this study is to evaluate the availability of lateral antebrachial cutaneous nerve (LACN) autograft for acute or delayed repair of segmented digital nerve injuries.Patients and Methods:13 digital nerve defects of 11 patients; treated with interposition of LACN graft that harvested from ipsilateral extremity were included in the study. Mean follow up period was 35, 7 months. The mean time from injury to grafting is 53, 3 days. The results of the mean 2PDT and SWMT values of injured /uninjured finger at the end of follow up period were evaluated with Paired T test. The correlation between the defect length and the difference of 2PDT, SWMT values between the uninjured and injured finger at the end of follow up period; were evaluated with Pearson - correlation analysis.Results:The mean value of our 2PDT and SWMT results are ~5,923, ~3, 52, respectively in which can be interpreted between the normal and diminished light touch. The defect length and difference percentage of SWMT values is positively and significantly correlated statistically. Mean length of interposed nerve grafts was 18.5 mm. The age of the patient and the mean values of 2PDT and SWMT with the difference % of 2PDT and % of SWMT are not statistically correlated.Conclusion:Based on results regarding sensory regaining at recipient side and negligible sensory deficit at harvesting side, we suggest that lateral antebrachial cutaneous nerve might be a valuable graft option for digital nerve defects.

Surgical Treatment of Distal Biceps Tendon Ruptures: An Analysis of Complications in 784 Surgical Repairs

Background: Distal biceps brachii tendon ruptures lead to substantial deficits in elbow flexion and supination; surgical repair restores muscle strength and endurance. Purpose: To examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multispecialty, integrated health care system. Study Design: Cohort study; Level of evidence, 3. Methods: Retrospective cohort study of distal biceps tendon repairs performed between January 1, 2008, and December 31, 2015. The repair methods were classified as double-incision approach using bone tunnel–suture fixation or anterior single-incision approach. Anterior single incisions were further classified according to the fixation method: cortical button alone, cortical button and interference screw, or suture anchors alone. Patient demographics, surgeon characteristics, range of motion, and complications were analyzed for all repair types. Results: Of the 784 repairs that met the inclusion criteria, 639 (81.5%) were single-incision approaches. When comparing double-incision and single-incision repairs, there was a significantly higher rate of posterior interosseous nerve palsy (3.4% vs 0.8%, P = .010), heterotopic bone formation (7.6% vs 2.7%, P = .004), and reoperation (8.3% vs 2.3%, P < .001). The most common nerve complication encountered was a lateral antebrachial cutaneous nerve palsy (n = 162), which was significantly more common in the single-incision repairs than in the double-incision repairs (24.4% vs 4.1%, P < .001). When excluding lateral antebrachial cutaneous nerve palsies, there was no significant difference in the overall nerve palsies between single-incision and double-incision (5.8% vs 6.9%, P = .612). The overall rate of tendon rerupture was 1.9% (single incision, 1.6%; double incision, 2.8%; P = .327). The overall rate of postoperative wound infection was 1.5% (single incision, 1.3%; double incision, 2.8%; P = .182). The average time from surgery to release from medical care was 14.4 weeks (single incision, 14 weeks; double incision, 16 weeks; P = .286). Patients treated with cortical button plus interference screw were released significantly sooner than were patients with other single-incision repair types (13.1 ± 8.01 weeks, P = .011). There were no significant differences in rates of motor neurapraxia, infection, rerupture, and reoperation with regard to surgeon’s years of practice, fellowship training, or case volume. Conclusion: The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, the double-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and reoperation rate. Surgeon’s years of practice, fellowship training, and case volume do not affect the rate of major complications.

Intramedullary Cortical Button Fixation Of Distal Biceps Tendon Rupture: Long-term Patient Outcomes

Objectives:No consensus currently exists for optimal distal biceps rupture fixation. Dorsal cortical button (DCB) and dual incision transosseous (DITO) provide the greatest biomechanical load-to-failure, permitting earlier mobilization to prevent arthrofibrosis. Both methods have associated complications, restricted range of motion (ROM) from heterotopic ossification and proximal radioulnar synostosis for DITO while DCB has increased incidence of cutaneous and posterior interosseous nerve (PIN) injuries despite different techniques to reduce their frequency. The intramedullary cortical button (ICB) fixation technique aims to decrease PIN palsy risk, decrease implant costs and provide strong tendon-bone fixation allow for early ROM. We set out to determine the long-term efficacy of this technique and any difference in complication rates including re-rupture.Methods:31 patients underwent ICB fixation of chronic and acute distal biceps tendon ruptures without allograft with more than 1 year follow up. 21 patients completed a questionnaire and Disabilities of the Arm, Shoulder and Hand (DASH) survey. Elbow and forearm ROM, cosmesis, pain, strength, motor nerve neuropraxia, cutaneous sensory changes and other complications were obtained from the chart and questionnaire. The ICB technique utilizes a 4cm transverse anterior incision 2cm distal to the distal antecubital flexion crease. The tuberosity is prepared, creating a clean, bleeding bony surface. A #2 high-strength braided suture is passed through the toggle hole at both ends of a Smith and Nephew Endobutton. A needle passes one suture pair in the 4.7mm hole and out the 2mm hole drilled with mild convergence in the distal and proximal tuberosity footprint with a 1.5cm bony bridge. This suture pair shuttles the Endobutton into the intramedullary canal, both limbs of each suture exits their respective hole. One limb from each suture is whipstitched proximally and back distally. Tensioning the free suture limb exiting the 2mm hole and tying to its free suture pair compresses the biceps stump against the radial tuberosity and secures the Endobutton against the intramedullary cortex at the 2mm hole. Finally the free suture limb exiting the 4.7mm hole is tensioned and tied to its suture pair limb, distributing tendon compression over the entire tuberosity footprint.Results:At an average of 4 (1.3-7.4) years postoperatively, 81% were extremely and 10% very satisfied with their overall outcome. 81% reported no strength or ROM limitations, 76% had pain-free activity, 86% and 81% were extremely satisfied with postoperative elbow ROM and forearm ROM respectively. The mean DASH and sports DASH score were 3.52 and 2.5. Transient sensory changes were noted in the lateral antebrachial cutaneous nerve and superficial radial nerve distributions in 38% and 19% of patients respectively. Excluding workers compensation patients improved the percent of extremely satisfied patients to 93% and the average DASH score to 0.93. No biceps re-ruptures or PIN palsies were observed.Conclusion:The ICB technique provides secure distal biceps tendon fixation with excellent long-term patient satisfaction and comparable functional outcomes to existing fixation techniques with restoration of normative DASH scores. The ICB technique has a cutaneous nerve complication rate comparable to other single incision studies and no observed PIN palsies or wound complications were noted while decreasing the implant costs.

Transfer of the lateral antebrachial cutaneous nerve to the dorsal branch of the ulnar nerve without nerve graft in case of lower brachial plexus injuries: Anatomical and feasibility study

In the context of lower (C8–T1) brachial plexus injury, transfer of the lateral antebrachial cutaneous nerve (LABCN) to the dorsal branch of the ulnar nerve (DBUN) with an interposed sural nerve graft has been proposed to restore sensitivity on the ulnar side of the hand. The purpose of this study was to assess the feasibility of performing this transfer directly – without interposition of a nerve graft – by intraneural dissection of the DBUN. An anatomical study was performed with 20 upper limbs from adult human cadavers. The LABCN and the DBUN were dissected. The LABCN emerged from the lateral side of the biceps brachii muscle at an average of 2.6±0.4cm from the interepicondylar line and was 13.5±2.6cm long, on average. The DBUN arose from the ulnar nerve 8.2±1.6cm from the styloid process of the ulna. The maximum length of DBUN intraneural dissection relative to the ulnar nerve was 7.5±2.1cm, on average. The LABCN could be transferred to the DBUN in a tension-free manner with end-to-end suturing. Intraneural dissection of the DBUN allows LABCN nerve transfer without interposition of a graft.

3-2-03. Does cervical radiculopathy complicate brachial plexopathy? An electrophysiological analysis

It is well known that cervical radiculopathy (CR) and neuralgic amyotrophy (NA) show very similar phenotype and sometimes difficult to differentiate each other. In 2015, we reported brachial plexus abnormality on three tesla magnetic resonance neurography (3T-MRN) in patients with CR. The purpose of this study is, to investigate signs of brachial plexus involvement with electrophysiological tests. We underwent retrospective chart review of 24 patients with CR from 2009 to 2014. In all patients, we performed 3T-MRN and nerve conduction study (NCS) to evaluate brachial plexus involvement. Mean age is 58 years old, and male patients dominated. Median disease duration was 60 days. Weakness and intervertebral foraminal stenosis were most frequent in C5 and C6 level. On 3T-MRN, brachial plexus involvement was detected in 70% of patients. Among NCS, Abnormal lateral antebrachial cutaneous nerve amplitude was most frequently detected (45%). Possible explanation for the brachial plexus involvement in patients with CR includes damage to dorsal root ganglion by herniated disc, and secondary immune-mediated mechanism involving brachial plexus, as suggested by van Alfen. We suggest phenotype of CR and NA may significantly overlap and we need to be cautious when making a diagnosis of NA.

Surgical Management of Acute Distal Biceps Tendon Ruptures.

➤ Acute distal biceps tendon ruptures are uncommon injuries that often affect young active males and typically result from an eccentric load on the dominant upper extremity.➤ Surgical treatment may be indicated to prevent substantial weakness in supination and flexion that can occur with nonoperative treatment.➤ Nonoperative management should be reserved for elderly or less active patients with multiple comorbidities, especially when the injury involves the nondominant arm.➤ Operative management can be performed using a single-incision or dual-incision technique, with multiple surgical options for tendon-to-bone fixation.➤ Single-incision repair techniques are more likely to be complicated by a transient neurapraxia, most often involving the lateral antebrachial cutaneous nerve, while dual-incision repair techniques are more likely to be complicated by heterotopic ossification and stiffness.

Relevant Insertion Site Anatomy of the Conventus Distal Radius System.

The Conventus Distal Radius System (DRS) is an intramedullary fixation scaffold inserted into the lateral aspect of the distal radius. The purpose of this study was to identify insertion site anatomy to illustrate risks associated with the minimally invasive nature of radial-sided implant application. Ten cadavers were utilized. Using fluoroscopy, the 1.1-mm Kirschner wire and template was introduced per manufacturer's guidelines, access guide assembled, and dissection carried out to the superficial radial nerve (SRN) with preservation of the native location. The access guide marked the insertion location for the side-cut drill. This point was measured in relationship to structures nearby, including the SRN, brachioradialis (BR), lateral antebrachial cutaneous nerve (LABCN), and radial styloid (RS). The large guide contacted the SRN in 4 of 10 cadavers and was volar to it in 6 of 10. When volar, the mean distance was 1.7 mm. The tip of the RS to the large access guide averaged 44.5 mm. The small guide contacted the SRN in 2 of 10, was volar to it in 4 of 10, and between the bifurcation in 4 of 10. When volar, the distance averaged 3.25 mm. When bifurcated, the distance from the small guide to both the dorsal and volar branches was 3.5 mm. The distance from the RS to the small guide averaged 37.8 mm. The LABCN was found in the field of dissection in 4 of 10 cadavers. Several structures are at risk during insertion of the Conventus DRS; thus, knowledge of the relevant anatomy of this minimally invasive approach is crucial to optimize outcomes and patient satisfaction, and to avoid nerve injury.

Radial Nerve Injury after Venipuncture.

Venipuncture is the most commonly performed invasive procedure in hospitals daily.[1] Nerves in the antecubital fossa classically lie on a plane just beneath and in close proximity to the veins, making them susceptible to injury during phlebotomy.[1] Cadaveric studies have demonstrated a great deal of variability in the nerves of the antecubital fossa in relationship to veins, suggesting that even a nontraumatic, straightforward venipuncture can directly damage a cutaneous nerve.[2] Despite this, there remains a relative paucity in the literature reporting cases of peripheral nerve injury secondary to venipuncture. Of the few reported cases, an even smaller percentage of these have been validated with electrodiagnostic evidence of injury. The majority of these studies report injury to the lateral antebrachial cutaneous nerve. To the best of our knowledge, there has been only one reported case in current literature of radial nerve injury.

Ultrasonographic Study of the Anatomical Relationship Between the Lateral Antebrachial Cutaneous Nerve and the Cephalic Vein.

ObjectiveTo define the anatomy of the lateral antebrachial cutaneous nerve (LABCN) and the cephalic vein (CV) in the anterior forearm region of living humans using ultrasonography for preventing LABCN injury during cephalic venipuncture.MethodsThirty forearms of 15 healthy volunteers were evaluated using ultrasonography to identify the point where the LABCN begins to contact with the CV, and the point where the LABCN separates from the CV. The LABCN pathway in the forearm in relation to a nerve conduction study was also evaluated.ResultsThe LABCNs came in contact with the CV at a mean of 0.6±1.6 cm distal to the elbow crease, and separated from the CV at a mean of 7.0±3.4 cm distal to the elbow crease. The mean distance between the conventionally used recording points (point R) for the LABCN conduction study and the actual sonographic measured LABCN was 2.4±2.4 mm. LABCN usually presented laterally at the point R (83.3%).ConclusionThe LABCN had close proximity to the CV in the proximal first quarter of the forearm. Cephalic venipuncture in this area should be avoided, and performed with caution if needed.

Sensory Distribution of the Lateral Cutaneous Nerve of Forearm After Ultrasound-Guided Block: Potential Implications for Thumb-Base Surgery.

Surgery of the wrist and hand commonly involves regional anesthesia of the median nerve and superficial radial nerve within the forearm. In this sonographic study, the contribution of the lateral cutaneous nerve of forearm (LCNF) to thumb cutaneous sensation was studied. Patients scheduled for thumb suspension arthroplasty (n = 35) were examined by ultrasound, with LCNF, median nerve, and superficial radial nerve identified. A single nerve was then injected with local anesthetic, and the area of cutaneous sensory loss mapped at 15 minutes. The remaining 2 nerves were then blocked for progression to theater. In 15 patients, the LCNF was blocked first at the antecubital fossa, where it was located posterior to the cephalic vein 9.1 (1.6) mm distal to the interepicondylar line. Bifurcation occurred further distally, 18 (2.6) mm from the interepicondylar line. In 14 of 15 cases, LCNF sensory distribution extended to the thumb base, 8.3 (7.8) mm distal to the radiocarpal joint. This study has demonstrated the LCNF to innervate the thumb base, indicating neural blockade of this nerve may be required for surgery of the basal thumb joint.

Variation of median nerve and lateral antebrachial cutaneous nerve: One case report

Variation of median nerve and lateral antebrachial cutaneous nerve: One case report

Variation of Median Nerve and Lateral Antebrachial Cutaneous Nerve: A Case Report

Variations of the brachial plexus regarding the composition of nerve fibres and absence or communications are common and being reported by several authors. The objective of the study was to observe and document the variation on the subject of branches of the median nerve. This report will assist clinicians and surgeons by considering anatomical variation associated with the median nerve in interpreting atypical clinical presentations. This report illustrates the two variations in details and explains the consequences they lead to. It also provides first hand anatomic data and great referential value for the future clinical work.