Morphometry of the anterior interosseous nerve: a cadaveric study

Year 2018, Volume: 12 Issue: 3, 111 - 114, 31.12.2018

Sibel Kibar , Burak Bilecenoğlu Luis Filgueira Aysun Uz

Abstract

Objectives: ​Pathophysiology and etiology
of anterior interosseous nerve (AIN) syndrome are still controversial. This
anatomical​ ​dissection study aimed to understand the anatomy of AIN.

Methods: From a random sample of
upper extremities of whole-body human cadavers (n=10), 20 upper extremities
were included​ ​in the study. Two of the cadavers were females and 8 were males
(age range 34–62 years). Specimens were dissected with​ ​the elbow in
extension, wrist in neutral position and forearm in pronation. After
superficial dissection, the pronator teres muscle​ ​was released, and the
branching pattern of the AIN and the separation of the nerve from the
interepicondylar line were​ ​recorded. The branches to the pronator teres,
flexor pollicis longus, flexor digitorum profundus and flexor digitorum
superficialis​ ​were recorded according to their distance from the
interepicondylar line.

Results: The AIN branched from
the main trunk 5.1 to 47.89 mm (mean 37.58±11.25 mm) distal to the
interepicondylar line.​ ​AIN gave off 1–4 branches to the pronator teres. The
first branch left the AIN 10.05–83.84 mm proximal and entered the muscle​
​23.49–43.72 mm distal to the interepicondylar line. AIN gave 1–4 branches to
the flexor pollicis longus, flexor digitorum profundus​ ​and flexor digitorum
superficialis at varying distances. The origin of the branches of AIN, as well
as the innervation by​ ​one or multiple branches for a muscle, was variable.

Conclusion: This study provides a
detailed map of the anterior interosseous nerve innervating flexor pollicis longus,
flexor​ ​digitorum profundus and flexor digitorum superficialis muscles, to
serve as a guide for location of AIN block in patients with​ ​upper extremity
spasticity and AIN syndrome.

 

Keywords

anterior interosseous nerve, cadaver, morphometry

References

• 1- Bilecenoğlu B, Uz A, Karalezli N. Possible anatomic structures causing entrapment neuropathies of the median nerve: an anatomic study. Acta Orthop Belg. 2005;71(2):169-762- Roy J, Henry BM, Pękala PA, Vikse J, Ramakrishnan PK, Walocha JA, Tomaszewski KA. The prevalence and anatomical characteristics of the accessory head of the flexor pollicis longus muscle: a meta-analysis. Peer J. 2015 Oct 1;3:e1255. doi: 10.7717/peerj.1255.3- Maldonado AA, Amrami KK, Mauermann ML, Spinner RJ. Reinterpretation of Electrodiagnostic Studies and Magnetic Resonance Imaging Scans in Patients with Nontraumatic "Isolated" Anterior Interosseous Nerve Palsy. Plast Reconstr Surg. 2016 Nov;138(5):1033-1039.4- Dunn AJ, Salonen DC, Anastakis DJ. MR imaging findings of anterior interosseous nerve lesions. Skeletal Radiol. 2007 Dec;36(12):1155-62.5- Gaitzsch G, Chamay A. Paralytic brachial neuritis or Parsonage-Turner syndrome anterior interosseous nerve involvement. Report of three cases. Ann Chir Main. 1986;5(4):288-946- Rennels GD, Ochoa J. Neuralgic amyotrophy manifesting as anterior interosseous nerve palsy. Muscle Nerve. 1980 Mar-Apr;3(2):160-47- Kim MY1, Kim DH, Park BK, Kim BH. Pseudo-anterior interosseous nerve syndrome by multiple intramuscular injection. Ann Rehabil Med. 2013 Feb;37(1):138-42. doi: 10.5535/arm.2013.37.1.138.8- Wertsch JJ. AAEM case report #25: anterior interosseous nerve syndrome. Muscle Nerve. 1992 Sep;15(9):977-83.9- Rodner CM, Tinsley BA, O'Malley MP. Pronator syndrome and anterior interosseous nerve syndrome. J Am Acad Orthop Surg. 2013 May;21(5):268-75. doi: 10.5435/JAAOS-21-05-268. Review.10- Lubahn JD, Cermak MB. Uncommon nerve compression syndromes of the upper extremity. J Am Acad Orthop Surg. 1998 Nov-Dec;6(6):378-86.11- Alexandre A1, Alexandre AM, Zalaffi A. Considerations on the treatment of anterior interosseous nerve syndrome. Acta Neurochir Suppl. 2011;108:247-50. doi: 10.1007/978-3-211-99370-5_38.12- Eker HE, Cok OY, Aribogan A, Arslan G. Management of neuropathic pain with methylprednisolone at the site of nerve injury. Pain Med. 2012 Mar;13(3):443-51. doi: 10.1111/j.1526-4637.2011.01323.x.13- Morris HH, Peters BH. Pronator syndrome: clinical and electrophysiological features in seven cases. J Neurol Neurosurg Psychiatry. 1976 May;39(5):461-4.14- Grutter PW1, Desilva GL, Meehan RE, Desilva SP. The accuracy of distal posterior interosseous and anterior interosseous nerve injection. J Hand Surg Am. 2004 Sep;29(5):865-70.15- Alfaro, A. Anterior interosseus nerve blocks to treat finger flexor muscle spasticity . Muscle & nerve.2012; 46(4):645-645 16- Yang F, Zhang X, Xie X, Yang S, Xu Y, Xie P. Intramuscular nerve distribution patterns of anterior forearm muscles in children: a guide for botulinum toxin injection. Am J Transl Res. 2016 Dec 15;8(12):5485-5493.17- Lepage D1, Parratte B, Tatu L, Vuiller F, Monnier G. Extra- and intramuscular nerve supply of the muscles of the anterior antebrachial compartment: applications for selective neurotomy and for botulinum toxin injection. Surg Radiol Anat. 2005 Dec;27(5):420-30.18- Bilecenoglu B1, Uz A, Karalezli N, Issi S. Two anatomic variations in the arm related to the median nerve. Saudi Med J. 2005 Nov;26(11):1827-8.19- MC Namara B. Clinical Anatomy of Median Nerve . Anatomy Primer. ACNR Volume 2 Number 6 January/ February 2003. Page 19,2020- Vincelet Y, Journeau P, Popkov D, Haumont T, Lascombes P. The anatomical basis for anterior interosseous nerve palsy secondary to supracondylar humerus fractures in children. Orthop Traumatol Surg Res. 2013 Sep;99(5):543-7. doi: 10.1016/j.otsr.2013.04.002.21-Canovas F, Mouilleron P, Bonnel F. Biometry of the muscular branches of the median nerve to the forearm. Clin Anat. 1998;11(4):239-45.22- Sunderland S. The intraneural topography of the radial, median and ulnar nerves. Brain 1945;68:243—99.