Purpose
Dissection of the radial nerve in the axilla and upper portion of and posterior aspect
of arm may be necessary for brachial plexus reconstruction, in axillary nerve paralysis,
and in radial nerve injuries. The radial nerve is in intimate contact with the profunda
brachial artery (PBA). The authors sought to describe the relationship of the PBA
with the radial nerve.
Materials and Methods
We dissected the PBA and the radial nerve bilaterally in 20 upper limbs from 10 fresh
cadavers after subclavian artery injection with green latex. We studied the relationship
of the PBA with the radial nerve, its branching patterns, and its diameters. In addition,
we performed surgery on 5 patients with brachial plexus, radial, or axillary nerve
injury in whom we dissected the PBA.
Results
The PBA was present in all dissections, originating from the brachial artery (n =
19 specimens) close to the latissimus dorsi tendon or from the subscapular artery
(n = 1 specimen). In 15 dissections, the PBA bifurcated into an anterior (AB) and
a posterior (PB) branch. In one dissection, the AB was absent. The AB traveled toward
the triceps medial head. The PB flanked the radial nerve posteriorly and traveled
around the humerus, with the radial nerve passing between the medial and the lateral
head of the triceps. The AB and PB were longer than the PBA and measured on average
53 mm (SD ± 33 mm) and 39 mm (SD ± 26 mm), respectively. Intraoperatively, the radial
nerve could be exposed in the upper arm by pulling the triceps medial head anteriorly
together with the AB. The PB was lateral to the radial nerve in the posterior arm
approach.
Conclusions
In the upper arm, the radial nerve was not flanked by a single branch as postulated
in anatomical textbooks but by 2 branches resulting from the bifurcation of the PBA.
Clinical Relevance
Awareness of PBA anatomy is essential during radial nerve dissection from the anterior
or posterior arm approach.
Key words
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Article info
Publication history
Published online: August 12, 2022
Accepted:
June 23,
2022
Received:
January 7,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
