Trans-Brachioradialis Approach To The Radial Tunnel, An Anatomic Study Of 5 Potential Compression Sites
Jason Ummel, D.O; Zachary Lum, D.O; Marc Trzeciak, D.O.
Valley Orthopedic Surgery Residency, Modesto, CA
Introduction: Radial tunnel syndrome is defined as posterior interosseous nerve (PIN) compression within the radial tunnel spanning from the fibrous radiocapitellar joint (RCJ) to the distal edge of the supinator. Recent anatomic studies2 have failed to demonstrate a single utilitarian approach to intraoperative identification and surgical release of all 5 potential sites of compression through a single incision without the use of additional anatomic windows.
Purpose: To utilize the technique described by Lister1, a single brachioradialis split approach, to expose the entire length of the radial tunnel including all five sites of PIN compression, allowing for adequate release.
Methods: Ten fresh frozen cadaver forearms (6 female, 4 male) were dissected utilizing a curvilinear 7cm incision over the brachioradialis. The muscle belly was split via simple blunt retraction, exposing the radial tunnel. The PIN was identified and mobilized at five compression sites: radiocapitellar joint, radial recurrent vessels (Leash of Henry), fibrous medioproximal edge of ECRB, arcade of Frohse, and distal edge of supinator.
Results: The PIN was identified and effectively released in all specimens without difficulty from a single approach. All five sites of compression were visible and accessible through the brachioradialis split approach. Specifically, there was no difficulty in identifying and releasing the PIN at the distal edge of supinator.
Conclusion: A single brachioradialis- split approach is adequate for complete visualization and release of all compression sites of the radial tunnel. Utilizing this technique allows for surgical access and ease as well as minimizing necessity for additional windows or multiple incisions.
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