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Average 4.6 of 24 Ratings
A 47-year-old male punches through a glass window and suffers a deep laceration that severs his brachioradialis muscle at the mid-forearm. What nerve is most likely injured?
Posterior interosseous nerve
Superficial radial nerve
Anterior interosseous nerve
Medial antebrachial cutaneous nerve
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The radial nerve splits at the level of the elbow joint into deep and superficial branches. The deep branch passes between the two heads of the supinator and continues to the wrist as the posterior interosseous nerve. The superficial branch of the radial nerve pierces the dorsal fascia and accompanies the radial artery down the forearm along the dorsal side of the brachioradialis, as shown in Illustration B. Therefore, a laceration that severs the brachioradialis would most likely injure the superficial radial nerve. It is a purely sensory nerve that supplies sensation to the dorsal aspects of the thumb, index, middle, and radial half of the ring fingers, as shown in Illustration A.
Answer 1: The PIN passes between the two heads of the supinator and then travels on the dorsal aspect of the interosseous membrane (see Illustration C).
Answer 2: The ulnar nerve splits the two heads of the FCU and then travels on the ulnar side of the forearm under the FCU.
Answer 4: The anterior interosseous nerve is a branch of the median nerve that travels along the volar interosseous membrane between the FPL and FDP.
Answer 5: The medial antebrachial cutaneous nerve is a subcutaneous sensory nerve that travels on the volar ulnar aspect of the forearm over the FDS.
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Average 4.0 of 13 Ratings
A 58-year-old female undergoes right elbow arthroscopy for loose body removal and debridement. During the case, the anterior capsule of the elbow is violated while the arthroscopic shaver is being used through an anterolateral portal. A clinical photograph demonstrating the patients post-operative physical exam deficits is shown in Figure A. Which structure labeled in Figure B has most likely been damaged?
None of the identified structures have been damaged
The clinical photograph demonstrates loss of finger extension and partial loss of wrist extension, the result of a posterior interosseus nerve (PIN) palsy. The PIN is at risk of iatrogenic damage when performing surgery on volar aspect of the proximal forearm. This is particularly a concern during elbow arthroscopy when working through a distally placed anterolateral portal. The PIN supplies the wrist and finger extensors with the exception of ECRL which is innervated by the radial nerve proximal to the bifurcation. Injury to the radial nerve (choice 1) would result in complete loss of wrist extension. Injury to the superficial radial nerve (choice 2) would result in sensory deficits only. The supinator (choice 4) is innervated by the PIN, but loss of supinator function would not result in the clinical photograph provided.
Average 3.0 of 45 Ratings
When approaching a proximal diaphyseal radius fracture via the Henry approach (volar), the forearm is supinated to minimize injury to what structure?
Posterior interosseus nerve
Lateral antebrachial cutaneous nerve
The Henry approach is the volar approach to the forearm. The internervous plane is pronator teres (median) and brachioradialis (radial nerve). The arm should be supinated to move the PIN away from the surgical field. Conversely, in the Thompson (posterior) approach to the forearm, the forearm should be pronated to move the PIN away from the surgical field.
Average 4.0 of 30 Ratings
Medvisual teaching example for distant learning - approach to the forearm.The Co...