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Open AccessArticle

The Branching and Innervation Pattern of the Radial Nerve in the Forearm: Clarifying the Literature and Understanding Variations and Their Clinical Implications

1
Department of Medical Education, Tufts University School of Medicine, Boston, MA 02111, USA
2
Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA 94305, USA
3
Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA 02115, USA
*
Author to whom correspondence should be addressed.
Diagnostics 2020, 10(6), 366; https://doi.org/10.3390/diagnostics10060366
Received: 20 May 2020 / Accepted: 29 May 2020 / Published: 2 June 2020
(This article belongs to the Special Issue Anatomical Variation and Clinical Diagnosis)
Background: This study attempted to clarify the innervation pattern of the muscles of the distal arm and posterior forearm through cadaveric dissection. Methods: Thirty-five cadavers were dissected to expose the radial nerve in the forearm. Each muscular branch of the nerve was identified and their length and distance along the nerve were recorded. These values were used to determine the typical branching and motor entry orders. Results: The typical branching order was brachialis, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, supinator, extensor digitorum, extensor carpi ulnaris, abductor pollicis longus, extensor digiti minimi, extensor pollicis brevis, extensor pollicis longus and extensor indicis. Notably, the radial nerve often innervated brachialis (60%), and its superficial branch often innervated extensor carpi radialis brevis (25.7%). Conclusions: The radial nerve exhibits significant variability in the posterior forearm. However, there is enough consistency to identify an archetypal pattern and order of innervation. These findings may also need to be considered when planning surgical approaches to the distal arm, elbow and proximal forearm to prevent an undue loss of motor function. The review of the literature yielded multiple studies employing inconsistent metrics and terminology to define order or innervation. View Full-Text
Keywords: radial nerve; variation; order of innervation; posterior interosseous nerve; superficial branch of radial nerve; forearm radial nerve; variation; order of innervation; posterior interosseous nerve; superficial branch of radial nerve; forearm
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Sawyer, F.K.; Stefanik, J.J.; Lufler, R.S. The Branching and Innervation Pattern of the Radial Nerve in the Forearm: Clarifying the Literature and Understanding Variations and Their Clinical Implications. Diagnostics 2020, 10, 366.

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