Quantitation of and superficial surgical landmarks for the anterior interosseous nerve

R. Shane TubbsDepartment of Cell Biology, University of Alabama at Birmingham; and Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama

Search for other papers by R. Shane Tubbs in
Current site
Google Scholar
PubMed
Close
 P.A.-C., Ph.D.
,
James W. CustisDepartment of Cell Biology, University of Alabama at Birmingham; and Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama

Search for other papers by James W. Custis in
Current site
Google Scholar
PubMed
Close
 M.D.
,
E. George SalterDepartment of Cell Biology, University of Alabama at Birmingham; and Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama

Search for other papers by E. George Salter in
Current site
Google Scholar
PubMed
Close
 Ph.D.
,
John C. Wellons IIIDepartment of Cell Biology, University of Alabama at Birmingham; and Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama

Search for other papers by John C. Wellons III in
Current site
Google Scholar
PubMed
Close
 M.D.
,
Jeffrey P. BlountDepartment of Cell Biology, University of Alabama at Birmingham; and Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama

Search for other papers by Jeffrey P. Blount in
Current site
Google Scholar
PubMed
Close
 M.D.
, and
W. Jerry OakesDepartment of Cell Biology, University of Alabama at Birmingham; and Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama

Search for other papers by W. Jerry Oakes in
Current site
Google Scholar
PubMed
Close
 M.D.
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

Object

There are scant data regarding the anterior interosseous nerve (AIN) in the neurosurgical literature. In the current study the authors attempt to provide easily identifiable superficial osseous landmarks for the identification of the AIN.

Methods

The AIN in 20 upper extremities obtained in adult cadaveric specimens was dissected and quantified. Measurements were obtained between the nerve and surrounding superficial osseous landmarks.

The AIN originated from the median nerve at mean distances of 5.4 cm distal to the medial epicondyle of the humerus and 21 cm proximal to the ulnar styloid process. The distance from the origin of the AIN to its branch leading to the flexor pollicis longus muscle and to the point it travels deep to the pronator quadratus (PQ) muscle measured a mean 4 and 14.4 cm, respectively. The mean distance from the AIN branch leading to the flexor pollicis longus muscle to the proximal PQ muscle was 12.1 cm, and the mean distance between this branch and the ulnar styloid process was 7.2 cm. The mean diameter of the AIN was 1.6 mm at the midforearm.

Conclusions

Additional landmarks for identification of the AIN can aid the neurosurgeon in more precisely isolating this nerve and avoiding complications. Furthermore, after quantitation of this nerve, the AIN branches can be easily used for neurotization of the median and ulnar nerves, and with the aid of a transinterosseous membrane tunneling technique, passed to the posterior interosseous nerve.

Abbreviations used in this paper:

AIN = anterior interosseous nerve; FDP = flexor digitorum profundus; FDS = flexor digitorum superficialis; FPL = flexor pollicis longus; PIN = posterior interosseous nerve; PQ = pronator quadratus.
  • Collapse
  • Expand
  • 1

    Bergman RA, , Afifi AK, & Miyauchi R: Median nerve. Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus III: Nervous System: Plexuses (http://www.anatomyatlases.org/AnatomicVariants/NervousSystem/Text/MedianNerve.shtml) [Accessed 8 March 2006]

    • Search Google Scholar
    • Export Citation
  • 2

    Botte MJ, Nerve anatomy. Doyle JR, & Botte MJ: Surgical Anatomy of the Hand and Upper Extremity Philadelphia, Lippincott Williams & Wilkins, 2002. 185236

    • Search Google Scholar
    • Export Citation
  • 3

    Canovas F, , Mouilleron P, & Bonnel F: Biometry of the muscular branches of the median nerve to the forearm. Clin Anat 11:239245, 1998

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Chidgey LK, & Szabo RM, Anterior interosseous nerve palsy. Szabo RM: Nerve Compression Syndromes: Diagnosis and Treatment Thorofare, NJ, SLACK, 1989. 154162

    • Search Google Scholar
    • Export Citation
  • 5

    Dellon AL, , Mackinnon SE, & Daneshvar A: Terminal branch of anterior interosseous nerve as source of wrist pain. J Hand Surg [Br] 9:316322, 1984

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Doyle JR, Forearm. Doyle JR, & Botte MJ: Surgical Anatomy of the Hand and Upper Extremity Philadelphia, Lippincott Williams & Wilkins, 2002. 461485

    • Search Google Scholar
    • Export Citation
  • 7

    Foucher G: Technique de dénervation du poignet. Ann Chir Main 8:8487, 1989

  • 8

    Freidberg SR, Entrapment neuropathies of the upper extremity. Benzel EC: Practical Approaches to Peripheral Nerve Surgery Park Ridge, IL, American Association of Neurological Surgeons, 1992. 5163

    • Search Google Scholar
    • Export Citation
  • 9

    Grant JCB: A Method of Anatomy: Descriptive and Deductive, ed 2 Baltimore, Williams & Wilkins, 1940

  • 10

    Grutter PW, , DeSilva GL, , Meehan RE, & DeSilva SP: The accuracy of distal posterior interosseous and anterior interosseous nerve injection. J Hand Surg [Am] 29:865870, 2004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Haase SC, & Chung KC: Anterior interosseous nerve transfer to the motor branch of the ulnar nerve for high ulnar nerve injuries. Ann Plast Surg 49:285290, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Hollinshead WH: Arm, elbow, and forearm. Anatomy for Surgeons: The Back and Limbs, ed 3 Philadelphia, Harper & Row, 1982. 341435

  • 13

    Kline DG, & Hudson AR: Nerve Injuries: Operative Results for Major Nerve Injuries, Entrapments, and Tumors Philadelphia, WB Saunders, 1995

    • Search Google Scholar
    • Export Citation
  • 14

    Lorei MP, & Hershman EB: Peripheral nerve injuries in athletes. Treatment and prevention. Sports Med 16:130147, 1993

  • 15

    Mackinnon SE, & Dellon AL: Surgery of the Peripheral Nerve New York, Thieme, 1988. 171196

  • 16

    Novak CB, & Mackinnon SE: Distal anterior interosseous nerve transfer to the deep motor branch of the ulnar nerve for reconstruction of high ulnar nerve injuries. J Reconstr Microsurg 18:459464, 2002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Oh CS, , Chung IH, & Koh KS: Anatomical study of the accessory head of the flexor pollicis longus and the anterior interosseous nerve in Asians. Clin Anat 13:434438, 2000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Pećina MM, , Krmpotić-Nemanić J, & Markiewitz AD: Tunnel Syndromes. Peripheral Nerve Compression Syndromes, ed 3 Boca Raton, FL, CRC Press, 2001

    • Search Google Scholar
    • Export Citation
  • 19

    Pirela-Cruz MA, , Omer GE, & Benzel EC, Surgical exposure of the peripheral nerves of the upper extremity. Benzel EC: Practical Approaches to Peripheral Nerve Surgery Park Ridge, IL, American Association of Neurological Surgeons, 1992. 131151

    • Search Google Scholar
    • Export Citation
  • 20

    Proudman TW, & Menz PJ: An anomaly of the median artery associated with the anterior interosseous syndrome. J Hand Surg [Br] 17:507509, 1992

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Puhaindran ME, & Wong HP: A case of anterior interosseous nerve syndrome after peripherally inserted central catheter (PICC) line insertion. Singapore Med J 44:653655, 2003

    • Search Google Scholar
    • Export Citation
  • 22

    Schmidt HM, & Lanz U: Surgical Anatomy of the Hand Stuttgart, Thieme, 2004

  • 23

    Schultz RJ, & Aiache A: An operation to restore opposition of the thumb by nerve transfer. Arch Surg 105:777779, 1972

  • 24

    Sunderland S: Nerves and Nerve Injuries, ed 2 Edinburgh, Churchill Livingstone, 1978. 656690

  • 25

    Üstün ME, , Öğün TC, & Büyükmumcu M: Neurotization as an alternative for restoring finger and wrist extension. J Neurosurg 94:795798, 2001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Üstün ME, , Öğün TC, , Büyükmumcu M, & Salbacak A: Selective restoration of motor function in the ulnar nerve by transfer of the anterior interosseous nerve. An anatomical feasibility study. J Bone Joint Surg Am 83:549552, 2001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Wang Y, & Zhu S: Transfer of a branch of the anterior interosseous nerve to the motor branch of the median nerve and ulnar nerve. Chin Med J (Engl) 110:216219, 1997

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 619 230 32
Full Text Views 182 10 1
PDF Downloads 105 9 1
EPUB Downloads 0 0 0