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Published online: 2024-07-23

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Anatomical analysis of the radial nerve and arcade of Frohse in the cubital fossa using human cadavers

Tomasz Lepich1, Radosław Karaś1, Kamil Kania1, Konrad Barszczewski1, Grzegorz Bajor12

Abstract

Background: The radial nerve (RN) is a peripheral nerve that originates from the posterior bundle of the brachial plexus and carries C5-Th1 fibers. In the cubital fossa radial nerve divides into a superficial branch of the radial nerve (SBRN) and a deep branch of the radial nerve (DBRN). Next DBRN enters under the arcade of Frohse (AF) and changes its name to posterior interosseous nerve of antebrachii (PIN). The AF was first described in 1908 by Frohs and Frankel. It is the superior proximal part of the supinator muscle, which can be tendinous or membranous. Materials and methods: Eight dissected upper limbs were examined to measure the distances and characteristics of the RN, DBRN, SBRN and AF, utilizing precise electronic caliper. Results: The average distance from the point of branching of the RN into its terminal branches to the AF was 54.64 mm on average. In half of the cases DBRN divided before entering the AF. The average distance from the point of branching of the DBRN to the AF in these cases was 13.88 mm. The width of the AF averaged 8.60 mm. Five tendinous AF and three membranous AF were identified. Conclusions: A thorough understanding of the anatomy of the radial nerve and its branches in the cubital fossa, as well as the AF, is important for the development of anatomy and may also contribute to the reduction of surgical complications during procedures in this area.

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References

  1. Benes M, Kachlik D, Kunc V, et al. The arcade of Frohse: a systematic review and meta-analysis. Surg Radiol Anat. 2021; 43(5): 703–711.
  2. Caetano EB, Vieira LA, Sabongi Ne, et al. Anatomical study of the motor branches of the radial nerve in the forearm. Rev Bras Ortop (Sao Paulo). 2020; 55(6): 764–770.
  3. Caetano EB, Vieira LA, Sabongi Neto JJ, et al. Anatomical study of radial tunnel and its clinical implications in compressive syndromes. Rev Bras Ortop (Sao Paulo). 2020; 55(1): 27–32.
  4. Cho H, Lee HY, Gil YC, et al. Topographical anatomy of the radial nerve and its muscular branches related to surface landmarks. Clin Anat. 2013; 26(7): 862–869.
  5. Clavert P, Lutz JC, Adam P, et al. Frohse's arcade is not the exclusive compression site of the radial nerve in its tunnel. Orthop Traumatol Surg Res. 2009; 95(2): 114–118.
  6. Debouck C, Rooze M. The arcade of Fröhse: an anatomic study. Surg Radiol Anat. 1995; 17(3): 245–248.
  7. Ebraheim NA, Jin F, Pulisetti D, et al. Quantitative anatomical study of the posterior interosseous nerve. Am J Orthop (Belle Mead NJ). 2000; 29(9): 702–704.
  8. Frohse F, Frankel M. Die Muskeln des menschlichen Armes. Fischer, Jena 1908: 164–169.
  9. Glover NM, Black AC, Murphy PB. Anatomy, shoulder and upper limb, radial nerve. Treasure Island (FL), StatPearls Publishing 2024.
  10. Guillain G, Courtellemont R. Role of the supinator in radial nerve paralysis: pathogenesis of a partial radial nerve paralysis in an orchestra conductor. Presse Medicale. 1905; 7: 50–52.
  11. Hazani R, Engineer NJ, Mowlavi A, et al. Anatomic landmarks for the radial tunnel. Eplasty. 2008; 8: e37.
  12. Hohenberger GM, Schwarz AM, Grechenig P, et al. Morphology of the posterior interosseous nerve with regard to entrapment syndrome. Indian J Orthop. 2020; 54(Suppl 1): 188–192.
  13. Kim Y, Ha DH, Lee SM. Ultrasonographic findings of posterior interosseous nerve syndrome. Ultrasonography. 2017; 36(4): 363–369.
  14. Latef TJ, Bilal M, Vetter M, et al. Injury of the radial nerve in the arm: a review. Cureus. 2018; 10(2): e2199.
  15. Latinovic R, Gulliford MC, Hughes RAC. Incidence of common compressive neuropathies in primary care. J Neurol Neurosurg Psychiatry. 2006; 77(2): 263–265.
  16. Lepich T, Karaś R, Kania K, et al. Anatomical and clinical aspects of the posterior interosseous nerveof the forearm. Medical Studies. 2024; 40(1): 61–68.
  17. Meng S, Tinhofer I, Weninger WJ, et al. Ultrasound and anatomical correlation of the radial nerve at the arcade of Frohse. Muscle Nerve. 2015; 51(6): 853–858.
  18. Nair S, Ankolekar VH, Hosapatna M, et al. A morphologic and histologic study of the radial nerve and its branches at potential compression sites. J Taibah Univ Med Sci. 2020; 15(5): 358–362.
  19. Ozkan M, Bacakoğlu AK, Gül O, et al. Anatomic study of posterior interosseous nerve in the arcade of Frohse. J Shoulder Elbow Surg. 1999; 8(6): 617–620.
  20. Ozturk A, Kutlu C, Taskara N, et al. Anatomic and morphometric study of the arcade of Frohse in cadavers. Surg Radiol Anat. 2005; 27(3): 171–175.
  21. Papadopoulos N, Paraschos A, Pelekis P. Anatomical observations on the arcade of Frohse and other structures related to the deep radial nerve. Anatomical interpretation of deep radial nerve entrapment neuropathy. Folia Morphol (Praha). 1989; 37(3): 319–327.
  22. Paul L, Lakshmi GV, Alex L. A cadaveric study of the Arcade of Frohse. Indian J Clin Anat Physiol. 2020; 7(2): 195–200.
  23. Portilla Molina AE, Bour C, Oberlin C, et al. The posterior interosseous nerve and the radial tunnel syndrome: an anatomical study. Int Orthop. 1998; 22(2): 102–106.
  24. Prasartritha T, Liupolvanish P, Rojanakit A. A study of the posterior interosseous nerve (PIN) and the radial tunnel in 30 Thai cadavers. J Hand Surg Am. 1993; 18(1): 107–112.
  25. Roles NC, Maudsley RH. Radial tunnel syndrome: resistant tennis elbow as a nerve entrapment. J Bone Joint Surg Br. 1972; 54(3): 499–508.
  26. Sapage R, Pereira PA, Vital L, et al. Surgical anatomy of the radial nerve in the arm: a cadaver study. Eur J Orthop Surg Traumatol. 2021; 31(7): 1457–1462.
  27. Spinner M. The arcade of Frohse and its relationship to posterior interosseous nerve paralysis. J Bone Joint Surg Br. 1968; 50(4): 809–812.
  28. Tatar I, Kocabiyik N, Gayretli O, et al. The course and branching pattern of the deep branch of the radial nerve in relation to the supinator muscle in fetus elbow. Surg Radiol Anat. 2009; 31(8): 591–596.
  29. Thomas SJ, Yakin DE, Parry BR, et al. The anatomical relationship between the posterior interosseous nerve and the supinator muscle. J Hand Surg Am. 2000; 25(5): 936–941.
  30. Tubbs RS, Mortazavi MM, Farrington WJ, et al. Relationships between the posterior interosseous nerve and the supinator muscle: application to peripheral nerve compression syndromes and nerve transfer procedures. J Neurol Surg A Cent Eur Neurosurg. 2013; 74(5): 290–293.
  31. Welle K, Prangenberg C, Hackenberg RK, et al. Surgical anatomy of the radial nerve at the dorsal region of the humerus: a cadaveric study. J Bone Joint Surg Am. 2022; 104(13): 1172–1178.