A Cadaveric Study of the Posterior Interosseous Nerve and Its Branches at the Level of the Distal Radius

Purpose: Posterior interosseous nerve (PIN) damage has been cited as a cause of wrist pain syndrome after distal radius fractures. The goal of this cadaveric study was to examine this hypothesis by looking for branches between the PIN and the periosteum of the distal radius. Methods: The PIN was dis...

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Main Authors:	Thomas M. Gregory, MD, PhD, Marion Goutard, MD, Jules Gregory, MD, Simon A. Hurst, MD, Lorenzo Merlini, MD, Jérome Pierrart, MD
Format:	Article
Language:	English
Published:	Elsevier 2019-04-01
Series:	Journal of Hand Surgery Global Online
Online Access:	http://www.sciencedirect.com/science/article/pii/S2589514118300616

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spelling	doaj-9832db83a77049118055ca031306290d2020-11-25T00:37:17ZengElsevierJournal of Hand Surgery Global Online2589-51412019-04-01127073A Cadaveric Study of the Posterior Interosseous Nerve and Its Branches at the Level of the Distal RadiusThomas M. Gregory, MD, PhD0Marion Goutard, MD1Jules Gregory, MD2Simon A. Hurst, MD3Lorenzo Merlini, MD4Jérome Pierrart, MD5Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique–Hôpitaux de Paris, University Paris-Seine-Saint-Denis, Sorbonne Paris Cité, Bobigny, France; Moveo Institute, University Paris-Seine-Saint-Denis, Sorbonne Paris Cité, Bobigny, France; Corresponding author: Thomas M. Gregory, MD, PhD, Department of Orthopaedic Surgery, Teaching Hospital Avicenne, Université Paris 13, 125 rue de Stalingrad, 93000 Bobigny, France.Department of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique–Hôpitaux de Paris, University Paris-Seine-Saint-Denis, Sorbonne Paris Cité, Bobigny, FranceDepartment of Radiology, Beaujon Teaching Hospital, Assistance Publique–Hôpitaux de Paris, Université Paris-Diderot, Paris, FranceDepartment of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique–Hôpitaux de Paris, University Paris-Seine-Saint-Denis, Sorbonne Paris Cité, Bobigny, France; Department of Orthopaedic Surgery, St Mary’s Hospital, London, United KingdomDepartment of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique–Hôpitaux de Paris, University Paris-Seine-Saint-Denis, Sorbonne Paris Cité, Bobigny, France; Moveo Institute, University Paris-Seine-Saint-Denis, Sorbonne Paris Cité, Bobigny, FranceDepartment of Orthopaedic Surgery, Avicenne Teaching Hospital, Assistance Publique–Hôpitaux de Paris, University Paris-Seine-Saint-Denis, Sorbonne Paris Cité, Bobigny, France; Moveo Institute, University Paris-Seine-Saint-Denis, Sorbonne Paris Cité, Bobigny, FrancePurpose: Posterior interosseous nerve (PIN) damage has been cited as a cause of wrist pain syndrome after distal radius fractures. The goal of this cadaveric study was to examine this hypothesis by looking for branches between the PIN and the periosteum of the distal radius. Methods: The PIN was dissected in 10 adult specimens (8 fresh and 2 embalmed) under ×2.5 magnification. All of the dissections started from the last motor branch of the PIN, innervating the extensor indicis proprius, and proceeded from proximal to distal. Results: The PIN was divided into 3 terminal segments in the dorsal wrist joint (proximal, middle, and distal segments). We were able to observe that branches to the distal radial periosteum were constant and emerged from the middle segment where the nerve is enclosed in a sturdy fibro-fatty sheath adhered to the dorsal periosteum of the distal radius. No collateral bundle was identified in the proximal segment. In the distal segment, every specimen had branches to the radiocarpal joint; 9 of 10 had a midcarpal innervation. Terminal branches to the carpometacarpal joints were identified in 2 cadaveric wrists. Conclusions: The radial periosteum PIN branches consistently identified in these specimens may contribute to dorsal wrist pain seen at the time of late follow-up in patients after distal radius fractures. Clinical relevance: The benefit of PIN denervation as an adjuvant procedure should be evaluated further in the surgical management of wrist injuries. Key words: cadaver study, complex regional pain syndrome, digital nerve graft, distal radius fracture, posterior interosseous nervehttp://www.sciencedirect.com/science/article/pii/S2589514118300616
collection	DOAJ
language	English
format	Article
sources	DOAJ
author	Thomas M. Gregory, MD, PhD Marion Goutard, MD Jules Gregory, MD Simon A. Hurst, MD Lorenzo Merlini, MD Jérome Pierrart, MD
spellingShingle	Thomas M. Gregory, MD, PhD Marion Goutard, MD Jules Gregory, MD Simon A. Hurst, MD Lorenzo Merlini, MD Jérome Pierrart, MD A Cadaveric Study of the Posterior Interosseous Nerve and Its Branches at the Level of the Distal Radius Journal of Hand Surgery Global Online
author_facet	Thomas M. Gregory, MD, PhD Marion Goutard, MD Jules Gregory, MD Simon A. Hurst, MD Lorenzo Merlini, MD Jérome Pierrart, MD
author_sort	Thomas M. Gregory, MD, PhD
title	A Cadaveric Study of the Posterior Interosseous Nerve and Its Branches at the Level of the Distal Radius
title_short	A Cadaveric Study of the Posterior Interosseous Nerve and Its Branches at the Level of the Distal Radius
title_full	A Cadaveric Study of the Posterior Interosseous Nerve and Its Branches at the Level of the Distal Radius
title_fullStr	A Cadaveric Study of the Posterior Interosseous Nerve and Its Branches at the Level of the Distal Radius
title_full_unstemmed	A Cadaveric Study of the Posterior Interosseous Nerve and Its Branches at the Level of the Distal Radius
title_sort	cadaveric study of the posterior interosseous nerve and its branches at the level of the distal radius
publisher	Elsevier
series	Journal of Hand Surgery Global Online
issn	2589-5141
publishDate	2019-04-01
description	Purpose: Posterior interosseous nerve (PIN) damage has been cited as a cause of wrist pain syndrome after distal radius fractures. The goal of this cadaveric study was to examine this hypothesis by looking for branches between the PIN and the periosteum of the distal radius. Methods: The PIN was dissected in 10 adult specimens (8 fresh and 2 embalmed) under ×2.5 magnification. All of the dissections started from the last motor branch of the PIN, innervating the extensor indicis proprius, and proceeded from proximal to distal. Results: The PIN was divided into 3 terminal segments in the dorsal wrist joint (proximal, middle, and distal segments). We were able to observe that branches to the distal radial periosteum were constant and emerged from the middle segment where the nerve is enclosed in a sturdy fibro-fatty sheath adhered to the dorsal periosteum of the distal radius. No collateral bundle was identified in the proximal segment. In the distal segment, every specimen had branches to the radiocarpal joint; 9 of 10 had a midcarpal innervation. Terminal branches to the carpometacarpal joints were identified in 2 cadaveric wrists. Conclusions: The radial periosteum PIN branches consistently identified in these specimens may contribute to dorsal wrist pain seen at the time of late follow-up in patients after distal radius fractures. Clinical relevance: The benefit of PIN denervation as an adjuvant procedure should be evaluated further in the surgical management of wrist injuries. Key words: cadaver study, complex regional pain syndrome, digital nerve graft, distal radius fracture, posterior interosseous nerve
url	http://www.sciencedirect.com/science/article/pii/S2589514118300616
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A Cadaveric Study of the Posterior Interosseous Nerve and Its Branches at the Level of the Distal Radius

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