- there are two approaches that allow decompression of PIN: anterior and posterior (see Henry and Thompson);
- Henry's mobile wad (brachioradialis, ECRL , and ECRB) serves as the focal area for orientation;
- anterior approach is more advantages since is allows decompression of all points of compression (fibrous bands, radial recurrent
vessels, origin of ECRB, origin of supinator (arcade of Frohse), and distal edge of the supinator at exit;
- in contrast the posterior approach only allows decompression at the proximal and distal aspects of the supinator muscles;
- anterolateral approach:
- incision begins on the anterolateral aspect of the arm, 4 cm proximal to elbow flexion crease, continues to flexion crease,
where it is directed ulnarward for 3 cm;
- incision continues distally ulnar border of mobile wad;
- dissection proceeds between brachialis & brachioradialis to locate radial nerve in distal aspect of the arm, just proximal to
elbow flexion crease;
- radial nerve is traced from proximal to distal to inspect potential sites of compression;
- fibrous bands are just anterior to the radial head;
- pronation of forearm and flexion of wrist may demonstrate compression of PIN by fibrous margin of ECRB,
& its released;
- arcade of Frohse, which forms fibrous rind at proximal border of superficial belly of supinator, are transected;
- complete division of superficial belly of supinator is performed if there is a compressive fibrous band at its distal
- Transbracial approach"
- Transbrachioradialis Approach to the Radial Tunnel: An Anatomic Study of 5 Potential Compression Sites.
- Anatomical Study of the Surgical Approaches to the Radial Tunnel.
- Superficial surgical landmarks for identifying the posterior interosseous nerve
Anatomical Study of the Surgical Approaches to the Radial Tunnel
Year Book: Posterior Interosseous Nerve Palsies.