In cases of humeral diaphyseal fractures, is lateral approach surgery without radial nerve exploration as effective and safe as conventional surgery?

BACKGROUND: This study compares the efficacy and safety of lateral approach surgery with and without radial nerve dissection in treating humeral diaphyseal fractures. It assesses clinical, radiological, and complication outcomes, providing a description of the surgical methods and perioperative benefits. METHODS: We retrospectively analyzed data from 71 patients admitted between May 2015 and December 2022 who underwent lateral approach surgery for humeral diaphyseal fractures. Group 1, consisting of 34 patients without radial nerve dissection, and Group 2, comprising 37 patients with radial nerve dissection, were compared. Parameters such as age, gender, fracture side (right/left), fracture type, follow-up time, surgical duration, blood loss, radiological and clinical evaluations (including Shoulder-Elbow range of motion [ROM] and Quick Disabilities of the Arm, Shoulder, and Hand score [Q-DASH]), and complications were examined. Surgical techniques and outcomes were documented. RESULTS: Both groups exhibited comparable distributions in age, gender, fracture types, and follow-up times (p>0.05). Group 1 demonstrated significantly lower surgical duration and blood loss compared to Group 2 (p<0.05 for both). Clinical assessment revealed satisfactory shoulder and elbow ROM within functional limits for all patients, with no instances of infection. Q-DASH scores were similar between groups. Postoperative radial nerve palsy occurred in one patient in Group 1 and three patients in Group 2, with all cases resolving uneventfully during outpatient follow-ups. Radiological assessment confirmed uneventful union in all patients. CONCLUSION: Lateral approach surgery without radial nerve dissection for humeral diaphyseal fractures offers comparable effectiveness and safety to conventional surgery, with potential perioperative advantages such as reduced operation time and blood loss.

Superficial thrombophlebitis in the forearm leading to entrapment of the radial nerve branch: a first case report and literature review.

This article reports a case of a female patient admitted with swelling and subcutaneous mass in the right forearm, initially suspected to be multiple nerve fibroma. However, through preoperative imaging and surgery, the final diagnosis confirmed superficial thrombophlebitis. This condition resulted in entrapment of the radial nerve branch, leading to noticeable nerve entrapment and radiating pain. The surgery involved the excision of inflammatory tissue and thrombus, ligation of the cephalic vein, and complete release of the radial nerve branch. Postoperative pathology confirmed the presence of Superficial Thrombophlebitis. Through this case, we emphasize the importance of comprehensive utilization of clinical, imaging, and surgical interventions for more accurate diagnosis and treatment. This is the first clinical report of radial nerve branch entrapment due to superficial thrombophlebitis.

Rare Variant of the Radial Artery Causing Compression of the Superficial Radial Nerve: A Case Report.

CASE: This case report describes a patient with paresthesia in the distribution of the superficial sensory branch of the radial nerve that was treated with surgery. Intraoperatively, there was a unique cause of internal compression by a rare superficial radial artery variant running adjacent to it. The nerve was mobilized from the artery with fascial releases. The patient had symptom resolution postoperatively. CONCLUSION: To our knowledge, this cause of compression has not been described before and should be considered in a differential diagnosis. In addition, clinicians should be aware of this anatomical variant during venipunctures and surgical approaches.

Superficial branch of the radial nerve regularly contains fibers from the lateral antebrachial cutaneous nerve: A role in neuroma treatment.

BACKGROUND: Many surgical strategies aim to treat the symptomatic neuroma of the superficial branch of the radial nerve (SBRN). It is still difficult to treat despite many attempts to reveal a reason for surgical treatment failure. The lateral antebrachial cutaneous nerve (LACN) is known to overlap and communicate with SBRN. Our study aims to determine the frequency of spreading of LACN fibers into SBRN branches through a microscopic dissection to predict where and how often LACN fibers may be involved in SBRN neuroma. METHODS: Eighty-seven cadaveric forearms were thoroughly dissected. The path of LACN fibers through the SBRN branching was ascertained using microscopic dissection. Distances between the interstyloid line and entry of LACN fibers into the SBRN and emerging and bifurcation points of the SBRN were measured. RESULTS: The LACN fibers joined the SBRN at a mean distance of 1.7 ± 2.5 cm proximal to the interstyloid line. The SBRN contained fibers from the LACN in 62% of cases. Most commonly, there were LACN fibers within the SBRN's third branch (59%), but they were also observed within the first branch, the second branch, and their common trunk (21%, 9.2%, and 22%, respectively). The lowest rate of the LACN fibers was found within the SBRN trunk (6.9%). CONCLUSION: The SBRN contains LACN fibers in almost 2/3 of the cases, therefore, the denervation of both nerves might be required to treat the neuroma. However, the method must be considered based on the particular clinical situation.

Ancient Schawanoma of radial nerve: a rare case report.

Soft tissue swellings on the forearm can present with a range of clinical and histopathological diagnosis. Ancient Schawanoma is a rare benign condition that can develop over the flexor surface of the forearm as a cystic swelling and can involve the median or the ulnar nerve. However, the presentation of this condition on the extensor surface with involvement of the radial nerve is an extremely uncommon diagnosis. A 69 year old female presented at the outpatient department with a swelling on the extensor aspect of her right forearm for the past 2 years. Ultrasound examination showed a mixed cystic solid mass and MRI report revealed a complex predominantly cystic mass in the extensor compartment of the forearm, measuring 4.3 x 5.3 x 7.2 cm size. After obtaining informed consent, the patient was operated under tourniquet control and the mass was removed sparing the radial nerve that was adherent to its capsule. The final histopathological report confirmed the diagnosis as Ancient Schawanoma.

Radial neuropathy.

Radial neuropathy is the third most common upper limb mononeuropathy after median and ulnar neuropathies. Muscle weakness, particularly wrist drop, is the main clinical feature of most cases of radial neuropathy, and an understanding of the radial nerve's anatomy generally makes localizing the lesion straightforward. Electrodiagnosis can help confirm a diagnosis of radial neuropathy and may help with more precise localization of the lesion. Nerve imaging with ultrasound or magnetic resonance neurography is increasingly used in diagnosis and is important in patients lacking a history of major arm or shoulder trauma. Radial neuropathy most often occurs in the setting of trauma, although many other uncommon causes have been described. With traumatic lesions, the prognosis for recovery is generally good, and for patients with persistent deficits, rehabilitation and surgical techniques may allow substantial functional improvement.

Superficial branch of the radial nerve passing through the supinator canal, emerging between the extensor digitorum and abductor pollicis longus muscles and consequently supplying the second finger and radial portion of the third finger: a case report and clinical implications.

Awareness of unique path of the superficial branch of the radial nerve and its unusual sensory distribution can help avoid potential diagnostic confusion. We present a unique case encountered during a routine dissection of a Central European male cadaver. An unusual course of the superficial branch of the radial nerve was found in the right forearm, where the superficial branch of the radial nerve originated from the radial nerve distally, within the supinator canal, emerged between the extensor digitorum and abductor pollicis longus muscles and supplied the second and a radial half of the third digit, featuring communications with the lateral antebrachial cutaneous nerve and the dorsal branch of the ulnar nerve. Due to dorsal emerging of the superficial branch of the radial nerve the dorsal aspect of the thumb was innervated by the lateral antebrachial cutaneous nerve. To our best knowledge such variation of the superficial branch of the radial nerve has never been reported before. This variation dramatically changes aetiology and manifestation of possible entrapment syndromes which clinicians should be aware of.

Safe zones in dorsal portals for wrist arthroscopy: a cadaveric study.

The standard dorsal portals are the most commonly used in wrist arthroscopy. This cadaveric study aims to determine safe zones, by quantitatively describing the neurovascular relationships of the dorsal wrist arthroscopy portals: 1-2, 3-4, midcarpal radial, midcarpal ulnar, 4-5, 6-radial and 6-ulnar. The neurovascular structures of twenty-one fresh frozen human cadaveric upper limbs were exposed, while the aforementioned portals were established with needles through portal sites. The minimum distance between portals and: dorsal carpal branch of radial artery, superficial branch of radial nerve, posterior interosseous nerve and dorsal branch of ulnar nerve, were measured accordingly with a digital caliper, followed by statistical analysis of the data. The median and interquartile range for each portal to structures at risk were determined and a safe zone around each portal was established. Free of any neurovascular structure safe zones surrounding 1-2, 3-4, midcarpal radial, midcarpal ulnar, 4-5, 6-radial and 6-ulnar portals were found at 0.46mm, 2.33mm, 10.73mm, 11.01mm, 10.38mm, 5.95mm and 0.64mm respectively. Results of statistical analysis from comparisons between 1-2, 3-4 and midcarpal radial portals, indicated that 1-2 was the least safe. The same analysis among 3-4, midcarpal radial, midcarpal ulnar and 4-5 portals indicated that midcarpal portals were safer, while 3-4 was the least safe. Results among midcarpal ulnar, 4-5, 6-radial and 6-ulnar portals indicated that 6-radial and specifically 6-ulnar were the least safe. This study provides a safe approach to the dorsal aspect of the wrist, enhancing established measurements and further examining safety of the posterior interosseous nerve.

Timing of surgery in peripheral nerve injury of the upper extremity.

Peripheral nerve injuries present a complex clinical challenge, requiring a nuanced approach in surgical management. The consequences of injury vary, with sometimes severe disability, and a risk of lifelong pain for the individual. For late management, the choice of surgical techniques available range from neurolysis and nerve grafting to tendon and nerve transfers. The choice of technique utilized demands an in-depth understanding of the anatomy, patient demographics and the time elapsed since injury for optimized outcomes. This paper focuses on injuries to the radial, median and ulnar nerves, outlining the authors' approach to these injuries.Level of evidence: IV.

Exploring Symptom Responses to Upper Limb Neural Test Variations of the Radial Nerve in Patients With Lateral Epicondylalgia: An Observational Study.

OBJECTIVE: Clinical practice guidelines recommend the radial nerve mechanosensitivity evaluation in patients with lateral epicondylalgia. Despite different positions and sequences having been described, no research analyzed how each variation triggers symptoms associated with lateral epicondylalgia. The aim of this study was to explore the effects of different positions and sequences in the upper limb neural tension test 2b (ULNT2b) in symptom responses in patients with lateral epicondylalgia. METHODS: In this observational study, 66 patients underwent 4 test conditions: standard ULNT2b, ULNT2b proximal to distal, ULNT2B with resisted supination, and resisted supination isolated. Paresthesia sensations, symptom reproduction, pain intensity (measured using a visual analog scale), and distribution of painful symptoms data were collected. RESULTS: Significant differences in paresthesia sensations were observed between groups, with significant differences between the standard ULNT2B and other ULNT variations or resisted supination maneuvers. Symptom reproduction also differed significantly across groups, with significant differences between the standard ULNT2B and other ULNT or resisted supination tests. The positive/negative test and percentage of distribution of painful symptoms scores varied significantly across 4 conditions in both lateral and frontal views. Although pain intensity scores during tests were comparable among the tests, distribution of painful symptoms differed significantly. CONCLUSION: Variations in the ULNT2b test can affect symptom responses in patients with lateral epicondylalgia. The standard ULNT2b test appears more effective at reproducing symptoms, intensity of paresthesia, and distribution of painful symptoms compared to other ULNT variations and the resisted supination test. IMPACT: ULNT2b sequences have been shown to elicit varying responses concerning paresthesia, replication of familiar symptoms, positive/negative test results, and distribution of painful symptoms. Clinicians should consider specific test variations during the patients' radial nerve mechanosensitivity assessment to identify aggravating factors reproducing recognizable symptoms. A control group of asymptomatic participants and the role of presence of other comorbidities, psychological factors, or the duration of symptoms were not considered in this study and might play an important role influencing the results of the tests.

A bilateral four-headed brachialis muscle with a variant innervation: a cadaveric report with possible clinical implications.

PURPOSE: Anterior compartment muscles of the arm present high morphological variability, with possible clinical significance. The current cadaveric report aims to describe a bilateral four-headed brachialis muscle (BM) with aberrant innervation. Emphasis on the embryological background and possible clinical significance are also provided. METHODS: Classical upper limb dissection was performed on an 84-year-old donated male cadaver. The cadaver was donated to the Anatomy Department of the National and Kapodistrian University of Athens. RESULTS: On the left upper limb, the four-headed BM was supplied by the musculocutaneous and the median nerves after their interconnection. On the right upper limb, the four-headed BM received its innervation from the median nerve due to the musculocutaneous nerve absence. A bilateral muscular tunnel for the radial nerve passage was identified, between the BM accessory heads and the brachioradialis muscle. CONCLUSION: BM has clinical significance, due to its proximity to important neurovascular structures and frequent surgeries at the humerus. Hence, knowledge of these variants should keep orthopedic surgeons alert when intervening in this area. Further dissection studies with a standardized protocol are needed to elucidate the prevalence of BM aberrations and concomitant variants.

Demystifying the Radial Nerve The Management of Radial Nerve Palsy in the Setting of Humeral Shaft Fracture.

The association of radial nerve palsy and humeral shaft fracture is well known. Primary exploration and fracture fixation is recommended for open fractures and vascular injury while expectant management remains the standard of care for closed injuries. In the absence of nerve recovery, exploration and reconstruction is recommended 3 to 5 months following injury. When direct repair or nerve grafting is unlikely to achieve a suitable outcome, nerve and tendon transfers are potential options for the restoration of wrist and finger extension.

The Accessory Muscular Head of the Triceps Brachii Muscle with Tendinous Attachment / Cabeza Muscular Accesoria del Músculo Triceps Braquial con Inserción Tendinosa

SUMMARY: Variations in the triceps brachii muscle are uncommon, and especially limited reports exist on the accessory heads of tendinous origin that attach near the upper medial part of the humerus. During anatomical training at Nagasaki University School of Medicine, the accessory head of the triceps brachii muscle was observed on the right upper arm of a 72-year-old Japanese female. It arose tendinously from the medial side of the upper humerus, then formed a muscle belly and joined the distal side of the long head. This accessory head had independent nerve innervation, and the innervating nerve branched from a bundle of the radial nerve, which divided the nerve innervating the long head and the posterior brachial cutaneous nerve. The origin of the innervation of the accessory head was the basis for determining that this muscle head was an accessory muscle to the long head of the triceps brachii muscle. Embryologically, we discuss that part of the origin of the long head of the triceps brachii muscle was separated early in development by the axillary nerve and the posterior brachial circumflex artery, and it slipped into the surgical neck of the humerus and became fixed there. The accessory head crossed the radial nerve and deep brachial artery. When clinicians encounter compression of the radial nerve or profunda brachii artery, they should consider the presence of accessory muscles as a possible cause.

Las variaciones en el músculo tríceps braquial son poco comunes y existen informes especialmente limitados sobre las cabezas accesorias de origen tendinoso que se insertan cerca de la parte medial superior del húmero. Durante un entrenamiento anatómico en la Facultad de Medicina de la Universidad de Nagasaki, se observó la cabeza accesoria del músculo tríceps braquial en la parte superior del brazo derecho de una mujer japonesa de 72 años. Se originaba tendinosamente desde el lado medial de la parte superior del húmero, luego formaba un vientre muscular y se unía al lado distal de la cabeza larga. Esta cabeza accesoria tenía inervación nerviosa independiente, cuyo nervio se ramificaba a partir de un ramo del nervio radial, que dividía el nervio que inervaba la cabeza larga y el nervio cutáneo braquial posterior. El origen de la inervación de la cabeza accesoria fue la base para determinar que esta cabeza muscular era un músculo accesorio de la cabeza larga del músculo tríceps braquial. Embriológicamente, discutimos que parte del origen de la cabeza larga del músculo tríceps braquial se separó temprananamente en el desarrollo por el nervio axilar y la arteria circunfleja braquial posterior, y se deslizó hacia el cuello quirúrgico del húmero y quedó fijado allí. La cabeza accesoria cruzaba el nervio radial y la arteria braquial profunda. Cuando los médicos encuentran compresión del nervio radial o de la arteria braquial profunda, deben considerar la presencia de mús- culos accesorios como una posible causa.

Anatomical considerations for nerve transfer in axillary nerve injury.

This study investigated the anatomical details of the axillary and radial nerves in 50 upper limbs from 29 adult formalin-embalmed cadavers, and ten fresh upper limbs. The focus was on understanding the course, division, and ramifications of these nerves to improve treatment of shoulder dysfunction caused by axillary nerve damage. The axillary nerve divided anteriorly and posteriorly before passing the quadrangular space in all specimens, with specific distances to the first ramifications. It was found that the deltoid muscle's clavicular and acromial parts were always innervated by the anterior division of the axillary nerve, whereas the spinous part was variably innervated. The longest and thickest branches of the radial nerve to the triceps muscles were identified, with no statistically significant differences in fiber numbers among triceps branches. The study concludes that nerve transfer to the anterior division of the axillary nerve can restore the deltoid muscle in about 86% of shoulders, and the teres minor muscle can be restored by nerve transfer to the posterior division. The medial head branch and long head branch of radial nerve were identified as the best donor options.

Rare Median Nerve and Digital Nerve Tumor Resection and Distal Nerve Transfers: A Report of 2 Cases.

CASES: We present 2 cases of median nerve reconstruction using distal nerve transfers after resection of unusual benign median nerve tumors. Critical sensation was restored in case 1 by transferring the fourth common digital nerve to first web digital nerves. Thumb opposition was regained by transferring the abductor digiti minimi ulnar motor nerve branch to the recurrent median motor nerve branch. Critical sensation was restored in case 2 by transferring the long finger ulnar digital nerve to the index finger radial digital nerve. CONCLUSION: Distal nerve transfers, even with short grafts, are reliable median nerve deficit treatments, sparing the need for larger autologous nerve grafts and late tendon opponensplasties.

Clinical efficacy analysis of minimally invasive intramedullary nailing in the treatment of humeral shaft fractures combined with radial nerve injury.

OBJECTIVE: The aim of this study was to research the therapeutic effectiveness of radial nerve damage paired with a humeral shaft fracture and intramedullary nailing. PATIENTS AND METHODS: Retrospective research was performed on the medical records of 58 individuals who had humeral shaft fractures and radial nerve injuries. The admission period was between June 1, 2020, and June 31, 2022. All study subjects that satisfied the requirements for inclusion were separated, using the random number table approach, into two groups: one for internal fixation (group N), which included 29 cases, and one for minimally invasive procedures (group W), which included 29 patients. Group W received minimally invasive intramedullary nail treatment, and group N received internal fixation with compression plates. The changes in the clinical effects, surgery-related indicators, joint function, nerve function, and levels of stress indicators of the two groups of treatment were analyzed. The changes in adverse reactions and satisfaction of patients were compared. RESULTS: The effective rate of group W was 89.66% (26/29), and that of group N was 72.41% (21/29). Although group W's effective rate was higher than group N's, there was no discernible disparity between the two groups (p>0.05). Surgical blood loss and incision length were much smaller in group W than in group N, and overall operation duration and length of stay were considerably shorter in group W than in group N (p<0.05). The excellent and good rate of elbow joint function in group W was 93.10% (27/29), whereas the excellent and good rate of group N was 65.52% (19/29). The excellent and good rate of elbow joint function in group W was considerably greater than that of group N (p<0.05). In group W, the excellent and good rate of shoulder joint was 96.55% (28/29), and that in group N was 68.97% (20/29), and group W had a considerably greater probability of excellent shoulder joint function than group N (p<0.05); the excellent and good rate of neurological function was 82.76% (24/29) in group W and 58.62% (17/29) in group N, and group W had much greater rates of excellent and good neurological function than group N (p<0.05). prostaglandin E-2 (PGE2), C-reactive protein (CRP) and Substance P (SP) levels in the W group and the N group were substantially higher after the surgery than they were prior to it (p<0.05), and in the W group, the aforementioned stress markers were much lower than they were in the N group (p<0.05). Group W experienced a 3.45% (1/29) rate of adverse events, while group N saw a 24.14% (7/29) incidence. The incidence of adverse responses was substantially lower in group W than in group N (p<0.05). The contentment rate of group W was 93.10% (27/29), and that of group N was 72.41% (21/29). Group W had a much greater contentment percentage than group N (p<0.05). CONCLUSIONS: Minimally invasive intramedullary nailing is a successful therapeutic approach for humeral shaft fractures with radial nerve damage, which may successfully enhance patients' shoulder and elbow joint function and nerve function, reduce patients' stress response, and has the characteristics of minimal adverse responses and high contentment, which is worthy of popularization and deployment.

Neuropathic pain of the superficial branch of the radial nerve - Factors influencing surgical outcome and patient satisfaction.

BACKGROUND: Due to its partially superficial course, the superficial branch of the radial nerve is vulnerable to injury by trauma or surgery, potentially leading to painful neuroma. Surgical treatment is difficult. Among other factors, smoking and duration of pain before revision surgery have been suggested as risk factors for persistent pain after surgical revision, without concrete evidence. The aim of this study was therefore to identify factors influencing the outcome of revision surgery in SBRN neuropathic pain in our department. METHODS: All 51 patients receiving revision surgery of the superficial branch of the radial nerve for neuropathic pain from 2010 to 2020 were contacted; 19 agreed to return for assessment. A medical chart review was performed to collect patient-, pain- and treatment-specific factors. Outcomes were recorded. In an outpatient consultation, clinical follow-up was performed and patients filled out the DASH, MHQ and painDETECT questionnaires. RESULTS: After revision surgery, all patients experienced persistent pain. On multivariate logistic regression evaluating the risk of persistent pain, only smoking emerged as an independent risk factor. Age, gender, dominant side, location, time between trigger and surgery or diagnosis did not emerge as risk factors. No predictor for successful return to work could be identified. CONCLUSIONS: Treatment of painful neuroma of the superficial branch of the radial nerve is a challenge. Patients with neuropathic pain should be coached toward smoking cessation before neuroma surgery. Surgery can show benefit even after long symptom duration. No correlations between study clinical variables or test results and return to work could be identified, suggesting that other factors play a role in return to work.

Rehabilitation Following a Triceps Branch to Axillary Motor Nerve Transfer-A Pragmatic Therapy Guide.

Peripheral motor nerve transfer surgery is a technique that may be used to restore motor function to paralyzed muscles. Motor nerve transfer involves harvesting an expendable motor nerve branch, and transfer to the motor branch of the denervated target muscle, using microsurgical coaptation. To date, a standardized rehabilitation protocol does not exist. The 6 stages of rehabilitation after motor nerve transfer surgery were outlined by colleagues in the Birmingham Peripheral Nerve Injury service in 2019. This article aims to provide a practical therapy perspective on the rehabilitation stages of motor nerve transfer surgery outlined in that paper, focusing on the radial to axillary nerve transfer. Timeframes for each stage along with exercise prescription and rationale are provided.

Case-based report of graded motor imagery experience in traumatic brachial plexus injury: The art of moving without moving.

BACKGROUND: We reported a 24-year-old woman who sustained multiple upper limb injuries after a traffic accident in March 2017. She sustained a C7-T1 brachial plexus injury and radial nerve injury on the left side diagnosed in November 2017. The patient underwent radial nerve reconstruction. The patient began her comprehensive therapy program in January 2018. PURPOSE: To describe the use of graded motor imagery (GMI) and outcomes after traumatic brachial plexus palsy. We presented changes in electromyographic (EMG) activity of target muscles during task execution and functional status following 10-session GMI therapy. STUDY DESIGN: Case report. METHODS: The program included 4 sessions of motor imagery and 6 sessions of a combination of motor imagery and mirror therapy. RESULTS: The patient successfully participated in the program with reported improvements in EMG activity, functional status, emotional well-being, and body awareness. CONCLUSIONS: GMI therapy appears to have peripheral motor effects, including altered surface EMG activity and contributes to a favorable outcome in the functional level of the affected arm. An improved emotional state and awareness of the affected hand could have a positive effect on function. Future long-term randomized controlled trials are needed to investigate the cumulative peripheral effects of treatment of graded motor imagery and the effects of variables mediating its effects on functional performance in patients with nerve injury.

Anatomy of the Superficial Radial Nerve and Its Target Nerves for Targeted Muscle Reinnervation: An Anatomical Cadaver Study.

BACKGROUND: Targeted muscle reinnervation (TMR) is a surgical procedure for treating symptomatic neuroma, in which the neuroma is removed and the proximal nerve stump is coapted to a donor motor branch innervating a nearby muscle. This study aimed to identify optimal motor targets for TMR of the superficial radial nerve (SRN). METHODS: Seven cadaveric upper limbs were dissected to describe the course of the SRN in the forearm and motor nerve supply-number, length, diameter, and entry points in muscle of motor branches-for potential recipient muscles. RESULTS: The radial nerve provided three (three of six) motor branches, two (two of six) motor branches, or one (one of six) motor branch to the brachioradialis muscle, entering the muscle 21.7 ± 17.9 to 10.8 ± 15 mm proximal to the lateral epicondyle. One (one of seven), two (three of seven), three (two of seven), or four (one of seven) motor branches innervated the extensor carpi radialis longus muscle, with entry points 13.9 ± 16.2 to 26.3 ± 14.9 mm distal from the lateral epicondyle. In all specimens, the posterior interosseous nerve gave off one motor branch to the extensor carpi radialis brevis, which divided into two or three secondary branches. The distal anterior interosseus nerve was assessed as a potential recipient for TMR coaptation and had a freely transferable length of 56.4 ± 12.7 mm. CONCLUSIONS: When considering TMR for neuromas of the SRN in the distal third of the forearm and hand, the distal anterior interosseus nerve is a suitable donor target. For neuromas of the SRN in the proximal two-thirds of the forearm, the motor branches to the extensor carpi radialis longus, extensor carpi radialis brevis, and brachioradialis are potential donor targets.