Anatomical features of the median nerve at the elbow and proximal forearm

Abstract

Introduction: Knowledge of anatomy of the median nerve in its course through the elbow allows understanding the origin of several pathologies; in addition, identifying the distribution and anatomical variants of the nerve branches is useful for defining surgical approaches for this nerve.
Materials and methods: Dissection of cadaveric specimens, convenience sample, with prior approval of the ethics committee and following a dissection protocol identifying the median nerve and its ramifications in the elbow and its relationship with vascular and myotendinous structures.
Results: Twenty elbows with an average age of 60.8 years were dissected, exploring the median nerve, its ramifications and adjacent anatomical structures in the antecubital fossa. No Struthers ligament was found, the distance to the pronator teres (PT) arcade from the inte- repichondyle line was 51.3 mm and 74.1 mm to the flexor digitorum superficialis (FDS) arch. The most frequent pattern was a trunk for PT, a proximal transverse branch with divisions for FDS, flexor carpi radialis (FCR) and palmaris longus (PL). The innervation of the FCR originated mostly from the trunk of the PT.
Discussion: Great variability of origin and distribution of the branches originated from the median nerve in the elbow was observed, the distances and morphological characteristics in the known compression sites were quantified. The FCR branch is put at risk in the exploration of the tendon arches of the PT and the FDS.