Anatomical Study of the Surgical Approaches to the Radial Tunnel.

PURPOSE To provide a cadaveric analysis of 3 surgical approaches (anterior, anterolateral, posterior) used for decompression of the posterior interosseous nerve within the radial tunnel. The aim of the study was to determine whether the number of compression sites visualized and safely released differed between approaches. We hypothesized that no single approach is adequate for visualization of all key compression sites. METHODS Thirty fresh-frozen cadaveric specimens were used to perform 10 anterior, 10 anterolateral, and 10 posterior approaches to the radial tunnel. For each approach, key anatomical structures and the 5 documented anatomical sites of nerve compression that were clearly visualized within the surgical exposure were recorded. The portion of the supinator that was directly visualized in each approach was released. A second window was then created to expose the remaining uncut portion of the supinator. Measurements were taken from each specimen. RESULTS Statistical analysis demonstrated that the anterior and anterolateral approaches were best for visualizing the fibrous bands of the radial head, the leash of Henry, the origin of the extensor carpi radialis brevis, and the arcade of Frohse. The posterior approach was best for visualizing the distal border of the supinator. The relative uncut supinator distance varied with approach. The anterior approach left a larger relative uncut portion than the posterior approach. CONCLUSIONS No single approach was adequate for complete visualization and release of all compression points of the radial tunnel. In cases of radial tunnel release, complete visualization of the posterior interosseous nerve compression sites is best achieved through multiple windows. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.