Identification of Radial Nerve in Relationship to Deltoid Tuberosity and Brachioradialis

Background: Several studies have identified the radial nerve in arm using different anatomic landmarks, however, acontroversy remains. Deltoid tuberosity (DT) and brachioradialis (BR) are reproducible landmarks that can be used toidentify the radial nerve (RN) during fracture surgery.Methods: Dissection of RN was carried out in 17 fresh frozen adult cadavers. Using a calibrated caliper, we measuredthe distance between DT and the origin of BR. The distance between DT and where RN becomes lateral in its relationshipwith the humerus (DT-RN) and the distance between RN and BR (RN-BR) were subsequently measured. The ratio ofDT-RN to DT-BR was calculated to see where the nerve lies in relationship to DT-BR.Results: Average DT-BR was 81.8 (±14.86) mm, average DT-RN was 48.9 (± 7.83) mm, and average RN-BR was 33.0(± 10.16) mm. RN was always found posterior to DT and was never found in the proximal third of DT-BR. The nervewas found in the middle third of DT-BR in 14 of 17 cadavers (82.4 %) and in the distal third in 3 out of 17 cadavers(17.6%). 16 of 17 cadavers (94%) had radial nerve in the distal half of DT-BR.Conclusion: Using the anatomic relationships between RN, DT, and the origin of BR, identification of RN is easilyreproducible. These two structures can serve as the stationary landmarks during fracture surgery to find the radialnerve, which can be found in the distal 2/3 of the distance between the deltoid tuberosity and the origin of brachioradialis.Level of evidence: V