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Nerves (Anatomy)

Elbow nerve anatomy: radial, median, ulnar & musculocutaneous – critical for surgical approach & fracture management injury prevention.

Overview

The anterior capsule of the elbow receives the majority of its innervation from the radial and musculocutaneous nerves, with minimal contribution from the median nerve [1]. During elbow arthroscopy of the antero-medial compartment, the median nerve is a structure at risk [5]. Conversely, simple intra-articularly accessible anatomical landmarks serve as safe guides for avoiding radial nerve injury at the elbow joint [15].

Nerve management requires precise anatomical knowledge to mitigate complications across various approaches. Surgeons must be vigilant regarding ulnar nerve complications associated with open reduction and internal fixation for adult distal humerus fractures [20], while dissection during a lateral approach should be limited to 4.0 cm from the radiocapitellar joint without formal identification of the posterior interosseous nerve [21]. Care must be taken to ensure the posterior interosseous nerve is not within the surgical window even when the forearm is pronated, as pronation does not reliably increase the distance of the nerve to the joint [13]. Current management options for cubital tunnel syndrome include a review of related anatomy, clinical presentation, and contemporary outcomes research [12].

Microsurgical repair and grafting rely on specific fascicular patterns. The intraneural fascicular groups of the ulnar and median nerves are identifiable for variable distances in the distal forearm, providing an anatomical basis for microsurgical group fascicular repair and nerve-grafting [3]. Authors have reported results of interfascicular nerve-grafting in thirty-three median and thirty-two ulnar nerve lesions [7], though further study is required to quantify differences in sensory recovery between traditional operative techniques and cross-palm nerve grafting for severe ulnar neuropathy [14]. While nerve injury occurred at a significantly higher rate for subpectoral techniques during long head of the biceps tenodesis, all nerve function recovered [6]. The anatomic branch pattern of the axillary nerve is useful for identifying each of its branches and has implications for surgeries related with selective innervation [2].

Anatomy & Pathophysiology

Vascular & Neural

The anterior capsule of the elbow receives the majority of its innervation from the radial and musculocutaneous nerves, with minimal contribution from the median nerve [1]. The course of the radial nerve in the distal upper arm exhibits great variety [4], while the posterior antebrachial cutaneous nerve typically gives off a discrete epicondylar branch after becoming superficial in the distal brachium, continuing distally as one or two longitudinal branches [43]. During elbow arthroscopy of the antero-medial compartment, the median nerve is a structure at risk [5], and care must be taken to ensure the posterior interosseous nerve is not within the surgical window even when the forearm is pronated [13]. Predictive accuracy for posterior interosseous nerve localization in the proximal forearm is highest when the arm is in a supinated position [42]. High-resolution sonography can clearly demonstrate the morphology and dynamics of the ulnar nerve in the cubital tunnel [27], though a study could not detect a definitive effect of elbow deformity on ulnar nerve strain or demonstrate the extent of acceptable clinical elbow deformity [37]. Elbow arthroscopy can be safely performed with proper knowledge and application of anatomy around the elbow when making portals and understanding at-risk areas beyond the capsule when working within the joint [33].

Osseous & Ligamentous

A consistent distribution pattern for articular sensory receptors in the human elbow joint capsule was observed [16]. Elbow dislocations associated with fractures of the medial epicondyle with intra-articular entrapment can be difficult to diagnose in the acute phase [8]. A distally based tendon graft reconstruction of the annular ligament of the elbow using the tendon of the superficial head of the brachialis muscle would be feasible in most patients [44]. Pitching 100 balls induces a significant reduction in dynamic stabilizing ability against elbow valgus laxity [32].

Classification

Innervation Patterns: The majority of the anterior elbow capsule receives innervation from the radial and musculocutaneous nerves, with minimal contribution from the median nerve [1]. A consistent distribution pattern for articular sensory receptors is observed in the human elbow joint capsule [16]. Specific innervation patterns to the accessory biceps head include Type IV for the biceps and Type III for the brachialis, adding these to the Yang classification [25].

Nerve Variations and Course: The course of the radial nerve in the distal upper arm exhibits great variety [4]. Variations in musculocutaneous nerve anatomy are quite common, and even unreported variations can be encountered [10]. The lateral antebrachial cutaneous nerve crossed over the biceps tendon in 50% of specimens [9]. Few cases of an unusual origin of the motor branch of the ulnar nerve to the flexor carpi ulnaris have been described in the literature [17].

Anatomical Constraints and Risks: The radial nerve is anatomically tethered in the brachium by the lateral intermuscular septum (LIS) and has limited excursion compared with the median and ulnar nerves [39]. Intraneural fascicular groups of the ulnar and median nerves are identifiable for variable distances in the distal forearm [3]. The median nerve is a structure at risk when performing elbow arthroscopy of the antero-medial compartment [5]. An understanding of the anatomy of the Guyon canal is essential for diagnosis in patients presenting with motor and/or sensory deficits in the hand [11].

Other Considerations: No specific fracture or soft-tissue classification systems (e.g., Schatzker, Gustilo–Anderson) are defined in the provided evidence base for this section.

Clinical Presentation

The clinical evaluation of elbow pathology requires precise knowledge of articular innervation and nerve vulnerability. The majority of the anterior capsule receives innervation from the radial and musculocutaneous nerves, with minimal contribution from the median nerve [1]. A consistent distribution pattern for articular sensory receptors has been observed in the human elbow joint capsule [16].

During physical examination, variations in anatomy must be anticipated. The course of the radial nerve in the distal upper arm exhibits great variety [4], and variations in musculocutaneous nerve anatomy are quite common, including unreported variants [10]. The lateral antebrachial cutaneous nerve crosses over the biceps tendon in 50% of specimens [9]. In the distal forearm, intraneural fascicular groups of the ulnar and median nerves are identifiable for variable distances [3]. Unusual origins of the motor branch to the flexor carpi ulnaris have been described, though few cases exist [17].

Specific nerve injuries and compression syndromes present distinct clinical patterns. The median nerve is a structure at risk during elbow arthroscopy of the antero-medial compartment [5]. Compression syndromes involving the median and ulnar nerves, as well as the brachial artery, have been reported in association with a supracondylar process [18]. An understanding of Guyon canal anatomy is essential for diagnosing patients with motor and/or sensory deficits in the hand [11].

Surgical planning must account for nerve positioning relative to operative windows. Care must be taken to ensure the posterior interosseous nerve is not within the surgical window, even when the forearm is pronated [13]. In long head of the biceps tenodesis, nerve injury occurred at a significantly higher rate for subpectoral techniques, although all nerve function recovered [6].

Investigations

MRI: MRI determination of posterior interosseous nerve position is reliable and consistent with prior cadaveric study [35]. High-resolution sonography can clearly demonstrate the morphology and dynamics of the ulnar nerve in the cubital tunnel [27].

Other Considerations: The majority of the innervation of the anterior capsule of the elbow comes from the radial and musculocutaneous nerves with minimal contribution from the median nerve [1]. The findings regarding the anatomic branch pattern of the axillary nerve are useful for identifying each of its branches and have implications for surgeries related with selective innervation [2]. The intraneural fascicular groups of the ulnar and median nerves are identifiable for variable distances in the distal forearm, providing an anatomical basis for microsurgical group fascicular repair and nerve-grafting [3]. The course of the radial nerve in the distal part of the upper arm has great variety [4]. The median nerve is a structure at risk when performing elbow arthroscopy of the antero-medial compartment [5]. Nerve injury occurred at a significantly higher rate for subpectoral techniques during long head of the biceps tenodesis, but all nerve function recovered [6]. The authors report on the results of interfascicular nerve-grafting in thirty-three median and thirty-two ulnar nerve lesions [7]. Elbow dislocations associated with fractures of the medial epicondyle with intra-articular entrapment can be difficult to diagnose in the acute phase, requiring a high level of suspicion [8]. The lateral antebrachial cutaneous nerve crossed over the biceps tendon in 50% of the specimens [9]. Variations in musculocutaneous nerve anatomy are quite common, and even unreported variations can be encountered [10]. An understanding of the anatomy of the Guyon canal is essential for diagnosis in patients presenting with motor and/or sensory deficits in the hand [11]. Simple intra-articularly accessible anatomical landmarks are safe guides for avoiding radial nerve injury at the elbow joint [15]. Few cases of an unusual origin of the motor branch of the ulnar nerve to the flexor carpi ulnaris have been described in the literature [17]. A compression syndrome involving the median and ulnar nerves as well as the brachial artery associated with a supracondylar process has been reported [18]. Tuberculomas in nerve tissue are thought to arise from tuberculous emboli [19]. The authors recommend limiting dissection to 4.0 cm from the radiocapitellar joint during a lateral approach without formal identification of the posterior interosseous nerve, regardless of forearm rotation, as pronation does not reliably increase the distance of the nerve to the joint [21]. The distances between the entering guidewire trajectory and the posterior interosseous nerve show that guidewire-inflicted injury to the nerve is unlikely during the anterior single-incision approach [24].

Treatment

Non-Operative

Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in childhood coxa vara, while moderate nonprogressive deformity often does not require surgery [38]. Custom hemiarthroplasty appears to be a reasonable method to salvage proximal humeral dysplasia epiphysealis hemimelica when nonsurgical management has failed to provide relief [34].

Operative

Indications: Surgical intervention is warranted for nerve-related complications requiring repair, such as severe ulnar neuropathy where further study is required to quantify differences in sensory recovery between traditional operative techniques and cross-palm nerve grafting [14]. Procedures are also indicated for contracture of the deltoid muscle to resolve pain, skin dimpling, palpable fibrous bands, and winging of the scapula [41].

Surgical Approach / Technique: The majority of the innervation of the anterior capsule of the elbow comes from the radial and musculocutaneous nerves with minimal contribution from the median nerve [1]. The course of the radial nerve in the distal part of the upper arm has great variety [4], and variations in musculocutaneous nerve anatomy are quite common, and even unreported variations can be encountered [10]. The lateral antebrachial cutaneous nerve crossed over the biceps tendon in 50% of the specimens [9]. Dissection during a lateral approach to the elbow should be limited to 4.0 cm from the radiocapitellar joint without formal identification of the posterior interosseous nerve, regardless of forearm rotation, as pronation does not reliably increase the distance of the nerve to the joint [21]. Care should be taken to ensure the posterior interosseous nerve is not within the surgical window even when the forearm is pronated [13]. Simple intra-articularly accessible anatomical landmarks are safe guides for avoiding radial nerve injury at the elbow joint [15]. The distances between the entering guidewire trajectory and the posterior interosseous nerve show that guidewire-inflicted injury to the nerve is unlikely during the anterior single-incision approach [24]. The median nerve is a structure at risk when performing elbow arthroscopy of the antero-medial compartment [5]. Surgeons must be vigilant about ulnar nerve complications associated with open reduction and internal fixation for adult distal humerus fractures [20]. Nerve injury occurred at a significantly higher rate for subpectoral techniques in long head of the biceps tenodesis, but all nerve function recovered [6]. Elbow dislocations associated with fractures of the medial epicondyle with intra-articular entrapment can be difficult to diagnose in the acute phase, requiring a high level of suspicion [8].

Implant Selection: The lack of integrity of a silicone implant is not the cause of recurrent ulnar drift in metacarpophalangeal joint surgery, which probably starts early in the postoperative course due to forces acting on the joints [23].

Alignment / Balancing Strategy: Knowledge of possible compression sites of the ulnar nerve is important to the surgeon so that complications are avoided and postoperative recurrence is decreased [22]. An understanding of the anatomy of the Guyon canal is essential for diagnosis in patients presenting with motor and/or sensory deficits in the hand [11].

Pain Management: No specific evidence regarding analgesia regimens was provided in the source bullets.

Adjuncts: No specific evidence regarding tourniquet, tranexamic acid, drains, navigation, or robotics was provided in the source bullets.

Revision: No specific evidence regarding revision-procedure principles was provided in the source bullets.

Other Considerations: The intraneural fascicular groups of the ulnar and median nerves are identifiable for variable distances in the distal forearm, providing an anatomical basis for microsurgical group fascicular repair and nerve-grafting [3]. The authors report on the results of interfascicular nerve-grafting in thirty-three median and thirty-two ulnar nerve lesions [7]. Interfascicular nerve-grafting gives results which are at least as good as those after epineural nerve suture under ideal conditions and better than those after neurorrhaphy under tension [28]. The findings regarding the anatomic branch pattern of the axillary nerve are useful for identifying each of its branches and have implications for surgeries related with selective innervation [2].

Complications

Nerve palsy: The median nerve is at risk during antero-medial compartment elbow arthroscopy [5], while the anterior capsule of the elbow receives the majority of its innervation from the radial and musculocutaneous nerves with minimal median nerve contribution [1]. Variations in musculocutaneous nerve anatomy are common, including unreported variations [10], and the lateral antebrachial cutaneous nerve crossed the biceps tendon in 50% of specimens [9]. Subpectoral techniques for long head of the biceps tenodesis result in a significantly higher rate of nerve injury compared to other techniques, though all nerve functions recovered [6]. Surgeons must remain vigilant regarding ulnar nerve complications during open reduction and internal fixation for adult distal humerus fractures [20], as knowledge of potential ulnar nerve compression sites is critical to avoiding complications and decreasing postoperative recurrence [22]. A compression syndrome involving the median and ulnar nerves alongside the brachial artery has been reported in association with a supracondylar process [18]. Intraneural fascicular groups of the ulnar and median nerves are identifiable for variable distances in the distal forearm, providing an anatomical basis for microsurgical group fascicular repair and nerve-grafting [3]. The authors reported results of interfascicular nerve-grafting in thirty-three median and thirty-two ulnar nerve lesions [7]. Further study is required to quantify differences in sensory recovery between traditional operative techniques and cross-palm nerve grafting for severe ulnar neuropathy [14]. The course of the radial nerve in the distal upper arm exhibits great variety [4], and findings regarding the anatomic branch pattern of the axillary nerve have implications for surgeries related to selective innervation [2].

Other Considerations: Elbow dislocations associated with fractures of the medial epicondyle with intra-articular entrapment can be difficult to diagnose in the acute phase, requiring a high level of suspicion [8]. Tuberculomas in nerve tissue are thought to arise from tuberculous emboli [19]. Patient, rehabilitation, and surgeon-specific factors did not influence the complication rate after traumatic distal triceps tears [50]. Although low-molecular-weight heparin is widely used for thromboembolism prophylaxis, its use carries a slight chance of being complicated by major hemorrhage and the development of compartment syndrome [48].

Recovery

Light activity (weeks): The provided evidence does not specify a distinct week range for light activity or desk work. However, nerve function recovery is documented following subpectoral tenodesis techniques, where all nerve functions recovered despite a significantly higher injury rate compared to other approaches [6].

Full activity (months): Evidence does not define a specific month range for full activity or manual work return. Tendon transfers may be utilized to restore hand function in patients with peripheral nerve injury, provided the limb maintains satisfactory tissue equilibrium and the donor is carefully selected [30].

Complete recovery / outcome plateau (months): The evidence does not establish a definitive month range for outcome plateauing. Interfascicular nerve-grafting yields results at least equivalent to epineural nerve suture under ideal conditions and superior to neurorrhaphy performed under tension [28]. Further study is required to quantify sensory recovery differences between traditional operative techniques and cross-palm nerve grafting for severe ulnar neuropathy [14]. In obstetric brachial plexus injury, reconstruction solely for shoulder function via nerve transfers shows potential but lacks high-quality evidence compared to natural history [45]. Focusing exclusively on elbow outcomes in this population may result in the under-treatment of shoulder dysfunction [45].

Rehabilitation protocol: The provided evidence does not contain specific data regarding PT phasing, immobilisation duration, weight-bearing progression, or sling removal timing.

Functional milestones: The provided evidence does not report validated PROM trajectories or specific outcome-measure benchmarks (e.g., Constant, ASES, WOMAC).

Other Considerations: No additional recovery-relevant content regarding predictors of return-to-work failure or patient-selection caveats for early ROM is present in the source evidence.

Key Evidence

  • [L5] The majority of the innervation of the anterior capsule comes from the radial and musculocutaneous nerves with minimal contribution from the median nerve. (10.1016/j.jhsa.2015.10.012)
  • [L5] The findings are useful for identifying each of the branches of the axillary nerve and have implications for surgeries related with selective innervation. (10.1016/j.jse.2006.05.003)
  • [L5] The intraneural fascicular groups of the ulnar and median nerves are identifiable for variable distances in the distal forearm, providing an anatomical basis for microsurgical group fascicular repair and nerve-grafting. (10.2106/00004623-198668020-00013)
  • [L5] The course of the radial nerve in the distal part of the upper arm has great variety. (10.1371/journal.pone.0186890)
  • [L5] The median nerve is a structure at risk when performing elbow arthroscopy of the antero-medial compartment. (10.1016/j.arthro.2019.11.082)
  • [L3] Nerve injury occurred at a significantly higher rate for subpectoral techniques, but all nerve function recovered. (10.1177/2325967117s00397)
  • [L4] The authors report on the results of this technique in thirty-three median and thirty-two ulnar nerve lesions. (10.2106/00004623-197254040-00004)
  • [L4] Elbow dislocations associated with fractures of the medial epicondyle with intra-articular entrapment can be difficult to diagnose in the acute phase, and thus a high level of suspicion is required. (10.1016/j.jse.2012.11.009)
  • [L5] The nerve crossed over the biceps tendon in 50% of the specimens. (10.1016/j.jhsa.2024.04.018)
  • [L4] Variations in musculocutaneous nerve anatomy are quite common, and even unreported variations can be encountered. (10.1016/j.jhsa.2022.07.014)
  • [L5] An understanding of the anatomy of the Guyon canal is essential for diagnosis in patients presenting with motor and/or sensory deficits in the hand. (10.5435/jaaos-22-11-699)
  • [L5] This article reviews related anatomy, clinical presentation, and current management options for cubital tunnel syndrome with an emphasis on contemporary outcomes research. (10.1016/j.jhsa.2015.03.011)
  • [L3] Care should be taken to ensure the nerve is not within the surgical window even when the forearm is pronated. (10.5397/cise.2024.00213)
  • [L4] Further study to quantify differences in sensory recovery between traditional operative techniques and cross-palm nerve grafting is required. (10.1177/1558944718822851)
  • [L5] These simple intra-articularly accessible anatomical landmarks are safe guides for avoiding radial nerve injury. (10.1016/j.arthro.2019.11.081)
  • [L5] A consistent distribution pattern for articular sensory receptors was observed, which allows further understanding of elbow pathology. (10.1177/1758573218760245)
  • [L4] Few cases of this type of anatomic variation of the ulnar nerve have been described in the literature. (10.1016/j.jse.2008.07.015)
  • [L4] Tuberculomas in nerve tissue are thought to arise from tuberculous emboli, and in this case, a small, undemonstrable pulmonary lesion was likely the source. (10.2106/00004623-197557010-00030)
  • [L3] Surgeons must be vigilant about ulnar nerve complications. (10.1186/s13018-022-03292-1)
  • [L5] The authors recommend limiting dissection to 4.0 cm from the radiocapitellar joint during a lateral approach without formal identification of the posterior interosseous nerve, regardless of forearm rotation, as pronation does not reliably increase the distance of the nerve to the joint. (10.1016/j.jse.2006.09.004)
  • [L5] Knowledge of possible compression sites of the ulnar nerve is important to the surgeon so that complications are avoided and postoperative recurrence is decreased. (10.1016/j.jse.2009.03.004)
  • [L4] The lack of integrity of the implant is not the cause of recurrent ulnar drift, which probably starts early in the postoperative course due to forces acting on the joints. (10.2106/00004623-197557070-00021)
  • [L4] The distances between the entering guidewire trajectory and PIN show that guidewire-inflicted injury to the nerve is unlikely during the anterior single-incision approach. (10.1177/0363546521992120)
  • [L4] The study describes specific innervation patterns to the accessory biceps head, adding Type IV for the biceps and Type III for the brachialis to the Yang classification. (10.1177/17531934221080952)
  • [L4] High-resolution sonography can clearly demonstrate the morphology and dynamics of the ulnar nerve in the cubital tunnel. (10.1054/jhsb.1999.0317)
  • [L4] Interfascicular nerve-grafting gives results which are at least as good as those after epineural nerve suture under ideal conditions and better than those after neurorrhaphy under tension. (10.2106/00004623-197658020-00008)
  • [L4] Complete resection and correction osteotomy in patients with functional impairment or remarkable deformity can lead to restoration of normal anatomy and result in good function without local recurrence. (10.1016/j.jse.2012.10.031)
  • [L5] Tendon transfers are useful to restore function to the hand impaired and unbalanced by peripheral nerve injury, provided the limb has satisfactory tissue equilibrium and the donor is carefully selected. (10.1016/j.jhsa.2010.05.023)
  • [L5] Pitching 100 balls induces a significant reduction in dynamic stabilizing ability against elbow valgus laxity. (10.1016/j.jse.2023.11.001)
  • [L5] Elbow arthroscopy can be safely performed with proper knowledge and application of anatomy around the elbow when making portals and understanding at-risk areas beyond the capsule when working within the joint. (10.1016/j.arthro.2024.05.001)
  • [Case_report] This appears to be a reasonable method to salvage this difficult and challenging problem when nonsurgical management has failed to provide relief. (10.1016/j.jse.2011.08.043)
  • [L4] MRI determination of PIN position is reliable and consistent with prior cadaveric study. (10.1016/j.arthro.2020.12.118)
  • [L5] The study could not detect a definitive effect of elbow deformity on ulnar nerve strain or demonstrate the extent of acceptable clinical elbow deformity. (10.1186/s12891-022-05786-9)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L5] The radial nerve is anatomically tethered in the brachium by the LIS and has limited excursion compared with the median and ulnar nerves. (10.1016/j.jhsa.2017.09.023)
  • [L3] The procedure resolved pain, skin dimpling, palpable fibrous bands, and winging of the scapula, with no infections or neuromuscular complications. (10.2106/00004623-199802000-00010)
  • [L5] Predictive accuracy was highest when the arm was in a supinated position. (10.1016/j.arthro.2013.03.056)
  • [L5] After becoming superficial in the distal brachium, the PABCN typically gives off a discrete epicondylar branch and then continues distally in the forearm as 1 or 2 longitudinal branches. (10.1016/j.jhsa.2019.08.011)
  • [L5] A distally based tendon graft reconstruction of the annular ligament of the elbow using the tendon of the superficial head of the brachialis muscle would be feasible in most patients, based on this anatomic study. (10.1016/j.jhsa.2013.04.008)
  • [Letter] The letter argues that focusing solely on elbow outcomes in obstetric brachial plexus injury may lead to under-treatment of shoulder dysfunction, while the reply acknowledges that while nerve repair affects elbow flexion, reconstruction solely for shoulder function via nerve transfers has potential but lacks high-quality evidence compared to natural history. (10.1177/1753193418802746)
  • [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. (10.1016/j.jse.2010.05.022)
  • [L3] The incidence of complications and reintervention was low (13.4% and 12.6%, respectively), with the main cause of reintervention being persistent stiffness, and no risk factors for complications were found in this study. (10.1177/17585732221079588)
  • [Case_report] Although low-molecular-weight heparin is widely used for thromboembolism prophylaxis, there is a slight chance that its use may be complicated by major hemorrhage and the development of compartment syndrome. (10.2106/00004623-199812000-00009)
  • [L3] Loosening leading to revision is more prevalent in TER and increases with time, while in HA, the most common type of revision involved addition of an ulna component with preservation of the humeral component. (10.1016/j.jse.2023.08.001)
  • [L3] Patient, rehabilitation, and surgeon-specific factors did not influence the complication rate. (10.1016/j.xrrt.2022.05.004)

See Also

  • Cubital Tunnel Syndrome

References

[1] Innervation of the Elbow Joint: A Cadaveric Study. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.10.012

[2] The anatomic branch pattern of the axillary nerve. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.05.003

[3] Anatomical basis for repair of ulnar and median nerves in the distal part of the forearm by group fascicular suture and nerve-grafting.. The Journal of Bone & Joint Surgery. 1986. DOI: 10.2106/00004623-198668020-00013

[4] The course of the radial nerve in the distal humerus: A novel, anatomy based, radiographic assessment. PLOS ONE. 2017. DOI: 10.1371/journal.pone.0186890

[5] Arthroscopic Anatomy of The Median Nerve And Brachial Artery Neurovascular Bundle At The Elbow. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.082

[6] Nerve Injury with Long Head of the Biceps Tenodesis. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00397

[7] The Interfascicular Nerve-Grafting of the Median and Ulnar Nerves. The Journal of Bone & Joint Surgery. 1972. DOI: 10.2106/00004623-197254040-00004

[8] A rare case of elbow dislocation associated with unrecognized fracture of medial epicondyle and delayed ulnar neuropathy in pediatric age. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.11.009

[9] Anatomy of the Lateral Antebrachial Cutaneous Nerve: Landmarks for Procedures in the Cubital Fossa. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.04.018

[10] Anatomic Variations of the Musculocutaneous Nerve and Clinical Implications for Restoration of Elbow Flexion. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.07.014

[11] Ulnar Nerve Entrapment at the Wrist. Journal of the American Academy of Orthopaedic Surgeons. 2014. DOI: 10.5435/jaaos-22-11-699

[12] The Management of Cubital Tunnel Syndrome. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.03.011

[13] In vivo dynamic migration of the posterior interosseous nerve across various elbow and forearm positions. Clinics in Shoulder and Elbow. 2024. DOI: 10.5397/cise.2024.00213

[14] Cross-Palm Nerve Grafts to Enhance Sensory Recovery in Severe Ulnar Neuropathy. HAND. 2019. DOI: 10.1177/1558944718822851

[15] Radial Nerve Anatomy at the Elbow Joint and Its Arthroscopic Relevance. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.081

[16] Neuroanatomical distribution of sensory receptors in the human elbow joint capsule. Shoulder & Elbow. 2018. DOI: 10.1177/1758573218760245

[17] Unusual origin of the motor branch of the ulnar nerve to the flexor carpi ulnaris. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2008.07.015

[18] Median and ulnar-nerve palsy: an unusual presentation of the supracondylar process. Report of a case.. The Journal of Bone and Joint Surgery. American Volume. 1978.

[19] Tuberculoma of the ulnar nerve. The Journal of Bone & Joint Surgery. 1975. DOI: 10.2106/00004623-197557010-00030

[20] Complications associated with open reduction and internal fixation for adult distal humerus fractures: a multicenter retrospective study. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03292-1

[21] Anatomic considerations regarding the posterior interosseous nerve at the elbow. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.09.004

[22] Regional anatomic structures of the elbow that may potentially compress the ulnar nerve. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2009.03.004

[23] Complications of silicone implant surgery in the metacarpophalangeal joint. The Journal of Bone & Joint Surgery. 1975. DOI: 10.2106/00004623-197557070-00021

[24] Distance of the Posterior Interosseous Nerve From the Bicipital (Radial) Tuberosity at Varying Positions of Forearm Rotation: A Magnetic Resonance Imaging Study With Clinical Implications. The American Journal of Sports Medicine. 2021. DOI: 10.1177/0363546521992120

[25] The innervation of the biceps brachii and brachialis muscles in specimens with a high incidence of an accessory biceps head. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221080952

[27] Morphology and Dynamics of the Ulnar Nerve in the Cubital Tunnel. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.1999.0317

[28] Further experience with interfascicular grafting of the median, ulnar, and radial nerves. The Journal of Bone & Joint Surgery. 1976. DOI: 10.2106/00004623-197658020-00008

[29] A rare case of Trevor's disease (dysplasia epiphysealis hemimelica) in the elbow. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.10.031

[30] Update on Tendon Transfers for Peripheral Nerve Injuries. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.05.023

[32] Weakening and factors of medial elbow dynamic stabilizers against elbow valgus laxity after repetitive pitching in high school baseball players. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.11.001

[33] Elbow Arthroscopy: Pearls to Avoid Nerve Injuries. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.05.001

[34] Treatment of proximal humeral dysplasia epiphysealis hemimelica with custom hemiarthroplasty: a case report. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2011.08.043

[35] Implications of Posterior Interosseus Nerve Distance from the Radial Tuberosity: A Radiologic Study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2020.12.118

[37] A cadaveric study of ulnar nerve strain at the elbow associated with cubitus valgus/varus deformity. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05786-9

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