{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T06:17:45Z","timestamp":1790403465908,"version":"4.1.0"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T00:00:00Z","timestamp":1721692800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T00:00:00Z","timestamp":1721692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002345","name":"Eberhard Karls Universit\u00e4t T\u00fcbingen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002345","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Musculoskelet Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>The close proximity of the radial nerve to the humerus poses a risk during upper arm surgery. Although the general course of the radial nerve is well-known, its exact position in relation to anatomical reference points remains poorly investigated. This study aimed to develop a standardized protocol for the sonographic and clinical identification of the radial nerve in the upper arm. The ultimate goal is to assist surgeons in avoiding iatrogenic radial nerve palsy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A total of 76 measurements were performed in 38 volunteers (both sides). Ultrasound measurements were performed using a linear transducer (10\u00a0MHz) to identify the radial nerve at two key points: RD (where the radial nerve crosses the dorsal surface of the humerus) and RL (where the radial nerve crosses the lateral aspect of the humerus). Distances from specific reference points (acromion, lateral epicondyle, medial epicondyle, olecranon fossa) to RD and RL were measured, and the angle between the course of the nerve and the humeral axis was recorded. Humeral length was defined as the distance between the posterodorsal corner of the acromion and the lateral epicondyle.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The distance from the lateral epicondyle to RD was on average 15.5\u00a0cm\u2009\u00b1\u20091.3, corresponding to 50% of the humeral length. The distance from the lateral epicondyle to RL was on average 6.7\u00a0cm\u2009\u00b1\u20090.8, corresponding to 21% of the humeral length. The course of the nerve between RD and RL showed an average angulation of 37\u00b0 to the anatomical axis of the humerus. Gender, BMI, dominant hand, and arm thickness did not correlate with the distances to RD or RL. Measurements were consistent between the left and right side.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The radial nerve can typically be identified by employing a 1\/2 and 1\/5 ratio on the dorsal and lateral aspects of the humerus. Due to slight variations in individual anatomy, the utilization of ultrasound-assisted visualization presents a valuable and straightforward approach to mitigate the risk of iatrogenic radial nerve palsy during upper arm surgery. This study introduces an easy and fast protocol for this purpose.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s12306-024-00841-1","type":"journal-article","created":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T11:05:14Z","timestamp":1721732714000},"page":"47-53","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ultrasound-guided localization of the radial nerve along the humerus: providing reference points for safer upper arm surgery"],"prefix":"10.1007","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6994-518X","authenticated-orcid":false,"given":"T.","family":"Da Silva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Mueck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Knop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Merkle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,23]]},"reference":[{"key":"841_CR1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-020-03438-y","author":"T Da Silva","year":"2020","unstructured":"Da Silva T, Rummel F, Knop C, Merkle T (2020) Comparing iatrogenic radial nerve lesions in humeral shaft fractures treated with helical or straight PHILOS plates: a 10-year retrospective cohort study of 62 cases. Arch Orthop Trauma Surg. https:\/\/doi.org\/10.1007\/s00402-020-03438-y","journal-title":"Arch Orthop Trauma Surg"},{"key":"841_CR2","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1007\/s00276-009-0568-x","volume":"32","author":"H Clement","year":"2010","unstructured":"Clement H, Pichler W, Tesch NP et al (2010) Anatomical basis of the risk of radial nerve injury related to the technique of external fixation applied to the distal humerus. Surg Radiol Anat 32:221\u2013224. https:\/\/doi.org\/10.1007\/s00276-009-0568-x","journal-title":"Surg Radiol Anat"},{"key":"841_CR3","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/j.jos.2021.09.015","volume":"28","author":"H-C Shon","year":"2023","unstructured":"Shon H-C, Yang JY, Lee Y et al (2023) Iatrogenic radial nerve palsy in the surgical treatment of humerus shaft fracture\u2014anterolateral versus posterior approach: a systematic review and meta-analysis. J Orthop Sci Off J Jpn Orthop Assoc 28:244\u2013250. https:\/\/doi.org\/10.1016\/j.jos.2021.09.015","journal-title":"J Orthop Sci Off J Jpn Orthop Assoc"},{"key":"841_CR4","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1002\/ca.20951","volume":"23","author":"CL Cox","year":"2010","unstructured":"Cox CL, Riherd D, Tubbs RS et al (2010) Predicting radial nerve location using palpable landmarks. Clin Anat N Y N 23:420\u2013426. https:\/\/doi.org\/10.1002\/ca.20951","journal-title":"Clin Anat N Y N"},{"key":"841_CR5","doi-asserted-by":"publisher","first-page":"e0186890","DOI":"10.1371\/journal.pone.0186890","volume":"12","author":"HP Theeuwes","year":"2017","unstructured":"Theeuwes HP, van der Ende B, Potters JW et al (2017) The course of the radial nerve in the distal humerus: a novel, anatomy based, radiographic assessment. PLoS ONE 12:e0186890. https:\/\/doi.org\/10.1371\/journal.pone.0186890","journal-title":"PLoS ONE"},{"key":"841_CR6","doi-asserted-by":"publisher","first-page":"1690","DOI":"10.2106\/00004623-199611000-00008","volume":"78","author":"M Gerwin","year":"1996","unstructured":"Gerwin M, Hotchkiss RN, Weiland AJ (1996) Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve. J Bone Joint Surg Am 78:1690\u20131695. https:\/\/doi.org\/10.2106\/00004623-199611000-00008","journal-title":"J Bone Joint Surg Am"},{"key":"841_CR7","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.injury.2009.08.002","volume":"41","author":"T Apivatthakakul","year":"2010","unstructured":"Apivatthakakul T, Patiyasikan S, Luevitoonvechkit S (2010) Danger zone for locking screw placement in minimally invasive plate osteosynthesis (MIPO) of humeral shaft fractures: a cadaveric study. 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Clin Orthop Relat Res 373:259\u2013264","journal-title":"Clin Orthop Relat Res"},{"key":"841_CR10","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1002\/ca.10181","volume":"17","author":"P Fleming","year":"2004","unstructured":"Fleming P, Lenehan B, Sankar R et al (2004) One-third, two-thirds: relationship of the radial nerve to the lateral intermuscular septum in the arm. Clin Anat N Y N 17:26\u201329. https:\/\/doi.org\/10.1002\/ca.10181","journal-title":"Clin Anat N Y N"},{"key":"841_CR11","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.rapm.2007.02.006","volume":"32","author":"GL Foxall","year":"2007","unstructured":"Foxall GL, Skinner D, Hardman JG, Bedforth NM (2007) Ultrasound anatomy of the radial nerve in the distal upper arm. Reg Anesth Pain Med 32:217\u2013220. https:\/\/doi.org\/10.1016\/j.rapm.2007.02.006","journal-title":"Reg Anesth Pain Med"},{"key":"841_CR12","unstructured":"Synthes D (2016) PHILOS and PHILOS long: the anatomic fixation system for the proximal humerus. <http:\/\/synthes.vo.llnwd.net\/o16\/LLNWMB8\/INT%20Mobile\/Synthes%20International\/Product%20Support%20Material\/legacy_Synthes_PDF\/DSEM-TRM-0815-0449-1_LR.pdf>"}],"container-title":["MUSCULOSKELETAL SURGERY"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12306-024-00841-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12306-024-00841-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12306-024-00841-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T14:54:18Z","timestamp":1741013658000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12306-024-00841-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,23]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["841"],"URL":"https:\/\/doi.org\/10.1007\/s12306-024-00841-1","relation":{},"ISSN":["2035-5114"],"issn-type":[{"value":"2035-5114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,23]]},"assertion":[{"value":"20 August 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 May 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This is an observational study. No prospective research on humans or animals was performed. Informed consent was obtained by all participants. Participants information was anonymized. The Research Ethics Committee of the University of Tuebingen has confirmed that no ethical approval is required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}