{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T02:24:49Z","timestamp":1788402289094,"version":"build-2803163510"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The aim of this study was to add to the understanding of nerve branching patterns in the proximal forearm and consider optimal nerve transfer options to address the various injuries that affect the function of the upper extremity.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Eleven upper-extremity cadaveric specimens were dissected to expose the radial, median, and ulnar nerves in the proximal forearm. The site of origin of nerve branches from the major nerves was assessed, with measurements made in reference to the lateral epicondyle for the radial nerve branches and the medial epicondyle for the median and ulnar nerve branches. The distances to where these branches entered their respective muscles (muscle entry point) were assessed using the same landmarks. To plan a transfer, the length of the nerve branches was then calculated as the difference from the apparent origin from the main nerve trunk to the location where the nerve entered the muscle. Importantly, the nerve branch origin was established as the location of obvious separation from the main nerve trunk without additional fascicular dissection from the major nerve trunk. The number of branches was determined, and the diameter for each branch was measured using a Vernier caliper.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The radial nerve branch to the extensor carpi radialis brevis (ECRB) muscle had an average length of 50.7 mm and average diameter of 1.6 mm. The mean medial and lateral lengths of the radial branches to the supinator muscle were found to be 22.2 mm (diameter 1.4 mm) and 15.3 mm (diameter 1.3 mm), respectively. The anterior interosseous nerve (AIN) branch of the median nerve was found 67.8 mm distal to the medial epicondyle with a diameter of 2.3 mm. The flexor carpi ulnaris (FCU) muscle innervation from the ulnar nerve was provided by 3 or 4 branches in most specimens. The second and third of these branches were the longest, with means of 30.5 mm (diameter 1.4 mm) and 30.7 mm (diameter 1.3 mm), respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>While there is variability of the nerve branching pattern in the proximal forearm between specimens, the authors provide evidence of commonalities (branching patterns and distances) that can facilitate planning for upper-extremity nerve reconstructions. Importantly, all measurements are provided with reference to easily identified bony landmarks and to their muscle entry points to aid operative decision-making. These data complement the growing practice of nerve transfers in the upper extremity for a variety of pathologies.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.5.spine23210","type":"journal-article","created":{"date-parts":[[2023,7,22]],"date-time":"2023-07-22T15:54:56Z","timestamp":1690041296000},"page":"593-599","source":"Crossref","is-referenced-by-count":1,"title":["Proximal forearm nerve branching patterns: an anatomical study and its clinical significance"],"prefix":"10.3171","volume":"39","author":[{"given":"Pablo","family":"Zancolli","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Ricardo Gutierrez Children\u2019s Hospital, Buenos Aires, Argentina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin R.","family":"Johnston","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Brigham & Women\u2019s Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezequiel F.","family":"Martinez","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Italian Hospital, Buenos Aires, Argentina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin M.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"HSS J","first-page":"77","article-title":"Nerve transfers for adult traumatic brachial plexus palsy (brachial plexus nerve transfer)","volume":"3","author":"Rohde RS","year":"2007","unstructured":"Rohde RS, Wolfe SW. Nerve transfers for adult traumatic brachial plexus palsy (brachial plexus nerve transfer). HSS J. 2007;3(1):77\u201382."},{"issue":"2","key":"b2","series-title":"Hand Clin","first-page":"227","article-title":"Nerve transfers in tetraplegia","volume":"32","author":"Fox IK","year":"2016","unstructured":"Fox IK. Nerve transfers in tetraplegia. Hand Clin. 2016;32(2):227\u2013242."},{"issue":"1","key":"b3","series-title":"Exp Neurol","first-page":"77","article-title":"Management of nerve gaps: autografts, allografts, nerve transfers, and end-to-side neurorrhaphy","volume":"223","author":"Ray WZ","year":"2010","unstructured":"Ray WZ, Mackinnon SE. Management of nerve gaps: autografts, allografts, nerve transfers, and end-to-side neurorrhaphy. 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J Neurosurg Spine. 2023;38(2):258\u2013264."},{"issue":"3","key":"b6","series-title":"Neurosurg Focus","first-page":"E13","article-title":"Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes","volume":"42","author":"Socolovsky M","year":"2017","unstructured":"Socolovsky M, Malessy M, Lopez D, Guedes F, Flores L. Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes. Neurosurg Focus. 2017;42(3):E13."},{"issue":"1","key":"b7","series-title":"Plast Reconstr Surg","first-page":"184e","article-title":"Current best peripheral nerve transfers for spinal cord injury","volume":"143","author":"Hill EJR","year":"2019","unstructured":"Hill EJR, Fox IK. Current best peripheral nerve transfers for spinal cord injury. 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Plast Reconstr Surg. 2015;136(4):780\u2013792."},{"issue":"1","key":"b20","series-title":"Neurourol Urodyn","first-page":"181","article-title":"Bladder reinnervation by somatic nerve transfer to pelvic nerve vesical branches does not reinnervate the urethra","volume":"39","author":"Barbe MF","year":"2020","unstructured":"Barbe MF, Braverman AS, Salvadeo DM,  Bladder reinnervation by somatic nerve transfer to pelvic nerve vesical branches does not reinnervate the urethra. Neurourol Urodyn. 2020;39(1):181\u2013189."},{"issue":"3 Suppl Operative","key":"b21","series-title":"Neurosurgery","first-page":"75","article-title":"Median to radial nerve transfer to restore wrist and finger extension: technical nuances","volume":"66","author":"Brown JM","year":"2010","unstructured":"Brown JM, Tung THH, Mackinnon SE. Median to radial nerve transfer to restore wrist and finger extension: technical nuances. 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Reliably restoring active hand opening in C5\/6 tetraplegia using the supinator nerve to posterior interosseous nerve transfer. Hand (N Y). 2016;11(1 suppl):91S-92S."},{"issue":"5","key":"b25","series-title":"J Neurosurg Spine","first-page":"641","article-title":"Nerve transfers in the upper extremity following cervical spinal cord injury. Part 2: Preliminary results of a prospective clinical trial","volume":"31","author":"Khalifeh JM","year":"2019","unstructured":"Khalifeh JM, Dibble CF, Van Voorhis A,  Nerve transfers in the upper extremity following cervical spinal cord injury. Part 2: Preliminary results of a prospective clinical trial. J Neurosurg Spine. 2019;31(5):641\u2013653."},{"issue":"2","key":"b26","series-title":"J Neurosurg Pediatr","first-page":"178","article-title":"Oberlin transfer compared with nerve grafting for improving early supination in neonatal brachial plexus palsy","volume":"21","author":"Chang KWC","year":"2018","unstructured":"Chang KWC, Wilson TJ, Popadich M, Brown SH, Chung KC, Yang LJS. Oberlin transfer compared with nerve grafting for improving early supination in neonatal brachial plexus palsy. J Neurosurg Pediatr. 2018;21(2):178\u2013184."},{"issue":"5","key":"b27","series-title":"Surg Radiol Anat","first-page":"785","article-title":"Anatomical feasibility of peripheral nerve transfer to reestablish external anal sphincter control\u2014cadaveric study","volume":"43","author":"Povedano A","year":"2021","unstructured":"Povedano A, Brown RS, Barbosa DAN, Fiorelli RKA, Guedes F. Anatomical feasibility of peripheral nerve transfer to reestablish external anal sphincter control\u2014cadaveric study. Surg Radiol Anat. 2021;43(5):785\u2013793."},{"issue":"1","key":"b28","series-title":"Neurosurg Focus","first-page":"E6","article-title":"A neurophysiological approach to nerve transfer to restore upper limb function in cervical spinal cord injury","volume":"43","author":"Mandeville RM","year":"2017","unstructured":"Mandeville RM, Brown JM, Sheean GL. A neurophysiological approach to nerve transfer to restore upper limb function in cervical spinal cord injury. Neurosurg Focus. 2017;43(1):E6."},{"issue":"6","key":"b29","series-title":"Am J Physiol Regul Integr Comp Physiol","first-page":"R897","article-title":"Nerve transfer for restoration of lower motor neuron-lesioned bladder function. Part 2: correlation between histological changes and nerve evoked contractions","volume":"320","author":"Barbe MF","year":"2021","unstructured":"Barbe MF, Testa CL, Cruz GE,  Nerve transfer for restoration of lower motor neuron-lesioned bladder function. Part 2: correlation between histological changes and nerve evoked contractions. Am J Physiol Regul Integr Comp Physiol. 2021;320(6):R897\u2013R915."},{"issue":"10198","key":"b30","series-title":"Lancet","first-page":"565","article-title":"Expanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case series","volume":"394","author":"van Zyl N","year":"2019","unstructured":"van Zyl N, Hill B, Cooper C, Hahn J, Galea MP. Expanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case series. 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Hand Clin. 2013;29(3):317\u2013330."},{"issue":"1","key":"b35","series-title":"Hand (N Y)","first-page":"92","article-title":"Motor nerve transfers to restore extrinsic median nerve function: case report","volume":"4","author":"Hsiao EC","year":"2009","unstructured":"Hsiao EC, Fox IK, Tung TH, Mackinnon SE. Motor nerve transfers to restore extrinsic median nerve function: case report. Hand (N Y). 2009;4(1):92-97."},{"key":"b36","series-title":"Surg Neurol Int","first-page":"102","article-title":"Transfer of flexor carpi ulnaris branches to selectively restore AIN function in median nerve sections: anatomical feasibility study and case report","volume":"2","author":"Socolovsky M","year":"2011","unstructured":"Socolovsky M, Bonilla G, Masi GD, Bianchi H. Transfer of flexor carpi ulnaris branches to selectively restore AIN function in median nerve sections: anatomical feasibility study and case report. Surg Neurol Int. 2011;2:102."},{"issue":"5","key":"b37","series-title":"J Neurosurg","first-page":"1442","article-title":"Results of wrist extension reconstruction in C5-8 brachial plexus palsy by transferring the pronator quadratus motor branch to the extensor carpi radialis brevis muscle","volume":"124","author":"Bertelli JA","year":"2016","unstructured":"Bertelli JA, Ghizoni MF, Tacca CP. Results of wrist extension reconstruction in C5-8 brachial plexus palsy by transferring the pronator quadratus motor branch to the extensor carpi radialis brevis muscle. J Neurosurg. 2016;124(5):1442\u20131449."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/39\/4\/article-p593.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/39\/4\/article-p593.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/39\/4\/article-p593.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:14:46Z","timestamp":1733490886000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/39\/4\/article-p593.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,1]]},"references-count":37,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2023.5.spine23210","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2023,10,1]]}}}