Nerve supply of the brachioradialis muscle: Surgically relevant variations of the extramuscular branches of the radial nerve

The brachioradialis muscle is utilized in tendon-transfer operations, carried out for a variety of purposes. The extramuscular branches of the radial nerve to the brachioradialis were dissected and studied in 43 embalmed cadaveric specimens. The number of primary and secondary branches and the spatial locations of their origins and muscle-entry points was determined for each specimen. All distances were measured relative to the lateral epicondyle. A wide anatomic variation was observed in both the nerve branching pattern as well as the number and locations of muscle-entry points. A single primary nerve branch was found in 20 specimens, or 46.5% of the cases. On an average, single primary nerve branches arose from the radial nerve 30 mm proximal to the lateral epicondyle. In 16 of these cases, the primary branch splits into two to four secondary branches. and in four cases there was only one branch entering the muscle. Seventeen specimens had two primary branches whose origin points were separated by 5 to 40 mm with an average of 15 mm. In seven of these seventeen cases one or both of the primary branches split into secondary branches. Six specimens had three primary branches; the origin points of the most proximal and the most distal branch were separated by up to 30 mm with an average of 13 mm. Excluding the four cases with extensive fanning into multiple thin branches, the number of muscle-entry points ranged from 1 to 4 (mean 2.7). The locations of the muscle-entry points for all specimens were widespread ranging from 50 mm proximal and 40 mm distal to the lateral epicondyle with an average at 6 mm proximal to the lateral epicondyle. The greatest distance between muscle-entry points was 50 mm in a single specimen. In surgical procedures involving dissection of the brachioradialis muscle more proximal than 50 mm distal to the elbow, the extramuscular branch(es) of the radial nerve branches to the brachioradialis may be at risk.