Localizing the Posterior Interosseous Nerve with Anatomic Landmarks During Surgical Approaches of the Lateral Elbow

Author(s): Gary Ulrich MD and Srinath Kamineni MD

The Posterior Interosseous Nerve (PIN) represents a critical neurovascular structure within the surgical field of the lateral approaches to the elbow. The PIN innervates the extensor muscles of the forearm, while also sending sensory fibers to the dorsal wrist capsule, and iatrogenic injury during surgical exposure can compromise these functions. Thus, a thorough understanding of how to localize the PIN with anatomic landmarks is needed to best avoid this complication. The literature describes utilizing the radiocapitellar joint, radial tuberosity, lateral epicondyle, and the transepicondylar distance to localize the PIN. Moreover, pronation relocates the PIN to more distal position due to tethering within the supinator muscle, and this protects the nerve regarding surgical work in the lateral elbow vicinity, such as on the radial head and neck. In this review, we report the literature describing the strategies to localize the PIN from anatomic landmarks with respect to surgical approaches of the lateral elbow.