A 52-year-old band director suffered problems in her right arm several days after strenuous field exercises for a major athletic tournament. Examination in the orthopedic clinic reveals wrist drop and weakness of grasp but normal extension of the elbow joint. There is no loss of sensation in the affected limb. Which nerve was most likely affected?
The radial nerve descends posteriorly between the long and lateral heads of the triceps and passes inferolaterally on the back of the humerus between the medial and lateral heads of the triceps. It eventually enters the anterior compartment and descends to enter the cubital fossa, where it divides into superficial and deep branches. The deep branch of the radial nerve winds laterally around the radius and runs between the two heads of the supinator and continues as the posterior interosseous nerve, innervating extensor muscles of the forearm. Because this injury does not result in loss of sensation over the skin of the upper limb, it is likely that the superficial branch of the radial nerve is not injured. If the radial nerve were injured very proximally, the woman would not have extension of her elbow. The branches of the radial nerve to the triceps arise proximal to where the nerve runs in the spiral groove. The anterior interosseous nerve arises from the median nerve and supplies the flexor digitorum profundus, flexor pollicis longus, and pronator quadratus, none of which seem to be injured in this example. Injury to the median nerve causes a characteristic flattening (atrophy) of the thenar eminence.
Ulnar
Anterior interosseous
Posterior interosseous
Median
Upper Extremity