Innervation of the Lateral Humeral Epicondyle

ABSTRACT

Innervation of the wrist and knee have been well described and have led to surgical approaches to treat pain in these joints when other approaches have failed or when the pain is of neural origin. In 1962, Wilhem described the innervation of the lateral elbow, but his line drawings of the innervation did not permit adoption of a plan for surgical intervention that has been uniformly accepted.

Ten fresh-frozen arms were dissected using 4.0 loupe magnification to identify lateral humeral epicondyle innervation. A consistent lateral epicondyle innervation was identified from the posterior cutaneous nerve of the forearm. The nerve originates at the posterolateral midhumeral level from the radial nerve. Along its path, it branches approximately 5-8 cm above the lateral epicondyle into anterior and posterior branches. The anterior branch continues towards posterolateral forearm skin, while the posterior branch provides innervation to the lateral epicondyle. In one specimen, the nerve branched distal to the elbow, therefore the epicondyle was innervated with a branch from this main trunk. Another source of innervation of this joint is a branch from the motor branch to the brachioradialis. This would require intraoperative nerve stimulation to identify the patient, and could not be reliably identified on cadaver dissection from among the many branches that go the brachioradialis muscle.

The uniform innervation of the lateral humeral epicondyle from branches of the posterior cutaneous nerve of the forearm and the radial nerve at its motor innervation of the brachioradialis allow design of a surgical approach that permits denervation of this joint.