Annals of Rehabilitation Medicine

Pain & Musculoskeletal rehabilitation

Ultrasonographic Identification of the High-Risk Zone for Medial Antebrachial Cutaneous Nerve Injury in the Elbow: Jeong Min Kim, Byungjun Kim, Joon Shik Yoon; Ann Rehabil Med 2022;46(4):185-191. Published online August 31, 2022; DOI: https://doi.org/10.5535/arm.22071

Abstract
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Objective
To demonstrate the sonoanatomy of the medial antebrachial cutaneous nerve (MACN) in the elbow region using high-resolution ultrasonography (HRUS) to identify areas at a high risk of MACN injury.
Methods
A total of 44 arms were included in the study. In the supine position, the participants’ arms were abducted 45° with the elbow fully extended. The MACN was visualized in the transverse view. The anterior branch of the MACN (ABMACN), posterior branch of the MACN (PBMACN), and location of the branching sites were determined. The distance between the ABMACN and superficial veins, including the basilic vein (BV) and median cubital veins (MCV) was measured. For the PBMACN, the distance to the ulnar nerve (UN) and to BV were measured.
Results
The MACN was subdivided into 2.18±1.00 branches, including ABMACN and PBMACN. The ABMACN and PBMACN were subdivided into 1.60±0.78 and 1.07±0.25 branches, respectively. The branching point of the MACN was 8.40±2.42 cm proximal to the interepicondylar line (IEL). We demonstrated that the ABMACN is located close to the BV and MCV in the elbow region, and the PBMACN was located approximately 1 cm and 0.8 cm anterior to the UN and posterior to the BV at the IEL level, respectively.
Conclusion
Considering the location of the MACN, including ABMACN and PBMACN, clinicians can perform invasive procedures around the elbow region more carefully to lower the risk of MACN injury.

Citations

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Ultrasound‐Guided Peripheral Nerve Blocks for Percutaneous Treatments of Common Tendinopathies
Tomás Ribeiro‐da‐Silva, Robert D. Pagan Rosado, Wesley Troyer, Matthew A. Cascio, Eva Kubrova, Sebastian Encalada, Nuno Ferreira‐Silva, Mark Friedrich B. Hurdle
Journal of Ultrasound in Medicine.2026;[Epub] CrossRef
US-guided Perineural Injections of the Upper Extremity from the Arm to the Wrist
Tanya L. Tivorsak, George R. Matcuk, Nathaniel W. Mizraki, Mitchel Seruya, Joseph C. Giaconi
RadioGraphics.2026;[Epub] CrossRef
Ultrasonographic differential diagnosis of medial elbow pain
Min Jeong Cho, Jee Won Chai, Dong Hyun Kim, Hyo Jin Kim, Jiwoon Seo
Ultrasonography.2024; 43(5): 299. CrossRef

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Determination of an Ideal Stimulation Site of the Medial Antebrachial Cutaneous Nerve Using Ultrasound and Investigation of the Efficiency: Chang Hoon Oh, Nam Su Park, Jae Min Kim, Min Wook Kim; Ann Rehabil Med 2014;38(6):836-842. Published online December 24, 2014; DOI: https://doi.org/10.5535/arm.2014.38.6.836

Abstract
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Objective

To determine an ideal stimulation site of the medial antebrachial cutaneous nerve (MACN) using ultrasound measurement and to compare the efficiency of the new stimulation site with the conventional stimulation site on the nerve conduction study.

Methods

Both arms of 15 healthy participants were measured using ultrasound. The MACN was identified in the transverse view at each 0, 2, 4, 6, and 8 cm proximal sites from the medial epicondyle, and the distances to the median nerve and to the skin from the MACN were measured. The ideal stimulation site should be located at the level which can give the shortest distance from the skin and the longest distance from the median nerve in terms of volume conduction. To confirm the efficiency of the ideal site, we measured the amplitude of the MACN conduction study at the ideal site against one at the 4 cm proximal to the medial epicondyle (conventional site).

Results

The ultrasound showed the ideal stimulation site for the MACN could be the elbow crease line. However, the nerve conduction study revealed that the amplitudes of the MACN were significantly larger at the 4 cm proximal to the medial epicondyle compared with ones at the ideal site.

Conclusion

The ideal stimulation site based on the ultrasound did not permit better stimulation site for the nerve conduction study of the MACN compared with the conventional site. Careful adjustment of the stimulation site on the basis of this study would contribute to an accurate conduction study of the MACN.

Citations

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Comparison of Proximal and Distal Techniques for the Medial Antebrachial Cutaneous Sensory Nerve Conduction Study
Devon I. Rubin, Christopher J. Lamb
Journal of Clinical Neurophysiology.2022; 39(5): 397. CrossRef
Use of Electroneuromyography in the Diagnosis of Neurogenic Thoracic Outlet Syndrome: A Systematic Review and Meta-Analysis
Pauline Daley, Germain Pomares, Raphael Gross, Pierre Menu, Marc Dauty, Alban Fouasson-Chailloux
Journal of Clinical Medicine.2022; 11(17): 5206. CrossRef
Ultrasonographic Identification of the High-Risk Zone for Medial Antebrachial Cutaneous Nerve Injury in the Elbow
Jeong Min Kim, Byungjun Kim, Joon Shik Yoon
Annals of Rehabilitation Medicine.2022; 46(4): 185. CrossRef
Thoracic radiculopathy as initial symptoms of hepatocellular carcinoma
Yongmin Kim, Sooa Kim, Kiyoung Oh, Yuntae Kim
Medicine.2018; 97(30): e11635. CrossRef
Optimal Radial Motor Nerve Conduction Study Using Ultrasound in Healthy Adults
Jungho Yeo, Yuntae Kim, Sooa Kim, Kiyoung Oh, Hyungdong Kang
Annals of Rehabilitation Medicine.2017; 41(2): 290. CrossRef
Origin and antimeric distribution of brachial plexus nerves in Macaca mulatta (Zimmermann, 1780) (Primates: Cercopithecidae)
C. A. Santos-Sousa, M. S. Gomes, N. Da Cruz De Carvalho, P. Souza-Junior, C. Machado Dos Santos, M. Abidu-Figueiredo
Italian Journal of Zoology.2016; 83(4): 469. CrossRef

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7 Web of Science
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Anatomical Considerations of Lateral and Medial Antebrachial Cutaneous Nerves.: Sin, Joo Yong , Kim, Dong Hwee , Bun, Hye Ryoung , Hwang, Mi Ryoung , Kang, Yoon Kyoo , Kwon, Hee Kyu , Lee, Hang Jae; J Korean Acad Rehabil Med 2007;31(3):329-332.

Abstract
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Objective
To evaluate the anatomic course of the lateral antebrachial cutaneous nerve (LABCN) and medial antebrachial cutaneous nerve (MABCN) in the forearm. Method: We dissected 29 upper extremities of 16 cadavers for LABCN and 20 upper extremities of 15 cadavers for the MABCN. We measured the distance (BT_L) between the biceps tendon (BT) and LABCN on the intercondylar line. The BT is the point at which biceps tendon crosses intercondylar line. The distance (L12) between LABCN and the point of 12 cm distal to BT on the line between BT and radial artery at wrist was measured. The distance (ME_M) between MABCN and medial epicondyle on the intercondylar line was measured. M8 and M10 are the distances between MABCN and the points 8 cm and 10 cm distal to BT on the line from BT to mid-point of flexor carpi radialis and palmaris longus at the wrist respectively. Results: BT_L and L12 were 1.4±3.7 mm and 4.4±3.7 mm respectively. ME_M, M8 and M10 were 28.6±6.9 mm, 18.9±8.9 mm and 18.3±8.2 mm respectively. The thickness of LABCN and MABCN was 19.1±4.9 mm and 13.2±4.2 mm respectively. Conclusion: The LABCN was emerge just lateral to biceps tendon at the elbow and ran down to radial artery. The anatomic course of MABCN was variable at the elbow and forearm. (J Korean Acad Rehab Med 2007; 31: 329-332)