Radial Nerve Branches to the Triceps Brachii: Cadaveric Analysis and Surgical Implications for Neurotization

Radial Nerve Branches to the Triceps Brachii: Cadaveric Analysis and Surgical Implications for Neurotization | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Radial Nerve Branches to the Triceps Brachii: Cadaveric Analysis and Surgical Implications for Neurotization Marc Mombellet, Christophe Destrieux, Guillaume Bacle This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7349920/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Mar, 2026 Read the published version in Surgical and Radiologic Anatomy → Version 1 posted 9 You are reading this latest preprint version Abstract Purpose: The radial nerve, originating from C5 to C8 and occasionally T1, is one of the two major nerves in the posterior brachial plexus bundle. Studies on the radial nerve vary regarding the number, arrangement, and emergence of its branches. This study aims to clarify the motor branch layout of the radial nerve to identify the optimal branch for neurotization. Methods: Thirty cadaveric dissections were performed using a posterior approach, spliting the triceps muscle heads. Results: Four distinct motor branches were consistently identified, all emerging before the nerve contacts the radial sulcus. Only the inferior branch to the medial head showed variability, sometimes giving additional branches to the lateral head, sensory branches, or both. Conclusion : We recommend the long head branch for neurotization due to its consistent anatomical position and reliability Level of evidence : IV Radial nerve triceps motor branches neurotization nerve transfert brachial plexus Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Mar, 2026 Read the published version in Surgical and Radiologic Anatomy → Version 1 posted Editorial decision: Revision requested 21 Oct, 2025 Reviews received at journal 14 Oct, 2025 Reviews received at journal 05 Oct, 2025 Reviewers agreed at journal 29 Sep, 2025 Reviewers agreed at journal 29 Sep, 2025 Reviewers invited by journal 29 Sep, 2025 Editor assigned by journal 12 Aug, 2025 Submission checks completed at journal 12 Aug, 2025 First submitted to journal 11 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7349920","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":526962171,"identity":"64310b49-a581-4ba7-974b-04c14d8043c1","order_by":0,"name":"Marc 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1","display":"","copyAsset":false,"role":"figure","size":128867,"visible":true,"origin":"","legend":"\u003cp\u003eEmergence ratio of radial nerve branches at the arm, expressed as a function of the length of the patient's arm (cm), in relation to the posterior acromial angle.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7349920/v1/71c56afd57e4592e3de11754.png"},{"id":93337929,"identity":"3bf9e527-67fd-4906-9df4-8587039285b6","added_by":"auto","created_at":"2025-10-12 14:14:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1512843,"visible":true,"origin":"","legend":"\u003cp\u003eFascicular aspect of the radial nerve in the left arm exposed posteriorly.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7349920/v1/064e2e9558b7d3d9618c4618.png"},{"id":93336520,"identity":"8973c641-5604-4fde-8aba-baf36e3664b0","added_by":"auto","created_at":"2025-10-12 14:06:22","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2309160,"visible":true,"origin":"","legend":"\u003cp\u003ePath of the radial nerve exposed via a posterior approach to the left arm.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7349920/v1/ec31cbdcda0be6d096c21f41.png"},{"id":93336523,"identity":"26ac6b6d-b6e8-4e60-87ed-916bebecd8f0","added_by":"auto","created_at":"2025-10-12 14:06:22","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1531942,"visible":true,"origin":"","legend":"\u003cp\u003eCommon high division of the branches of the radial nerve in the left arm into a posteromedial bundle, posterior view.\u003c/p\u003e\n\u003cp\u003eWhite arrows: posteromedial dividing bundle, black arrows: radial trunk\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7349920/v1/5a5c5964527cc64d6c04c127.png"},{"id":93336522,"identity":"1f829c43-2bf8-4599-ad9a-8480c088f968","added_by":"auto","created_at":"2025-10-12 14:06:22","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1429916,"visible":true,"origin":"","legend":"\u003cp\u003eBranch of the long head of the triceps exposed posteriorly in the left arm.\u003c/p\u003e\n\u003cp\u003eWhite arrows: branch of the long head.\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-7349920/v1/dd6dff7be513c2c1b40d3fd6.png"},{"id":93337930,"identity":"f842111a-fe60-482a-a66f-57852ace3b76","added_by":"auto","created_at":"2025-10-12 14:14:22","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1833227,"visible":true,"origin":"","legend":"\u003cp\u003eSuperomedial branch exposed in the left arm via a posterior approach.\u003c/p\u003e\n\u003cp\u003eWhite arrows: superomedial branch, black arrows: ulnar nerve.\u003c/p\u003e","description":"","filename":"Figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-7349920/v1/b26dd1fe97960d3d9c62c993.png"},{"id":93336538,"identity":"9adf6300-f729-4f95-bea6-b0885395e57e","added_by":"auto","created_at":"2025-10-12 14:06:22","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":2252535,"visible":true,"origin":"","legend":"\u003cp\u003eBranch of the lateral head, exposed to the left arm via a posterior approach.\u003c/p\u003e\n\u003cp\u003eWhite arrows: branch of the lateral head\u003c/p\u003e","description":"","filename":"Figure7.png","url":"https://assets-eu.researchsquare.com/files/rs-7349920/v1/7a054be531d3dd8f3fd96be2.png"},{"id":93336537,"identity":"30d4658d-a5db-4959-819e-e93d71e074dc","added_by":"auto","created_at":"2025-10-12 14:06:22","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":2311578,"visible":true,"origin":"","legend":"\u003cp\u003eInferomedial branch exposed posteriorly to the left arm.\u003c/p\u003e\n\u003cp\u003eWhite arrows: inferomedial branch,\u003c/p\u003e","description":"","filename":"Figure8.png","url":"https://assets-eu.researchsquare.com/files/rs-7349920/v1/e6e1ffe1218640161dca866d.png"},{"id":93336525,"identity":"33c89904-e0fa-4982-af66-d5170e37a837","added_by":"auto","created_at":"2025-10-12 14:06:22","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":2216194,"visible":true,"origin":"","legend":"\u003cp\u003eInferomedial branch with its intramuscular course to the anconeus, exposed posteriorly in the left arm.\u003c/p\u003e\n\u003cp\u003eWhite arrows: inferomedial branch, AM: anconeus muscle\u003c/p\u003e","description":"","filename":"Figure9.png","url":"https://assets-eu.researchsquare.com/files/rs-7349920/v1/367eeaec58b702312dcdaa23.png"},{"id":93336526,"identity":"e04e1a7a-a836-4991-8937-7c40d74055a8","added_by":"auto","created_at":"2025-10-12 14:06:22","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":287305,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic representation of the variants of the inferomedial branch according to the presence of additional branches.\u003c/p\u003e\n\u003cp\u003eType 1: none, Type 2: posterior forearm cutaneous branch, Type 3: additional lateral head branch, Type 4: posterior forearm cutaneous branch and additional lateral head branch, Type 5: two additional lateral head branches, Type 6: three additional lateral head branches, Type 7: two additional lateral head branches and posterior forearm cutaneous sensory branch.\u003c/p\u003e","description":"","filename":"Figure10.png","url":"https://assets-eu.researchsquare.com/files/rs-7349920/v1/3d3b8b28f3924976157c8ee8.png"},{"id":105755014,"identity":"e7718789-5b04-4d10-b2aa-b2bf90857893","added_by":"auto","created_at":"2026-03-30 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Neurotization","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"surgical-and-radiologic-anatomy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sara","sideBox":"Learn more about [Surgical and Radiologic Anatomy](http://link.springer.com/journal/276)","snPcode":"276","submissionUrl":"https://submission.nature.com/new-submission/276/3","title":"Surgical and Radiologic Anatomy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Radial nerve, triceps motor branches, neurotization, nerve transfert, brachial plexus","lastPublishedDoi":"10.21203/rs.3.rs-7349920/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7349920/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e The radial nerve, originating from C5 to C8 and occasionally T1, is one of the two major nerves in the posterior brachial plexus bundle. Studies on the radial nerve vary regarding the number, arrangement, and emergence of its branches. This study aims to clarify the motor branch layout of the radial nerve to identify the optimal branch for neurotization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Thirty cadaveric dissections were performed using a posterior approach, spliting the triceps muscle heads.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Four distinct motor branches were consistently identified, all emerging before the nerve contacts the radial sulcus. Only the inferior branch to the medial head showed variability, sometimes giving additional branches to the lateral head, sensory branches, or both.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: We recommend the long head branch for neurotization due to its consistent anatomical position and reliability\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of evidence\u003c/strong\u003e: IV\u003c/p\u003e","manuscriptTitle":"Radial Nerve Branches to the Triceps Brachii: Cadaveric Analysis and Surgical Implications for Neurotization","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-12 14:06:17","doi":"10.21203/rs.3.rs-7349920/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-21T11:11:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-14T05:03:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-05T19:37:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"226516561787236998361400398522088419537","date":"2025-09-29T16:26:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"47987789004005728496820724696569405026","date":"2025-09-29T10:49:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-29T08:13:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-12T05:35:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-12T04:19:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Surgical and Radiologic Anatomy","date":"2025-08-11T23:05:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"surgical-and-radiologic-anatomy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sara","sideBox":"Learn more about [Surgical and Radiologic Anatomy](http://link.springer.com/journal/276)","snPcode":"276","submissionUrl":"https://submission.nature.com/new-submission/276/3","title":"Surgical and Radiologic Anatomy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"dd6de58e-a715-415d-9847-02e126e96a4a","owner":[],"postedDate":"October 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:19:21+00:00","versionOfRecord":{"articleIdentity":"rs-7349920","link":"https://doi.org/10.1007/s00276-026-03855-5","journal":{"identity":"surgical-and-radiologic-anatomy","isVorOnly":false,"title":"Surgical and Radiologic Anatomy"},"publishedOn":"2026-03-24 16:11:39","publishedOnDateReadable":"March 24th, 2026"},"versionCreatedAt":"2025-10-12 14:06:17","video":"","vorDoi":"10.1007/s00276-026-03855-5","vorDoiUrl":"https://doi.org/10.1007/s00276-026-03855-5","workflowStages":[]},"version":"v1","identity":"rs-7349920","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7349920","identity":"rs-7349920","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}