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Dynamic rotational alteration in positional relationship of neurovascular structures and distal biceps tendon insertion: a cadaveric study
  1. Deepak Bhatia1,2,
  2. Rajib Naskar3,
  3. Pascal DeNiese3
  1. 1 Shoulder and Upper Limb Surgery, Sportsmed Mumbai, Mumbai, India
  2. 2 Orthopaedic Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
  3. 3 Sportsmed Mumbai, Mumbai, India
  1. Correspondence to Dr Deepak Bhatia; shoulderclinic{at}


Objectives This study analysed the change in positional relationship of major neurovascular (NV) structures with the distal biceps tendon (DBT) insertion with dynamic rotation.

Methods Fresh frozen cadaveric upper extremities (n=10) were dissected to expose DBT and five major NV structures (ulnar artery (UA), radial artery (RA), median nerve (MN), superficial radial nerve (SRN) and posterior interosseous nerve (PIN)). The distance between each NV structure and the DBT insertion was measured with the elbow in (a) full supination (90°), (b) neutral rotation (0°) and (c) full pronation (80°). Statistical analysis was performed to determine significant changes in rotational NV excursion in relation to DBT insertion.

Results RA and UA were in contact with DBT just distal to the bifurcation of brachial artery. RA was closest to DBT insertion in supination (5 mm), and MN (7 mm) and UA (9 mm) were further away. UA was in close proximity in neutral (4 mm) and pronated (6 mm) positions. UA moved significantly closer to DBT insertion when rotated from supination to neutral (p<0.0001) and pronated (p<0.0018) positions. RA and MN moved significantly further from DBT in these positions (p<0.05). SRN and PIN were the farthest structures from DBT insertion in supination and neutral positions.

Conclusion NV structures in the cubital fossa are in close proximity to DBT and its tuberosity insertion and dynamic rotation significantly changes their positional relation with DBT insertion.

Level of evidence Basic science study

  • ulnar artery
  • radial artery
  • distal biceps tendon
  • biceps endoscopy
  • cadaveric study
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  • JISAKOS 2019 Gary G. Poehling Award, 2nd place

  • Contributors DB: study design and planning, performed all dissections, data collection, data analysis, statistical analysis and manuscript preparation. RN: assisted all dissections, data collection, data analysis, statistical analysis. PD: assisted all dissections, data collection, data analysis and statistical analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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