Lateral Antebrachial Cutaneous Nerve Injury, Anatomy, Pain, Origin, Surgery

Lateral Antebrachial Cutaneous Nerve Injury, Anatomy, Pain, Origin, Surgery

Lateral Antebrachial Cutaneous Nerve Injury

Lateral or radial forearm sensation is provided by this lateral antebrachial cutaneous nerve. Compression of the Lateral Antebrachial Cutaneous Nerve (LABC) is an uncommon but debilitating injury. Numbness or neuropathic discomfort across the elbow and the lateral portion of the forearm is the most prevalent manifestation of this condition. Patients usually have a history of elbow injury or overuse from sports like weightlifting and tennis that involve elbow extension and maximal pronation. 

Narasanagi initially diagnosed the condition, and Bassett and Nunley later characterized the pathologic mechanism in which the nerve is crushed by the biceps aponeurosis and tendon against the brachialis muscle fascia. The relationship between proximal biceps rupture and LABC nerve compression is unclear.

Injury to the LABC nerve can also occur as a result of phlebotomy, windsurfing, handbag compression, slam-dunking a basketball, or posture when under general anesthesia. 

Lateral Antebrachial Cutaneous Nerve Anatomy

LACN serves as a sensory nerve for the lateral side of the forearm. It penetrates the deep fascia laterally to the biceps tendon and passes far behind the cephalic vein. It splits into dorsal and volar branches at the elbow. It is an extension of the musculocutaneous nerve after it gives off muscular branches to the brachialis muscles and the biceps brachii. It is capable of being damaged by surgery and cubital fossa venipuncture.

Lateral Antebrachial Cutaneous Nerve Pain

One of the less prevalent causes of elbow pain among throwers is lateral antebrachial cutaneous neuropathy, which is often easily ignored because of its rarity. The biceps tendon compresses this lateral antebrachial cutaneous nerve at the place where it emerges from the brachial fascia, which is close to the flexion crease of the elbow. 

Symptoms of this compression or injury in the Lateral Aterbrachial cutaneous nerve mostly consist of pain in the front of the elbow and burning sensations in the side of the forearm, particularly after one’s forearm is fully pronated and the elbow is fully stretched. 

At first, patients are treated with nonsteroidal anti-inflammatory drugs, rest, a change in their activities, and an extension block device. If nonoperative treatment fails, local anesthetic nerve decompression relieves pain and restores full activity.

Lateral Antebrachial Cutaneous Nerve Origin

The distal arm’s musculocutaneous nerve is the origin point of the lateral cutaneous nerve. It subsequently pierces the brachial fascia and enters subcutaneous about two to five centimeters proximal to the elbow flexion crease from beneath the biceps’ lateral border. It now goes behind the cephalic vein and splits into volar and dorsal branches, supplying sensations to both the radial dorsal and the radial volar ends of the forearm.

Lateral Antebrachial Cutaneous Nerve Surgery

Surgery to repair a damaged nerve entails locating the nerve’s affected area and excising the damaged tissue or scarring from the nerve’s endings. After that, if the nerve ends are long enough, a direct reconnection can be made with minimal tension.

Lateral antebrachial cutaneous nerve compression is usually treated by immobilizing the elbow at an angle of 90° and giving nonsteroidal anti-inflammatory drugs or infiltrations of corticosteroids and local anesthetics for about three months. Usually surgical release is performed four to eight months following the initial diagnosis if non-operative treatment is ineffective at alleviating symptoms. 

A longitudinal or transverse incision is made at the location of peak tenderness about two to four centimeters above the elbow crease to liberate the nerve from the fixing deep fascia and partially excise the biceps aponeurosis. Patients who appear with paresthesia frequently require surgical surgery because paresthesia signals a more advanced degree of nerve entrapment.

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