Innervation of the supinator muscle and its relationship to two-incision distal biceps tendon repair: an anatomic study.

Reinsertion of the ruptured distal biceps tendon has been performed using either a single-anterior incision or a two-incision approach. A systematic review of these two repair methods has identified a higher incidence of supination weakness following the two-incision approach. The objective of this study was to describe the innervation of the supinator muscle and its implications regarding a two-incision distal biceps repair. Twelve fresh upper extremity specimens from 12 males were dissected with the forearm in full pronation. The number of branches of the posterior interosseous nerve (PIN) to the supinator, their site of exit from the PIN trunk, and their distance from a variety of known anatomic landmarks were recorded. Specimens were characterized as high (<5 mm), moderate (6-10 mm), or low (>10 mm) risk of nerve branch injury depending on the proximity of nerve branches to the bicipital tuberosity. In general, we found the innervation of the supinator to be highly variable. There were from two to nine branches of the PIN which supplied the supinator, with 0-3 arising from the ulnar side of the nerve. Four specimens were at low, five at moderate, and three at high risk of nerve branch injury during dorsal exposure of the bicipital tuberosity. We conclude that there is a substantial amount of variability in the innervation of the supinator, with certain patterns being at higher risk of nerve branch injury if dissection of the supinator is carried out over the bicipital tuberosity. 2010 Wiley-Liss, Inc.