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Nerves (Anatomy)

Elbow nerve anatomy: radial, median, ulnar & musculocutaneous – critical for surgical approach & fracture management injury prevention.

41 citationsUpdated Oct 2026
Illustration: Nerves (Anatomy)

Overview

The brachial plexus is anatomically conceptualized as a network beginning with five nerves and terminating in five nerves [4]. Accurate treatment of brachial plexus lesions requires a clear understanding of this anatomy and its variations, alongside adequate exposure and delineation of pathology [6]. While the radial nerve exhibits significant variety in its course through the distal upper arm [2], the majority of innervation to the anterior capsule derives from the radial and musculocutaneous nerves, with minimal contribution from the median nerve [1]. Awareness of this neuroanatomical distribution allows for the preservation of joint capsule receptors during surgical procedures for elbow pathology [25].

Individual nerve anatomy presents specific surgical considerations. Variations in musculocutaneous nerve anatomy are common, and even unreported variations can be encountered [7]. The anatomic branch pattern of the axillary nerve is useful for identifying branches and has implications for surgeries related to selective innervation [5]. Ulnar nerve anatomy is complex, featuring numerous variations and potential compression sites including the arcade of Struthers, medial intermuscular septum, and cubital tunnel [12]. Knowledge of ulnar nerve anatomy and its variations is necessary to prevent iatrogenic injury to the nerve and its aberrant branches during ulnar nerve release at the elbow [16]. Additionally, an understanding of the anatomy of the Guyon canal is essential for diagnosis in patients presenting with motor and/or sensory deficits in the hand [44].

Functional assessment relies on specific nerve contributions: the median nerve creates the “rock position” of the pronated fist, the radial nerve extends the wrist and hand forming the “paper position”, and the ulnar nerve creates the “scissor position” [17]. Most nerve lesions sustained by athletes are best described as neuropraxias, which is the mildest form of nerve injury denoting a conduction block where all nerve elements remain in continuity [19]. Magnetic resonance neurography provides anatomical correlation and pinpoints nerve pathology, thereby enhancing diagnostic confidence and guiding appropriate treatment planning [3].

Osseous Anatomy

In growing children, the positions of the radial and axillary nerves maintain linear relationships with arm lengths [18]. Consequently, the locations of these nerves in relation to palpable osseous landmarks are predictable [18]. An anatomic variation involving a bony canal for the median nerve at the distal humerus has been reported [21].

Ligaments and Joint Capsule

The anterior capsule of the elbow joint receives the majority of its innervation from the radial and musculocutaneous nerves [1]. In contrast, the median nerve provides only a minimal contribution to the sensory supply of this region [1]. Surgeons should recognize that awareness of this specific neuroanatomical distribution of receptors within the joint capsule may allow for their preservation during surgical procedures for elbow joint pathology [25].

Muscles and Tendons

The musculocutaneous nerve or its twigs demonstrates consistent anatomical proximity to the coracoid process, with entry points located within 5 cm below the coracoid process in 91.7% of specimens [20]. Within the nerve itself, fasciculi groups maintain a constant lateral-to-medial arrangement, comprising the nerve to the biceps, the nerve to the brachialis, and the lateral cutaneous nerve of the forearm [40].

Surgical planning must account for variable relationships between neural structures and tendons. Specifically, the lateral antebrachial cutaneous nerve crossed over the biceps tendon in 50% of specimens [14]. This variability necessitates careful dissection to avoid iatrogenic injury during procedures involving the anterior elbow compartment.

Reconstructive options for the annular ligament of the elbow include the use of a distally based tendon graft. Reconstruction using the tendon of the superficial head of the brachialis muscle is feasible in most patients [41].

Neurovascular Anatomy

Brachial Plexus

Radial Nerve: The radial nerve extends the wrist and hand, forming the “paper position” [17].

Median Nerve: The median nerve creates the “rock position” of the pronated fist [17]. An anatomic variation involving a bony canal for the median nerve at the distal humerus was related strongly to a patient’s median nerve palsy [21]. The intraneural fascicular groups of the median nerve are identifiable for variable distances in the distal forearm, providing an anatomical basis for microsurgical group fascicular repair and nerve-grafting [13].

Ulnar Nerve: The ulnar nerve creates the “scissor position” [17]. The intraneural fascicular groups of the ulnar nerve are identifiable for variable distances in the distal forearm, providing an anatomical basis for microsurgical group fascicular repair and nerve-grafting [13]. The inferior ulnar collateral artery provided the only direct vascularization to the nerve in the region just proximal to the cubital tunnel [32]. The extrinsic vascular supply can be preserved during anterior transposition of the ulnar nerve, even after extensive mobilization of the nerve [9].

Axillary Nerve: The anatomic branch pattern of the axillary nerve is useful for identifying each of the branches and has implications for surgeries related with selective innervation [5].

Vascular Anatomy and Grafting

Vascularised nerve grafts have limited applications because there are few potential donor sites and a high rate of thrombosis, particularly in digital nerves and poor tissue beds [34].

Biomechanics and Function

The anterior elbow capsule receives the majority of its innervation from the radial and musculocutaneous nerves [1], while the median nerve provides a minimal contribution to this specific region [1]. The course of the radial nerve in the distal upper arm exhibits significant anatomical variety [2]. In the cubital tunnel, maximum strains in the ulnar nerve occur at maximum elbow flexion and directly behind the medial epicondyle [36]. A wide range of maximal strains, from 0% to 14%, has been documented in the ulnar nerve at the elbow [36]. High-resolution sonography clearly demonstrates the morphology and dynamics of the ulnar nerve within this tunnel [37].

Diagnostic Imaging: Magnetic resonance neurography provides anatomical correlation and pinpoints nerve pathology to enhance diagnostic confidence and guide treatment planning [3].

Surgical Risks and Nerve Protection: The median nerve is a structure at risk during elbow arthroscopy of the antero-medial compartment [8]. Initial inflation of the elbow prior to arthroscope introduction leads to a minimal extent of transpositioning of anteriorly positioned nerves at risk [26]. During a lateral approach, dissection without formal identification of the posterior interosseous nerve should be limited to 4.0 cm from the radiocapitellar joint [28]. Pronation does not reliably increase the distance of the posterior interosseous nerve to the radiocapitellar joint [28]. Guidewire-inflicted injury to the posterior interosseous nerve is unlikely during the anterior single-incision approach based on distances between the entering guidewire trajectory and the nerve [15].

Iatrogenic and External Injury: Nerve injury occurred at a significantly higher rate for subpectoral techniques during long head of the biceps tenodesis [22]. All nerve function recovered following nerve injury associated with this procedure [22]. Local pressure exerted by a below-elbow cast is a cause of median and radial nerve injury after coronary bypass surgery [43]. Peripheral fluid retention in the perioperative period may exacerbate nerve deficits caused by cast pressure [43]. Higher levels of pneumatic tourniquet inflation may create deleterious shear forces applied to the nerves due to pressure gradients between areas under the edges and midpoint of the cuff [10].

Repair and Grafting Considerations: The extrinsic vascular supply of the ulnar nerve can be preserved during anterior transposition, even after extensive mobilization of the nerve [9]. An autogenous vein graft with a smooth inner surface improves the gliding of the nerve trunk during joint motion, decreasing gliding friction [38]. Tension at the suture site is identified as the most important factor influencing repair results in interfascicular nerve-grafting [42].

Common Sites of Injury

Elbow

The anterior capsule of the elbow receives the majority of its innervation from the radial and musculocutaneous nerves, with minimal contribution from the median nerve [1]. Simple intra-articularly accessible anatomical landmarks at the elbow serve as safe guides for avoiding radial nerve injury [11]. A nerve located within the medial intermuscular septum, just proximal to the medial humeral epicondyle, can be injured by direct or repetitive trauma [23]. In a series of 21 patients with acute nerve injury as a complication of closed fractures or dislocations of the elbow, 9 patients still had evidence of nerve damage [30]. Of the 9 patients with persistent nerve damage in this series, 6 had ulnar nerve lesions, 2 had median nerve lesions, and 1 had a radial nerve lesion [30]. Nerve injury occurred at a significantly higher rate for subpectoral techniques during long head of the biceps tenodesis, but all nerve function recovered [22].

Forearm and Wrist

The intraneural fascicular groups of the ulnar and median nerves are identifiable for variable distances in the distal forearm, providing an anatomical basis for microsurgical group fascicular repair and nerve-grafting [13]. The distances between the entering guidewire trajectory and the posterior interosseous nerve indicate that guidewire-inflicted injury to the nerve is unlikely during the anterior single-incision approach [15].

General and Mechanisms

At higher levels of inflation, the pressure gradient between areas under the edges and midpoint of a pneumatic tourniquet cuff may result in the creation of deleterious shear forces applied to the nerves [10]. Peripheral nerve injuries account for less than 0.5% of all sports-related injuries, with the majority of conditions responding well to nonsurgical care [29].

Surgical Anatomy

Musculocutaneous Nerve

The previously described safe zone of 5 cm below the coracoid process may not be reliable to protect the musculocutaneous nerve or its twigs, as 91.7% of specimens had nerve entry points within this distance when twigs were accounted for [20]. Accurate anatomic localization of the lateral antebrachial cutaneous nerve is of interest to surgeons and anesthesiologists for supplementing failed axillary blockade, diagnosing and treating musculocutaneous impingement syndrome, and differentiating sensory distributions [33].

Ulnar Nerve

Knowledge of possible compression sites of the ulnar nerve is important to the surgeon so that complications are avoided and postoperative recurrence is decreased [24].

Radial Nerve

Simple intra-articularly accessible anatomical landmarks are safe guides for avoiding radial nerve injury [11].

Posterior Interosseous Nerve

The distances between the entering guidewire trajectory and the posterior interosseous nerve show that guidewire-inflicted injury to the nerve is unlikely during the anterior single-incision approach [15]. Care should be taken to ensure the posterior interosseous nerve is not within the surgical window even when the forearm is pronated [31].

General Nerve Considerations

At higher levels of inflation, the pressure gradient between areas under the edges and midpoint of the cuff may result in the creation of deleterious shear forces applied to the nerves [10].

Key Evidence

  • [L5] The majority of the innervation of the anterior capsule comes from the radial and musculocutaneous nerves with minimal contribution from the median nerve. [1] (10.1016/j.jhsa.2015.10.012)
  • [L5] The course of the radial nerve in the distal part of the upper arm has great variety. [2] (10.1371/journal.pone.0186890)
  • [Paper] Its main benefit is providing anatomical correlation and pinpointing nerve pathology, thereby enhancing diagnostic confidence and guiding appropriate treatment planning. [3] (10.1177/23259671251400763)
  • [L5] The brachial plexus may be visualized simply as beginning with five nerves and terminating in five nerves. [4] (10.1016/s0749-0712(03)00088-x)
  • [L5] The findings are useful for identifying each of the branches of the axillary nerve and have implications for surgeries related with selective innervation. [5] (10.1016/j.jse.2006.05.003)
  • [L5] A clear understanding of the anatomy of the brachial plexus and its variations, along with adequate exposure and delineation of pathology, is essential for accurate treatment of brachial plexus lesions. [6] (10.1016/j.hcl.2004.09.006)
  • [L4] Variations in musculocutaneous nerve anatomy are quite common, and even unreported variations can be encountered. [7] (10.1016/j.jhsa.2022.07.014)
  • [L5] The median nerve is a structure at risk when performing elbow arthroscopy of the antero-medial compartment. [8] (10.1016/j.arthro.2019.11.082)
  • [L5] On the basis of these anatomic dissections, it is suggested that the extrinsic vascular supply can be preserved during anterior transposition of the ulnar nerve, even after extensive mobilization of the nerve. [9] (10.1016/0363-5023(93)90086-i)
  • [Paper] At higher levels of inflation the pressure gradient between areas under the edges and midpoint of the cuff may result in the creation of deleterious shear forces applied to the nerves. [10] (10.1016/0266-7681(92)90111-e)
  • [L5] These simple intra-articularly accessible anatomical landmarks are safe guides for avoiding radial nerve injury. [11] (10.1016/j.arthro.2019.11.081)
  • [L5] The ulnar nerve anatomy is complex with numerous variations and potential compression sites, including the arcade of Struthers, medial intermuscular septum, and cubital tunnel. [12] (10.1016/j.hcl.2007.05.001)
  • [L5] The intraneural fascicular groups of the ulnar and median nerves are identifiable for variable distances in the distal forearm, providing an anatomical basis for microsurgical group fascicular repair and nerve-grafting. [13] (10.2106/00004623-198668020-00013)
  • [L5] The nerve crossed over the biceps tendon in 50% of the specimens. [14] (10.1016/j.jhsa.2024.04.018)
  • [L4] The distances between the entering guidewire trajectory and PIN show that guidewire-inflicted injury to the nerve is unlikely during the anterior single-incision approach. [15] (10.1177/0363546521992120)
  • [L4] A good knowledge of anatomy of ulnar nerve and its variations is necessary to prevent iatrogenic injury to this nerve and its aberrant branches during ulnar nerve release at the elbow. [16] (10.1016/j.jse.2008.07.015)
  • [L4] The median nerve creates the “rock position” of the pronated fist, the radial nerve extends the wrist and hand forming the “paper position”, and the ulnar nerve creates the “scissor position”. [17] (10.1016/s0020-1383(02)00102-x)
  • [L4] The positions of the radial and axillary nerves maintain linear relationships with arm lengths in growing children, and their locations in relation to palpable osseous landmarks are predictable. [18] (10.2106/jbjs.19.00019)
  • [L5] Most nerve lesions sustained by athletes are best described as neuropraxias, which is the mildest form of nerve injury denoting a conduction block where all nerve elements remain in continuity. [19] (10.1016/s0278-5919(05)70256-8)
  • [L5] The previously described safe zone of 5 cm below the coracoid process may not be reliable to protect the musculocutaneous nerve or its twigs, as 91.7% of specimens had nerve entry points within this distance when twigs were accounted for. [20] (10.1177/2325967120954417)
  • [L5] We suggest that this anatomic variation was related strongly to this patient’s median nerve palsy. [21] (10.1016/j.jhsa.2004.05.018)
  • [L3] Nerve injury occurred at a significantly higher rate for subpectoral techniques, but all nerve function recovered. [22] (10.1177/2325967117s00397)
  • [L5] The nerve located within the medial intermuscular septum, just proximal to the medial humeral epicondyle, can be injured, either by direct or repetitive trauma. [23] (10.1016/j.jhsb.2005.12.014)
  • [L5] Knowledge of possible compression sites of the ulnar nerve is important to the surgeon so that complications are avoided and postoperative recurrence is decreased. [24] (10.1016/j.jse.2009.03.004)
  • [L5] Awareness of the neuroanatomical distribution of the receptors in the elbow joint capsule may allow their preservation during surgical procedures for elbow joint pathology. [25] (10.1177/1758573218760245)
  • [L5] Current inflation of the elbow initial to introduction of the arthroscope merely leads to a minimal extent of the desired transpositioning of anteriorly positioned nerves at risk. [26] (10.1016/s1058-2746(95)80170-7)
  • [L5] The authors recommend limiting dissection to 4.0 cm from the radiocapitellar joint during a lateral approach without formal identification of the posterior interosseous nerve, regardless of forearm rotation, as pronation does not reliably increase the distance of the nerve to the joint. [28] (10.1016/j.jse.2006.09.004)
  • [Paper] Peripheral nerve injuries account for less than 0.5% of all sports-related injuries, with the majority of conditions responding well to nonsurgical care. [29] (10.1016/j.csm.2020.02.006)
  • [L4] In our series, 9 out of 21 patients we examined still had evidence of nerve damage, 6 patients having ulnar nerve lesions, 2 patients median nerve lesions and 1 patient a radial nerve lesion. [30] (10.1016/s0020-1383(79)80015-7)
  • [L3] Care should be taken to ensure the nerve is not within the surgical window even when the forearm is pronated. [31] (10.5397/cise.2024.00213)
  • [L5] The inferior ulnar collateral artery provided the only direct vascularization to the nerve in the region just proximal to the cubital tunnel. [32] (10.1016/s1058-2746(99)90048-4)
  • [L4] The accurate anatomic localization of this nerve is of interest to surgeons and anesthesiologists for supplementing failed axillary blockade, diagnosing and treating musculocutaneous impingement syndrome, and differentiating sensory distributions. [33] (10.1016/s0363-5023(87)80050-3)
  • [L4] Vascularised nerve grafts have limited applications because there are few potential donor sites and a high rate of thrombosis, particularly in digital nerves and poor tissue beds. [34] (10.1016/0266-7681(91)90099-a)
  • [L5] Maximum strains in the ulnar nerve occurred at maximum elbow flexion and directly behind the medial epicondyle, with a wide range of maximal strains (0% to 14%) found. [36] (10.1016/s0363-5023(98)80005-1)
  • [L4] High-resolution sonography can clearly demonstrate the morphology and dynamics of the ulnar nerve in the cubital tunnel. [37] (10.1054/jhsb.1999.0317)
  • [L5] In addition, the autogenous vein graft with its smooth inner surface should improve the gliding of the nerve trunk during motion of the joint, decreasing gliding friction. [38] (10.1053/jhsu.2001.21536)
  • [L5] Serial sectioning showed that the groups of fasciculi of the nerve to the biceps, the nerve to the brachialis, and the lateral cutaneous nerve of the forearm were constantly located laterally to medially. [40] (10.1016/s0363-5023(98)80122-6)
  • [L5] A distally based tendon graft reconstruction of the annular ligament of the elbow using the tendon of the superficial head of the brachialis muscle would be feasible in most patients, based on this anatomic study. [41] (10.1016/j.jhsa.2013.04.008)
  • [L4] The paper describes a microsurgical technique for interfascicular nerve-grafting that avoids tension at the suture site, which is identified as the most important factor influencing repair results. [42] (10.2106/00004623-197254040-00004)
  • [L5] Investigations clearly suggest that the cause of the nerve deficit was the local pressure exerted by the cast, potentially exacerbated by peripheral fluid retention in the perioperative period. [43] (10.1016/s0020-1383(00)00106-6)
  • [L5] An understanding of the anatomy of the Guyon canal is essential for diagnosis in patients presenting with motor and/or sensory deficits in the hand. [44] (10.5435/jaaos-22-11-699)

See Also

References

[1] Innervation of the Elbow Joint: A Cadaveric Study. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.10.012

[2] The course of the radial nerve in the distal humerus: A novel, anatomy based, radiographic assessment. PLOS ONE. 2017. DOI: 10.1371/journal.pone.0186890

[3] Magnetic Resonance Neurography Findings in Clinically Suspected Posterior Interosseous Neuropathy: Response. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251400763

[4] Brachial plexus anatomy. Hand Clinics. 2004. DOI: 10.1016/s0749-0712(03)00088-x

[5] The anatomic branch pattern of the axillary nerve. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.05.003

[6] Clinically relevant surgical anatomy and exposures of the brachial plexus. Hand Clinics. 2005. DOI: 10.1016/j.hcl.2004.09.006

[7] Anatomic Variations of the Musculocutaneous Nerve and Clinical Implications for Restoration of Elbow Flexion. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2022.07.014

[8] Arthroscopic Anatomy of The Median Nerve And Brachial Artery Neurovascular Bundle At The Elbow. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.082

[9] The extrinsic blood supply of the ulnar nerve at the elbow: An anatomic study. The Journal of Hand Surgery. 1993. DOI: 10.1016/0363-5023(93)90086-i

[10] Perineural Pressures under the Pneumatic Tourniquet in the Upper Extremity. Journal of Hand Surgery. 1992. DOI: 10.1016/0266-7681(92)90111-e

[11] Radial Nerve Anatomy at the Elbow Joint and Its Arthroscopic Relevance. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.11.081

[12] Ulnar Nerve Anatomy. Hand Clinics. 2007. DOI: 10.1016/j.hcl.2007.05.001

[13] Anatomical basis for repair of ulnar and median nerves in the distal part of the forearm by group fascicular suture and nerve-grafting.. The Journal of Bone & Joint Surgery. 1986. DOI: 10.2106/00004623-198668020-00013

[14] Anatomy of the Lateral Antebrachial Cutaneous Nerve: Landmarks for Procedures in the Cubital Fossa. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.04.018

[15] Distance of the Posterior Interosseous Nerve From the Bicipital (Radial) Tuberosity at Varying Positions of Forearm Rotation: A Magnetic Resonance Imaging Study With Clinical Implications. The American Journal of Sports Medicine. 2021. DOI: 10.1177/0363546521992120

[16] Unusual origin of the motor branch of the ulnar nerve to the flexor carpi ulnaris. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2008.07.015

[17] Rock–paper–scissors. Injury. 2003. DOI: 10.1016/s0020-1383(02)00102-x

[18] Establishing Safe Zones to Avoid Nerve Injury in the Approach to the Humerus in Pediatric Patients. Journal of Bone and Joint Surgery. 2019. DOI: 10.2106/jbjs.19.00019

[19] Nerve Injuries of the Elbow, Wrist, and Hand in Athletes. Clinics in Sports Medicine. 2001. DOI: 10.1016/s0278-5919(05)70256-8

[20] Relationship of the Musculocutaneous Nerve and Its Twigs to the Coracoid Process: An Operative Exposure. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120954417

[21] Anatomic variation—A bony canal for the median nerve at the distal humerus: A case report. The Journal of Hand Surgery. 2004. DOI: 10.1016/j.jhsa.2004.05.018

[22] Nerve Injury with Long Head of the Biceps Tenodesis. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00397

[23] The Innervation of the Medial Humeral Epicondyle: Implications for Medial Epicondylar Pain. Journal of Hand Surgery. 2006. DOI: 10.1016/j.jhsb.2005.12.014

[24] Regional anatomic structures of the elbow that may potentially compress the ulnar nerve. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2009.03.004

[25] Neuroanatomical distribution of sensory receptors in the human elbow joint capsule. Shoulder & Elbow. 2018. DOI: 10.1177/1758573218760245

[26] Topographic anatomy of peripheral nerves of the elbow and their positional changes during arthroscopy — An experimental study. Journal of Shoulder and Elbow Surgery. 1995. DOI: 10.1016/s1058-2746(95)80170-7

[28] Anatomic considerations regarding the posterior interosseous nerve at the elbow. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.09.004

[29] Conditions and Injuries Affecting the Nerves Around the Elbow. Clinics in Sports Medicine. 2020. DOI: 10.1016/j.csm.2020.02.006

[30] Acute nerve injury as a complication of closed fractures or dislocations of the elbow. Injury. 1979. DOI: 10.1016/s0020-1383(79)80015-7

[31] In vivo dynamic migration of the posterior interosseous nerve across various elbow and forearm positions. Clinics in Shoulder and Elbow. 2024. DOI: 10.5397/cise.2024.00213

[32] The extraneural and intraneural arterial anatomy of the ulnar nerve at the elbow. Journal of Shoulder and Elbow Surgery. 1999. DOI: 10.1016/s1058-2746(99)90048-4

[33] Locating the lateral antebrachial cutaneous nerve. The Journal of Hand Surgery. 1987. DOI: 10.1016/s0363-5023(87)80050-3

[34] Vascularised Nerve Grafts. Journal of Hand Surgery. 1991. DOI: 10.1016/0266-7681(91)90099-a

[36] Ulnar nerve strains at the elbow. The Journal of Hand Surgery. 1998. DOI: 10.1016/s0363-5023(98)80005-1

[37] Morphology and Dynamics of the Ulnar Nerve in the Cubital Tunnel. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.1999.0317

[38] Findings of exploration of a vein-wrapped ulnar nerve: Report of a case. The Journal of Hand Surgery. 2001. DOI: 10.1053/jhsu.2001.21536

[40] Anatomy and internal topography of the musculocutaneous nerve: The nerves to the biceps and brachialis muscle. The Journal of Hand Surgery. 1998. DOI: 10.1016/s0363-5023(98)80122-6

[41] Annular Ligament Reconstruction Using the Distal Tendon of the Superficial Head of the Brachialis Muscle: An Anatomical Feasibility Study. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.04.008

[42] The Interfascicular Nerve-Grafting of the Median and Ulnar Nerves. The Journal of Bone & Joint Surgery. 1972. DOI: 10.2106/00004623-197254040-00004

[43] The below elbow cast: a cause of median and radial nerve injury after coronary bypass surgery. Injury. 2001. DOI: 10.1016/s0020-1383(00)00106-6

[44] Ulnar Nerve Entrapment at the Wrist. Journal of the American Academy of Orthopaedic Surgeons. 2014. DOI: 10.5435/jaaos-22-11-699

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k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.