The deep branch of the radial nerve separates from the superficial branch just proximal to the lateral epicondyle, entering the forearm between the brachialis and brachioradialis. It then passes through the radial tunnel and beneath the arcade of Frohse in the supinator to become the posterior interosseous nerve. The transition from deep radial to posterior interosseous nerve occurs at the distal supinator edge.
The deep radial nerve at its forearm origin is the target for radial tunnel decompression, where all four sites of potential compression from the radiocapitellar joint to the distal supinator are systematically released. Its separation from the superficial radial nerve just above the elbow makes proximal radial nerve injuries at the spiral groove affect both branches equally, while distal lesions may selectively involve only the deep branch (motor) or superficial branch (sensory).
Isolated motor loss from deep radial nerve injury below the origin of the superficial radial nerve, producing finger and thumb extensor weakness without wrist drop or sensory loss, from penetrating trauma or compressive lesion at the elbow.
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