The nerve to the anconeus is a branch of the radial nerve arising in the radial groove or just below it, supplying the anconeus muscle at the posterolateral elbow. The anconeus is a small triangular muscle extending from the lateral epicondyle to the olecranon that assists in elbow extension and in stabilising the ulna during forearm rotation. As a branch of the radial nerve, the nerve to anconeus is spared in posterior interosseous nerve lesions distal to the branch point.
| Origin | Radial nerve, as a continuation of the branch to the medial head of triceps (C7, C8) |
|---|---|
| Course | Descends within the medial head of triceps close to the bone, passes behind the elbow, and ends in the anconeus |
| Motor | |
| Sensory |
|
The nerve to anconeus is important in radial nerve surgery and nerve transfers. It arises high, as a continuation of the branch to the medial head of triceps, so EMG of anconeus helps localise radial nerve injuries: loss of anconeus with preserved triceps long head points to a lesion at or below the spiral groove, while preserved anconeus with weak finger and wrist extensors points to a more distal lesion. In lateral elbow approaches (Kocher and Kaplan) it must be protected as it enters the muscle. Because anconeus is expendable, the nerve is a useful donor for motor nerve transfer in radial nerve palsy.
In radial nerve palsy from humeral shaft fracture, the expendable nerve to anconeus provides a nearby motor donor nerve for nerve transfer to the posterior interosseous nerve or wrist extensor branches, providing reinnervation without sacrificing a critical motor unit and allowing earlier recovery than nerve grafting from a remote donor site.
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