The nerve to the medial head of triceps arises from the radial nerve at multiple levels — both proximal and distal to the spiral groove — making the medial head the most reliably innervated portion of triceps in radial nerve palsy. Its dual proximal and distal supply provides redundancy.
The dual innervation of the medial head of triceps (from branches above and below the spiral groove) is the reason why medial head triceps function is often preserved in spiral groove radial nerve palsy, unlike lateral and long head triceps. EMG of the medial head of triceps is therefore a critical localisation test: preserved activity indicates a spiral groove or more distal lesion; denervation indicates an axillary or posterior cord lesion.
Preserved medial head triceps EMG in spiral groove palsy distinguishes it from posterior cord injury, guiding management — spontaneous recovery expected in 85% of spiral groove palsies within 3-4 months.
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