Clinical Anatomy 16:368 –369 (2003)
Letter to the Editor
Radial Nerve Innervation to the Inferolateral
Segment of the Brachialis Muscle:
From Anatomy to Clinical Reality
To the Editor:
The nerve supply to the brachialis muscle has been
poorly understood and, in fact, even misunderstood.
Many previous authors have vaguely alluded to a dual
innervation to this muscle, whereas some have either
considered the musculocutaneous nerve as the sole
supply or thought the radial nerve contribution en-
tirely sensory. In their study, Mahakkanukrauh and
Somsarp (2002) provide important detailed data de-
scribing the dual innervation of the brachialis muscle.
In 152 cadaveric limbs, they found the musculocuta-
neous nerve innervating the brachialis in 100% of
specimens and the radial nerve providing a dual sup-
ply in 81.6%. This study corroborated the results of an
earlier study characterizing the dual supply of the
brachialis muscle (Ip and Chang, 1968), although the
two studies differed in the exact prevalence of this
radial motor branch and its specific supply to the
inferolateral segment of the brachialis muscle.
There has been limited clinical support in the lit-
erature for the anatomic description of a dual inner-
vation for the brachialis muscle available. Wood Jones
(1919) detected localized contraction of the brachialis
muscle in a patient with a completely severed mus-
culocutaneous nerve. Stimulation of the radial nerve
or its brachialis branch has been shown to produce
contraction in a portion of the brachialis muscle (Hol-
linshead, 1958). We have confirmed both of these
observations intraoperatively in selected cases of our
own (unpublished data).
Furthermore, MR imaging can supply additional
evidence on this subject through its capacity to dis-
play characteristic signal changes of denervation atro-
phy within muscle. We recently imaged two patients
with radial nerve paralysis (Figs. 1, 2). The zone of
denervation in the brachialis visualized on MRI,
namely the inferolateral portion, closely resembled
the area of innervation of the brachialis by the radial
nerve, demonstrated by meticulous intramuscular dis-
section in cadaveric specimens (Yan et al., 1998). MR
© 2003 Wiley-Liss, Inc.
imaging adds a new dimension to the timeless ele-
gance and relative simplicity of careful anatomic dis-
section.
Let there be no more doubt about the relatively
consistent motor contribution to the brachialis muscle
from the radial nerve.
Robert J. Spinner*
Mayo Clinic
Department of Neurologic Surgery
Department of Orthopedics
Rochester, Minnesota
Mark A. Pichelmann
Mayo Clinic
Department of Neurologic Surgery
Rochester, Minnesota
Rolfe Birch
Royal National Orthopaedic Hospital
Peripheral Nerve Injury Unit
Stanmore, United Kingdom
REFERENCES
Hollinshead WH. 1958. Anatomy for surgeons. Vol. 3. London:
Cassell and Co. p 365.
Ip MC, Chang KSF. 1968. A study on the radial supply of the
human brachialis muscle. Anat Rec 162:363–372.
Jones FW. 1919. Voluntary muscular movements in cases of
nerve lesions. J Anat Lond 54:41–57.
Mahakkanukrauh PB, Somsarp V. 2002. Dual innervation of
the brachialis muscle. Clin Anat 15:206 –209.
Yan J, Aizawa Y, Honma S, Horiguchi M. 1998. Re-evaluation
of the human brachialis muscle by fiber analysis of supply
nerves [in Japanese]. Kaibogaku Zasshi 7:247–258.
*Correspondence to: Robert J. Spinner, MD, Mayo Clinic E-6B,
Rochester, MN 55905. E-mail: spinner.robert@mayo.edu
Received 4 December 2002; Accepted 27 December 2002
Published online in Wiley InterScience (www.interscience.wiley.
com). DOI 10.1002/ca.10153
 Fig. 1. A 50-year-old woman presented with an asymptomatic
mass of the mid-arm. Clinically, the primary surgeon thought it a
lipoma. At operation, however, it proved to be a schwannoma of the
radial nerve. The mass was resected, but the patient awoke with a
complete palsy of the radial nerve localized to the mid-arm (sparing
the triceps brachii, which is innervated more proximally in the axilla).
There was no evidence of clinical or electrical recovery when she
presented to us 6 weeks later. A: At re-exploration, the radial nerve
(blue loop, left side of field) was identified in the plane between the
brachialis (BR) and brachioradialis (Br) and the triceps brachii (T).
Dissection revealed a neuroma in continuity (*) in the mid-arm.
Muscle branches to the brachialis (red loops) and brachioradialis
(yellow loop) and sensory branches (two blue loops at bottom of field)
were mobilized and preserved. Intraoperatively a nerve action poten-
tial could not be obtained across the lesion and stimulation of the nerve
did not produce contraction in any muscle distal to the lesion. The
neuroma was excised and the nerve ends were repaired directly.
Pathology confirmed a neuroma without residual tumor. B: T-1
weighted spinecho MRI demonstrating the neuroma in continuity
confirmed at operation (arrowhead). C: T-2 weighted MRI (fast spin
echo [FSE] with fat suppression) at the same location in (B) showing
the radial nerve (arrowhead) and the denervation (high intensity) in the
inferolateral portion of the brachialis muscle; (D) and in imaging
further distally (short tau inversion recovery sequence), in the brachi-
oradialis muscle. Contrast the normal muscle signal in the triceps
brachii. B, biceps brachii; P, proximal; D, distal.

Fig. 2. A 61-year-old woman presented

with an isolated high radial nerve lesion 10 years
after radiation treatment for breast cancer. A: T-2
weighted FSE MRIs (with fat saturation) show-
ing denervation (high intensity) in the triceps
brachii (T) and the inferolateral portion of the
brachialis (BR), and (B) the brachioradialis (Br).
Contrast the normal muscle signal in the biceps
brachii (B) in (A).