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Jenkins S, Iwanaga J, Loukas M, Dumont AS, Tubbs RS. A comprehensive review of the "supracondylar process" with translation of Adachi. Clin Anat 2021; 35:434-441. [PMID: 34585786 DOI: 10.1002/ca.23794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/24/2021] [Indexed: 11/06/2022]
Abstract
The supracondylar process is a nonpathological projection from the distal humerus that in some patients, can result in compression of regional neurovascular structures, for example, median nerve. Since the first description of the supracondylar process in 1818, it has also been a focus of anthropological study because of its possible relevance to human origins and relationships to other species. Although its overall incidence is low, it is more common in races of European descent. It is particularly interesting for anatomists and anthropologists, but knowledge of its anatomical relationships and effect on pathological processes helps in the diagnosis and treatment of supracondylar process syndrome. One of the most detailed descriptions of this variant process stems from the work of Buntaro Adachi. Herein, a translation of his findings is provided and a review of the supracondylar process and its potential pathological presentations presented.
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Affiliation(s)
- Skyler Jenkins
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Department of Anatomy, University of Warmia and Mazury, Olsztyn, Poland
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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Wininger AE, Liberman SR, Jafarnia KK. Fracture of the supracondylar process of the humerus in an adolescent athlete. JSES Int 2020; 4:1018-1020. [PMID: 33345250 PMCID: PMC7738557 DOI: 10.1016/j.jseint.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Gamble JG, Krygier JE. Fracture of the Supracondylar Process in a Child: A Case Report and Review of the Literature. JBJS Case Connect 2019; 9:e0396. [PMID: 31633496 DOI: 10.2106/jbjs.cc.18.00396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE A 5-year-9-month-old boy sustained a fracture of the supracondylar process of the distal humerus. The fracture healed with cast immobilization and with no neurovascular complications. Magnetic resonance imaging showed the medial nerve and the brachial artery to be located under the ligament of Struthers that extended from the supracondylar process to the medial epicondyle. CONCLUSIONS Fracture of the supracondylar process of the humerus in children is rare and easy to misdiagnose, but once discovered, the fracture can be treated successfully with cast immobilization and without compromise to the neurovascular structures passing under the ligament of Struthers.
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Affiliation(s)
- James G Gamble
- Department of Orthopaedic Surgery, Packard Children's Hospital, Stanford University Medical Center, Stanford, California
| | - Jeffrey E Krygier
- Department of Orthopaedic Surgery, Santa Clara Valley Health and Hospital System, San Jose, California
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Mutnuru PC, Perubhotla LM. Rare Mimickers of Exostosis: A Case Series. J Clin Diagn Res 2016; 10:TR06-7. [PMID: 27630926 DOI: 10.7860/jcdr/2016/18794.8193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 05/16/2016] [Indexed: 11/24/2022]
Abstract
Exophytic growths from bones are a common entity. Osteochondroma is the most common benign exophytic lesion and we tend to diagnose every benign looking exophytic lesion as osteochondroma. Here we reported two entities of cases, one was Nora's lesion and another one was supracondylar process of humerus, both of which were mimickers of osteochondroma and their salient and differentiating features from osteochondromas.
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Affiliation(s)
- Phani Chakravarty Mutnuru
- Assistant Professor, Department of Radiology, Nizam's Institute of Medical Sciences , Punjagutta, Hyderabad, Telangana, India
| | - Lakshmi Manasa Perubhotla
- Ex Lecturer, Department of Pathology, Nizam's Institute of Medical Sciences , Punjagutta, Hyderabad, Telangana, India
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Bain G, Gupta P, Phadnis J, Singhi PK. Endoscopic Excision of Supracondylar Humeral Spur for Decompression of the Median Nerve and Brachial Artery. Arthrosc Tech 2016; 5:e67-70. [PMID: 27073779 PMCID: PMC4809732 DOI: 10.1016/j.eats.2015.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 08/28/2015] [Indexed: 02/03/2023] Open
Abstract
The humeral supracondylar process and Struthers ligament comprise a relatively rare but well-known anatomic variant. They are usually asymptomatic but may produce clinical symptoms related to compression of the median nerve or brachial artery below the ligament. Previously, surgery has been performed with an open ligament release and supracondylar process excision. This article reports on the use of endoscopic findings and the method of ligament release and process excision. Endoscopy is a minimally invasive technique that provides excellent visualization and enables the surgeon to perform dissection with magnification and precision. It allows the surgeon to introduce open surgical techniques into the depths of the wound in a controlled manner. Because of the dead space created, there is a risk of hematoma formation. Many of the concepts used in open surgery are now being used for endoscopic surgery, and vice versa. The barriers and differences among endoscopic, arthroscopic, and open procedures are being broken down. We report another endoscopic technique, which is part of the ongoing evolution of musculoskeletal surgery.
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Affiliation(s)
- Gregory Bain
- Department of Orthopaedic Surgery, Flinders University, Adelaide, Australia
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
| | - Prince Gupta
- Department of Orthopaedic Surgery, Flinders University, Adelaide, Australia
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
- Alchemist Hospital, Gurgaon, India
| | - Joideep Phadnis
- Department of Orthopaedic Surgery, Flinders University, Adelaide, Australia
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
| | - Prahalad K. Singhi
- Department of Orthopaedic Surgery, Flinders University, Adelaide, Australia
- Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
- International Musculoskeletal Research Institute, Adelaide, Australia
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Abstract
The supracondylar process of the humerus is an anatomic variant present in 1% of the population associated with a fibrous band, the ligament of Struthers that attaches it to the medial epicondyle, and may serve as a proximal origin of a fascicle of the pronator teres. Fractures of the supracondylar process of the humerus are extremely rare. To the best of our knowledge, this is the first report of a stress fracture of the supracondylar process. We present the case of a professional tennis player with a stress fracture of the supracondylar process who underwent surgery to avoid possible displacement and neurovascular complications. Clinicians should consider the diagnosis of a supracondylar process fracture with or without neurovascular compression when examining athletes with otherwise unexplained arm or elbow pain. Stress fracture of the supracondylar process may be secondary to the excessive traction of the pronator teres.
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Opanova MI, Atkinson RE. Supracondylar process syndrome: case report and literature review. J Hand Surg Am 2014; 39:1130-5. [PMID: 24862112 DOI: 10.1016/j.jhsa.2014.03.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 03/27/2014] [Accepted: 03/27/2014] [Indexed: 02/02/2023]
Abstract
The supracondylar process is a congenital bone projection on the distal anteromedial humerus often associated with a ligament of Struthers, a fibrous connection between the process and medial epicondyle. It is largely asymptomatic and only on rare occasions presents with neurovascular compression resulting in a supracondylar process syndrome. This case report describes a 28-year-old woman with supracondylar process syndrome, and our management. The topic is further explored with a literature review of 43 reported cases. Analysis of the case reports indicates that isolated median nerve injuries are the most common. Other presentations such as fractures, vascular compromise, and ulnar nerve involvement are less frequent.
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Affiliation(s)
- Maria I Opanova
- Department of Orthopaedic Surgery, University of Hawaii, Honolulu, HI.
| | - Robert E Atkinson
- Department of Orthopaedic Surgery, University of Hawaii, Honolulu, HI
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C. S, B.S. S, G.V. K, S. L. Morphological study of the supracondylar process of the humerus and its clinical implications. J Clin Diagn Res 2014; 8:1-3. [PMID: 24596708 PMCID: PMC3939513 DOI: 10.7860/jcdr/2014/6743.3915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/24/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND The supracondylar process of the humerus, which is also called the supra-epitrochlear, epicondylar, epicondylic process or a supratrochlear spur, is a hook-like, bony spine of variable size that may project distally from the anteromedial surface of the humerus. It represents the embryologic vestigial remnant of climbing animals and seen in many reptiles, most marsupials, cats, lemurs and American monkeys. MATERIALS AND METHODS Two hundred and forty dried humeri were studied from department of Anatomy, Sri Siddhartha Medical College, Tumkur, Karnataka, India. The bones were examined for supracondylar process. On finding, the dimensions were recorded and photographed. RESULTS Out of 240 dried humeri examined we found only 1 humerus of the left side with an osseous spine on the anteromedial surface. The incidence calculated in this study was 0.41%. CONCLUSION The supracondylar process is frequently misjudged as a pathological condition of the bone rather than as a normal anatomical variation. Though, this process has been of more interest to anatomists and anthropologists because of a possible link to the origins and relations of the human races than to clinicians, many of whom are not aware of its occasional presence. It is usually clinically silent, but may become symptomatic by presenting as a mass or can be associated with symptoms of median nerve compression and claudication of the brachial artery.
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Affiliation(s)
- Shivaleela C.
- Assistant Professor, Department of Anatomy, Sri Siddhartha Medical College, Tumkur-572117, Karnataka, India
| | - Suresh B.S.
- Associate Professor, Department of Anatomy, Sri Siddhartha Medical College, Tumkur-572117, Karnataka, India
| | - Kumar G.V.
- Assistant Professor, Department of Pediatrics, Sri Siddhartha Medical College, Tumkur-572117, Karnataka, India
| | - Lakshmiprabha S.
- Professor & HOD, Department of Anatomy, Sri Siddhartha Medical College, Tumkur-572117, Karnataka, India
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Tzaveas AP, Dimitriadis AG, Antoniou KI, Pazis IG, Paraskevas GK, Vrettakos AN. Supracondylar process of the humerus: a rare case with compression of the ulnar nerve. J Plast Surg Hand Surg 2010; 44:325-6. [PMID: 20158419 DOI: 10.3109/02844310903123320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A patient presented with a 6-month history of numbness and pain in the left forearm and hand over the ulnar nerve distribution. Radiographs showed a supracondylar process, which was excised. The ulnar nerve had been compressed. The patient was symptom-free two months postoperatively.
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Thompson JK, Edwards JD. Supracondylar process of the humerus causing brachial artery compression and digital embolization in a fast-pitch softball player. A case report. Vasc Endovascular Surg 2005; 39:445-8. [PMID: 16193218 DOI: 10.1177/153857440503900510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The supracondylar process of the humerus is a rare abnormality found in 0.4-2.7% of the population. It has been documented to cause neurovascular compression in the upper extremity owing to its local impingement on the median nerve and brachial artery at its medial location on the humerus just proximal to the elbow. The authors report the first known case of digital ischemia from embolization of thrombus caused by local compression of the brachial artery attributed to a supracondylar process.
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Affiliation(s)
- J Keith Thompson
- University of Cincinnati Medical Center, Cincinnati, OH 45267, USA.
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Kazuki K, Egi T, Okada M, Takaoka K. Anatomic variation--a bony canal for the median nerve at the distal humerus: a case report. J Hand Surg Am 2004; 29:953-6. [PMID: 15465251 DOI: 10.1016/j.jhsa.2004.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Accepted: 05/20/2004] [Indexed: 02/02/2023]
Abstract
We report a rare anatomic variation in which the median nerve travels in a bony canal of the distal humerus, separating from the brachial artery. We encountered this during neurolysis for posttraumatic median nerve palsy in a 10-year-old boy. We suggest that this anatomic variation was related strongly to this patient's median nerve palsy.
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Affiliation(s)
- Kenichi Kazuki
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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