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Becciolini M, Pivec C, Raspanti A, Riegler G. Ultrasound of the Ulnar Nerve: A Pictorial Review: Part 2: Pathological Ultrasound Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1153-1173. [PMID: 38444253 DOI: 10.1002/jum.16442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024]
Abstract
This is the second part of a two-part article in which we focus on the ultrasound (US) appearance of the pathological ulnar nerve (UN) and its main branches. Findings in a wide range of our pathological cases are presented with high-resolution US images obtained with the latest-generation US machines and transducers.
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Affiliation(s)
- Marco Becciolini
- Department of Ultrasound, Misericordia di Pistoia, Pistoia, Italy
- Scuola Siumb di Ecografia Muscolo-Scheletrica, Pisa, Italy
| | - Christopher Pivec
- Department of Ultrasound, PUC - Private Ultrasound Center Vienna, Vienna, Austria
| | - Andrea Raspanti
- Department of Orthopedics, SOC Ortopedia e Traumatologia, Ospedale Santa Maria Annunziata, Azienda USL Toscana Centro, Firenze, Italy
| | - Georg Riegler
- Department of Ultrasound, PUC - Private Ultrasound Center Graz, Graz, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
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Munro SR, Mac Dermott KA, Keet K. The anatomical variations of the cubital tunnel in a South African body donor sample. Surg Radiol Anat 2024; 46:777-785. [PMID: 38551675 PMCID: PMC11161423 DOI: 10.1007/s00276-024-03327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/22/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The ulnar nerve (UN) courses through the cubital tunnel, which is a potential site of entrapment. Anatomical variations of the cubital tunnel may contribute towards cubital tunnel syndrome (CuTS), however, these are not well described. The aim was to compare the range of variations and dimensions of the cubital tunnel and the UN between sexes and sides of the body. METHODS Sixty elbows from 30 embalmed bodies (17 males and 13 females) were dissected. The prevalence of the cubital tunnel retinaculum (CuTR) or anconeus epitrochlearis (AE) forming the roof of the tunnel was determined. The length, width, thickness, and diameter of the cubital tunnel and its roof were measured. The diameter of the UN was measured. RESULTS The AE was present in 5%, whereas the CuTR was present in the remaining 95% of elbows. The tunnel was 32.1 ± 4.8 mm long, 23.4 ± 14.2 mm wide, 0.18 ± (0.22-0.14) mm thick, and the median diameter was 7.9 ± (9.0-7.1) mm, while the median diameter of the UN was 1.6 ± (1.8-1.3) mm. The AE was thicker than the CuTR (p < 0.001) and the UN was larger in elbows with the AE present (p = 0.002). The tunnel was longer in males (p < 0.001) and wider on the right (p = 0.014). CONCLUSION The roof of the cubital tunnel was more frequently composed of the CuTR. The cubital tunnel varied in size between sexes and sides. Future research should investigate the effect of the variations in patients with CuTS.
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Affiliation(s)
- Sophie Rose Munro
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kerryn-Anne Mac Dermott
- Department of Paediatric Surgery, Surgical Skills Training Centre, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Kerri Keet
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Chaudhary RK, Karkala N, Nepal P, Gupta E, Kaur N, Batchala P, Sapire J, Alam SI. Multimodality imaging review of ulnar nerve pathologies. Neuroradiol J 2024; 37:137-151. [PMID: 36961518 PMCID: PMC10973834 DOI: 10.1177/19714009231166087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
The ulnar nerve is the second most commonly entrapped nerve after the median nerve. Although clinical evaluation and electrodiagnostic studies remain widely used for the evaluation of ulnar neuropathy, advancements in imaging have led to increased utilization of these newer / better imaging techniques in the overall management of ulnar neuropathy. Specifically, high-resolution ultrasonography of peripheral nerves as well as MRI has become quite useful in evaluating the ulnar nerve in order to better guide treatment. The caliber and fascicular pattern identified in the normal ulnar nerves are important distinguishing features from ulnar nerve pathology. The cubital tunnel within the elbow and Guyon's canal within the wrist are important sites to evaluate with respect to ulnar nerve compression. Both acute and chronic conditions resulting in deformity, trauma as well as inflammatory conditions may predispose certain patients to ulnar neuropathy. Granulomatous diseases as well as both neurogenic and non-neurogenic tumors can also potentially result in ulnar neuropathy. Tumors around the ulnar nerve can also lead to mass effect on the nerve, particularly in tight spaces like the aforementioned canals. Although high-resolution ultrasonography is a useful modality initially, particularly as it can be helpful for dynamic evaluation, MRI remains most reliable due to its higher resolution. Newer imaging techniques like sonoelastography and microneurography, as well as nerve-specific contrast agents, are currently being investigated for their usefulness and are not routinely being used currently.
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Affiliation(s)
| | - Nikitha Karkala
- Department of Radiology, Northwell North Shore University Hospital, Long Island Jewish Medical Center, Queens, NY, USA
| | - Pankaj Nepal
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Elina Gupta
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
| | - Neeraj Kaur
- Department of Radiology, University Hospital of Northern British Columbia, Prince George, BC, Canada
| | - Prem Batchala
- Department of Radiology, University of Virginia, Charlottesville, VA, USA
| | - Joshua Sapire
- Department of Radiology, St. Vincent’s Medical Center, Bridgeport, CT, USA
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Hannaford A, Simon NG. Ulnar neuropathy. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:103-126. [PMID: 38697734 DOI: 10.1016/b978-0-323-90108-6.00006-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Ulnar neuropathy at the elbow is the second most common compressive neuropathy. Less common, although similarly disabling, are ulnar neuropathies above the elbow, at the forearm, and the wrist, which can present with different combinations of intrinsic hand muscle weakness and sensory loss. Electrodiagnostic studies are moderately sensitive in diagnosing ulnar neuropathy, although their ability to localize the site of nerve injury is often limited. Nerve imaging with ultrasound can provide greater localization of ulnar injury and identification of specific anatomical pathology causing nerve entrapment. Specifically, imaging can now reliably distinguish ulnar nerve entrapment under the humero-ulnar arcade (cubital tunnel) from nerve injury at the retro-epicondylar groove. Both these pathologies have historically been diagnosed as either "ulnar neuropathy at the elbow," which is non-specific, or "cubital tunnel syndrome," which is often erroneous. Natural history studies are few and limited, although many cases of mild-moderate ulnar neuropathy at the elbow appear to remit spontaneously. Conservative management, perineural steroid injections, and surgical release have all been studied in treating ulnar neuropathy at the elbow. Despite this, questions remain about the most appropriate management for many patients, which is reflected in the absence of management guidelines.
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Affiliation(s)
- Andrew Hannaford
- Westmead Clinical School, Westmead Hospital, University of Sydney, Westmead, NSW, Australia
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Sydney, NSW, Australia.
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Gruener JS, Paulsen F, Barth AA, Horch RE. Anconeus epitrochlearis muscle (epitrochlearisanconeus muscle; Musculus epitrochleoanconeus) with cubital tunnel syndrome - a rare but relevant clinical entity. Ann Anat 2023; 250:152152. [PMID: 37633501 DOI: 10.1016/j.aanat.2023.152152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/06/2023] [Accepted: 08/06/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Compression of the ulnar nerve at the elbow within the cubital tunnel is related to the anatomical structures and is generally believed to be caused by Osborne's ligament (also known as the cubital retinaculum). However, in rare cases an anatomical variation of the developmental peculiarity of a remaining anconeus epitrochlearis muscle may be responsible for the disease. METHODS We present a series of five cases in which an anconeus epitrochlearis muscle was found as the cause of illness. RESULTS All patients presented with typical symptoms of numbness and tingling in the hand and ulnar fingers, and recurring pain as well as weakness of the ulnar innervated muscles. With neurophysiologically confirmed diminished nerve conduction velocity and unsuccessful conservative treatment, surgical decompression revealed an anconeus epitrochlearis muscle as the reason of compression. Full symptom relief was achieved immediately after the procedure in all cases. CONCLUSIONS This article strives to call attention to this entity when diagnosing ulnar nerve compression. Myectomy and medial epicondylectomy is the preferred treatment option in such cases.
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Affiliation(s)
- J S Gruener
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.
| | - F Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - A A Barth
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - R E Horch
- Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Kelley N, Hubbard J, Belton M. Cubital tunnel compression neuropathy in the presence of an anomalous venous complex: a case study. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:427-430. [PMID: 37588498 PMCID: PMC10426564 DOI: 10.1016/j.xrrt.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Naomi Kelley
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - James Hubbard
- Department of Orthopedic Surgery, Mercy Hospital St. Louis, St. Louis, MO, USA
| | - Matthew Belton
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Schwabl C, Hörmann R, Strolz CJ, Drakonaki E, Zimmermann R, Klauser AS. Anatomical Variants of the Upper Limb Nerves: Clinical and Preoperative Relevance. Semin Musculoskelet Radiol 2023; 27:129-135. [PMID: 37011614 PMCID: PMC10069954 DOI: 10.1055/s-0043-1761952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Profound knowledge of nerve variations is essential for clinical practice. It is crucial for interpreting the large variability of a patient's clinical presentation and the different mechanisms of nerve injury. Awareness of nerve variations facilitates surgical safety and efficacy. Clinically significant anatomical variations can be classified into two main groups: variability in the course of the nerve and variability of structures surrounding the nerve. In this review article we focus on the most common nerve variants of the upper extremity and their clinical relevance.
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Affiliation(s)
- Christoph Schwabl
- Radiology Department, Medical University of Innsbruck, Innsbruck, Austria
| | - Romed Hörmann
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elena Drakonaki
- Independent MSK Radiology Practice, Heraklion, Crete, Greece
| | - Robert Zimmermann
- Department of Surgery, University Hospital for Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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Bonczar M, Ostrowski P, Plutecki D, Dziedzic M, Depukat P, Walocha J, Koziej M. A complete analysis of the surgical treatment for cubital tunnel syndrome: an umbrella review. J Shoulder Elbow Surg 2023; 32:850-860. [PMID: 36584870 DOI: 10.1016/j.jse.2022.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Numerous original studies have been presented regarding various surgical treatments for cubital tunnel syndrome (CubTS). The results of these analyses regarding the different surgical treatments for CubTS frequently differ and, in some cases, contradict each other, creating confusion. Therefore, our umbrella review aimed to summarize the evidence from meta-analyses and systematic reviews regarding the surgical treatments of CubTS, and along with the new, more detailed outcomes, provide an evidence-based tool for surgeons performing these procedures. MATERIALS AND METHODS To perform this umbrella review, a systematic search was conducted for meta-analyses investigating CubTS in PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library, BIOSIS, and EBSCO medical databases. RESULTS Detailed comparison of surgical outcomes, such as clinical improvement, complications, or reoperation rates, of different treatment methods for CubTS was performed. New risk ratios in all categories were established based on all of the primary studies available in the literature. DISCUSSION The goal of the present umbrella review was to gather and summarize all data about the surgical treatments for CubTS in the available literature and provide new outcomes and an evidence-based tool for surgeons performing these procedures. Each comparison of the surgical techniques has been discussed, and the present study's results were compared with the outcomes of the previous studies.
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Affiliation(s)
- Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; Youthoria, Youth Research Organization, Kraków, Poland.
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; Youthoria, Youth Research Organization, Kraków, Poland
| | - Dawid Plutecki
- Youthoria, Youth Research Organization, Kraków, Poland; Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Martyna Dziedzic
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; Youthoria, Youth Research Organization, Kraków, Poland
| | - Paweł Depukat
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; Youthoria, Youth Research Organization, Kraków, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland; Youthoria, Youth Research Organization, Kraków, Poland
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Martín-Noguerol T, Luna A. Diffusion Tensor Imaging of Ulnar Neuropathy Caused by an Accessory Anconeus Muscle. Radiology 2023; 307:e221854. [PMID: 36943074 DOI: 10.1148/radiol.221854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Affiliation(s)
- Teodoro Martín-Noguerol
- From the Department of Radiology, MRI Unit, HT Médica, Clínica Las Nieves, Calle Carmelo Torres 2, 23007 Jaén, Spain
| | - Antonio Luna
- From the Department of Radiology, MRI Unit, HT Médica, Clínica Las Nieves, Calle Carmelo Torres 2, 23007 Jaén, Spain
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Anatomical variants complicating the posterior approaches towards the elbow joint. Surg Radiol Anat 2023; 45:587-592. [PMID: 36920516 PMCID: PMC10130116 DOI: 10.1007/s00276-023-03124-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Anatomical variants observed during the posterior approach to the elbow joint require special attention due to their clinical relevance. We aim to present a compendious review of described variants potentially encountered during the posterior approach towards the elbow joint to the experts in the elbow surgery. METHODS A narrative review of surgical and anatomical textbooks, as well as search of scientific databases was carried out. RESULTS Variability of the subcutaneous nerves is important during incision planning. Accessory muscles such as dorsoepitrochlearis, chondroepitrochlearis, epitrochleoanconeus, subanconeus or supernumerary flexor carpi ulnaris may confuse even the senior surgeon during the dissection and possibly complicate the fracture reduction. Some bony variants such as supratrochlear foramen may lead to fracture or possibly interfere with the osteosynthesis placement. Accessory bones are also present in the region of the elbow joint. Those situated intra-articular may present with symptoms. CONCLUSION Many variants can be encountered in the area of the elbow joint and their knowledge is essential to truly understand its anatomy. The presented review enables easier orientation in the current literature with the aim on the posterior approach towards the elbow joint.
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Sanjuan-Cervero R, Peña-Molina F, Franco-Ferrando N. Dynamic Compression of the Ulnar Nerve Associated With the Anconeus Epitrochlearis Muscle: Do We Really Know Everything? JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022. [PMID: 37521541 PMCID: PMC10382867 DOI: 10.1016/j.jhsg.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Ulnar nerve compression associated with the anconeus epitrochlearis muscle (AE) is an uncommon cause of peripheral nerve compression at the elbow. It is often seen in young women with a hypertrophied or severely edematous muscle. Its causes are unclear. Numerous observed features, such as a hypertrophic AE, a palpable mass on the medial side of the elbow, and the dynamic nature of symptoms, have sparked controversy in the literature. Its clinical presentation is often insidious, and occasionally symptoms only occur in prolonged positions (dynamic compression). EMG tests are usually negative, and a correct diagnosis relies on imaging. We present the case of a 21-year-old student and clarinet player who presented with dynamic compression of the ulnar nerve at the elbow associated with AE. Much remains to be elucidated about the incidence, pathophysiology, and contributing factors of this peripheral form of cubital compression. It may be time to revisit this condition.
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Duran S, Gunaydin E, Cayhan V. The prevalence of the anatomical variation in a Turkish population: supernumerary muscle-anconeus epitrochlearis. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1409-1415. [PMID: 36151223 DOI: 10.1007/s00276-022-03021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/19/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The anconeus epitrochlearis (AE) muscle is an accessory muscle located between the medial cortex of the olecranon and the inferior surface of the medial epicondyle, posterior to the ulnar nerve. This muscle may compress the ulnar nerve causing a clinical neuropathy. We aimed to determine the gender and side characteristics of the AE muscle in patients who underwent elbow magnetic resonance imaging (MRI) and report its prevalence in a Turkish population. MATERIALS AND METHODS A total of 209 patients (210 elbows) who underwent elbow MRI between January and December 2020 were retrospectively evaluated. Cases with the AE muscle were included in the study. The craniocaudal (CC) dimension was examined from the coronal section, and the transverse (TR) and anteroposterior (AP) dimensions from the axial sections. Statistical analyses were performed to determine the relationship between the presence of the AE muscle and age, gender, and side (right/left). Differences between sexes and sides in terms of muscle sizes were evaluated using statistical tests. RESULTS The AE muscle was detected in 17 patients (18 elbows) (8.1%). The mean age of the patients was 41.52 ± 14.63 years. There was no statistically significant difference between the male and female patients in terms of age. This accessory muscle was found in nine female (9.8%) and eight male (6.3%) patients in total. There was one (0.5%) patient with the bilateral AE muscle, who was female. The accessory muscle was located in the right elbow in 13 patients (10.71%), and left elbow in five (4.10%). It was more common in the right elbow in both genders. The muscle was larger in the male patients and the right elbow, but this was not statistically significant. CONCLUSION The prevalence of the AE muscle was determined to be 8.1% in a Turkish population, and this muscle was more common among the women and in the right elbow.
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Affiliation(s)
- Semra Duran
- Department of Radiology, Ankara Bilkent City Hospital, University of Health Sciences, Bilkent Bulvari No.1, Ankara, Turkey.
| | - Elif Gunaydin
- Department of Radiology, Ankara MedikalPark Hospital, Yuksek Ihtisas University, Ankara, Turkey
| | - Velihan Cayhan
- Department of Radiology, Ankara Bilkent City Hospital, University of Health Sciences, Bilkent Bulvari No.1, Ankara, Turkey
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Liu Z, Zhang D. Clinical efficacy of decompression and anterior transposition of the ulnar nerve in osteoarthritis-induced cubital tunnel syndrome and influencing factors. HAND SURGERY & REHABILITATION 2022; 41:370-376. [DOI: 10.1016/j.hansur.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
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Yurasakpong L, Nantasenamat C, Janta S, Eiamratchanee P, Coey J, Chaiyamoon A, Kruepunga N, Senarai T, Langer MF, Meemon K, Suwannakhan A. The decreasing prevalence of the thyroid ima artery: A systematic review and machine learning assisted meta-analysis. Ann Anat 2021; 239:151803. [PMID: 34265384 DOI: 10.1016/j.aanat.2021.151803] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/20/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Thyroid ima artery is a variant artery found on the anterior surface of the trachea. The aim of this meta-analysis was to obtain pooled prevalence data of the thyroid ima artery and discuss its clinical importance especially for tracheostomy. METHODS A systematic literature search was performed through five electronic databases until May 2021. A set of inclusion and exclusion criteria based on AQUA guidelines were used to select relevant studies. Meta-analysis, subgroup analyses, meta-regression, and tests for publication bias were performed. Factors that influence the prevalence of the thyroid ima artery were detected using simple and interpretable machine learning (linear regression and K means). RESULTS Thirty-six studies with a total of 4335 subjects met the inclusion criteria. The prevalence of the thyroid ima artery was 3.8% (95% CI: 0.027-0.049, I2=56.2%). Machine learning identified age, region and year of publication as potential covariates. Subgroup analysis showed that the prevalence of the thyroid ima artery was 4.5 times higher in fetuses (14.8%) than adults (3.3%) (z=-6.76, p<0.01). There was a significant negative correlation between the adult prevalence of the thyroid ima artery and the year of publication (Pearson's r=-0.354, p=0.040) thereby suggesting a decline in thyroid ima artery prevalence over time. This artery, if present, may originate from the brachiocephalic trunk (74%), right common carotid artery (9.6%), arch of aorta (7.7%), right internal thoracic artery (4.8%), left common carotid artery (1.9%) and left internal thoracic artery (1.9%). CONCLUSION In addition to evidence-based synthesis of the thyroid ima artery, this study is the first ever study to report the decreasing prevalence over time of a human body structure in the postnatal life. Knowledge of the thyroid ima artery is of vital importance for surgeons to avoid accidental hemorrhage during tracheostomy.
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Affiliation(s)
| | - Chanin Nantasenamat
- Center of Data Mining and Biomedical Informatics, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand
| | - Sirorat Janta
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Pinthusorn Eiamratchanee
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, United Kingdom; Department of Anatomical Sciences, St. George's University, School of Medicine, Grenada, West Indies
| | - James Coey
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, United Kingdom; Department of Anatomical Sciences, St. George's University, School of Medicine, Grenada, West Indies
| | - Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nutmethee Kruepunga
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Thanyaporn Senarai
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Martin Franz Langer
- Department of Traumatology and Hand Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Münster, Germany
| | - Krai Meemon
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Athikhun Suwannakhan
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand.
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