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Teodonno F, Maffeis J, Latini F, Chevrier B, Teboul F. Intraosseous Nontraumatic Median Nerve Entrapment at the Elbow: A Case Report. Hand (N Y) 2024:15589447231222319. [PMID: 38265033 DOI: 10.1177/15589447231222319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Intraosseous median nerve entrapment at the level of the elbow can occur after a traumatic event such as fracture and/or dislocation of the elbow. It is considered a rare and severe entity. We present a rare case of nontraumatic median nerve entrapment inside the distal humerus. No article about atraumatic intraosseous entrapment was encountered in literature.
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Affiliation(s)
| | - Jacopo Maffeis
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Frédéric Teboul
- Centre International de Chirurgie de la Main, Paris, France
- Hppe Sos Mains, Champigny-sur-Marne, France
- Institut de la Main, Clinique Bizet, Paris, France
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Vital L, Vidinha V, Neves N, Negrão P. Supracondylar Apophysis of the Humerus: Rare Cause of High Compression of the Median Nerve. Rev Bras Ortop 2023; 58:e659-e661. [PMID: 37663176 PMCID: PMC10468235 DOI: 10.1055/s-0040-1718509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022] Open
Abstract
Supracondylar apophysis (SA) is a bony prominence that originates from the anteromedial aspect of the distal humerus with a lower projection and which, although usually asymptomatic, due to the relationship with adjacent structures can cause symptoms. We describe the case of a 42-year-old woman with pain complaints radiating from her elbow to her hand, with 6 months of evolution. On objective examination, the patient had a sensory deficit in the median nerve territory and decreased grip strength. Radiographs of the distal humerus were performed, in which a bone spike was visible, and magnetic resonance imaging showed thickening of the median nerve epineurium. Electromyography showed severe axonal demyelination of the median nerve proximal to the elbow. A median nerve compression caused by a SA was diagnosed. The patient underwent surgery and, 1 year after the operation, she had a complete clinical recovery. Supracondylar apophysis is a rare, but possible and treatable cause of high median nerve compression.
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Affiliation(s)
- Luísa Vital
- Médicos Ortopedistas, Departamento de Ortopedia e Traumatologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Vitor Vidinha
- Médicos Ortopedistas, Departamento de Ortopedia e Traumatologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Nuno Neves
- Médicos Ortopedistas, Departamento de Ortopedia e Traumatologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Negrão
- Médicos Ortopedistas, Departamento de Ortopedia e Traumatologia, Centro Hospitalar Universitário de São João, Porto, Portugal
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Yarbrough B, Chan PYW, Tan V. Unusual Anatomic Location of the Median Nerve Within the Pronator Teres Muscle: A Case Report. JBJS Case Connect 2022; 12:01709767-202209000-00034. [PMID: 36049029 DOI: 10.2106/jbjs.cc.22.00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 57-year-old man presented with pain and paresthesia in both hands and was diagnosed with pronator teres syndrome. Surgical decompression of the left elbow and forearm revealed the median nerve in an unusual anatomic location, specifically running within the pronator teres muscle. CONCLUSION Anatomic anomalies of the pronator teres muscle and the path of the median nerve have been described. However, there are no reports of the median nerve entering and traveling within the pronator teres. Surgeons should be aware of this anomaly to avoid potential iatrogenic injury when performing an anterior surgical approach to the elbow and proximal forearm.
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Affiliation(s)
- Ben Yarbrough
- Institute for Hand and Arm Surgery, Madison, New Jersey
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Chalidis B, Karagergou E, Givissis P. Simultaneous Compression of the Neurovascular Bundle of Both Arms by a Bilateral Supracondylar Humeral Process: A Rare Case of Bilateral Nerve Entrapment of the Elbow in a Child. Cureus 2022; 14:e22694. [PMID: 35386159 PMCID: PMC8967118 DOI: 10.7759/cureus.22694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
The supracondylar process is a beak-shaped bone spur arising from the anteromedial area of the distal humerus and in the majority of cases, it is connected to the medial epicondyle with a band of connective tissue which is known as ligament of Struthers. The complex of bone spur and ligament creates a ring that may compress the median nerve causing soreness and paresthesia of the hand and fingers. We present a rare case of bilateral supracondylar process compressing the neurovascular bundles in both arms and causing simultaneous bilateral upper limb pain, numbness, and weakness in an otherwise healthy young child. Surgical excision of the bone spurs and release of Struthers' ligaments provided immediate pain relief and complete resolution of symptoms. Three years after the index surgery, no limitations of activities or signs of recurrence were reported. Median nerve compression neuropathy in a child or a young adult should always raise the suspicion of the presence of supracondylar process particularly when bilateral symptoms exist. Although there are limited data about the incidence of recurrence and the extent of bone resection, the supracondylar process should be excised together with the overlying periosteum to minimize the theoretical risk of local regrowth.
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Abstract
Compressive neuropathies of the forearm are common and involve structures innervated by the median, ulnar, and radial nerves. A thorough patient history, occupational history, and physical examination can aid diagnosis. Electromyography, X-ray, and Magnetic Resonance Imaging may prove useful in select syndromes. Generally, first line therapy of all compressive neuropathies consists of activity modification, rest, splinting, and non-steroidal anti-inflammatory drugs. Many patients experience improvement with conservative measures. For those lacking adequate response, steroid injections may improve symptoms. Surgical release is the last line therapy and has varied outcomes depending on the compression. Carpal Tunnel syndrome (CTS) is the most common, followed by ulnar tunnel syndrome. Open and endoscopic CTS release appear to have similar outcomes. Endoscopic release appears to incur decreased cost baring a low rate of complications, although this is debated in the literature. Additional syndromes of median nerve compression include pronator syndrome (PS), anterior interosseous syndrome, and ligament of Struthers syndrome. Ulnar nerve compressive neuropathies include cubital tunnel syndrome and Guyon’s canal. Radial nerve compressive neuropathies include radial tunnel syndrome and Wartenberg’s syndrome. The goal of this review is to provide all clinicians with guidance on diagnosis and treatment of commonly encountered compressive neuropathies of the forearm.
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Abstract
The supracondylar process is a rare but commonly reported anatomical variant of the humerus. Though it is usually asymptomatic, it can lead to serious symptoms. In this report, a lateral supracondylar process of the humerus was found. This is much rarer than a medial supracondylar process, and to our knowledge, it has not been reported previously. Surgeons and radiologists must account for supracondylar process variations to diagnose neurovascular pathology in the forearm accurately and quickly to optimize surgical outcomes. Here, we describe the origin and clinical importance of the supracondylar process variant.
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Affiliation(s)
- Somya Bhatnagar
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Joe Iwanaga
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Aaron S Dumont
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - R Shane Tubbs
- Neurosurgery and Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, USA
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Chun SW, Lim SK. The utility of electrodiagnostic inching study and conservative treatment in supracondylar process syndrome: A case report. Medicine (Baltimore) 2020; 99:e20506. [PMID: 32481471 DOI: 10.1097/md.0000000000020506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Supracondylar process is a rare bony anomaly that can cause neurovascular symptoms. Previous reports on supracondylar process syndrome mostly suspect the condition by physical examination and simple radiograph with little assistance of electrodiagnostic methods and report efficiency of surgical treatment. PATIENTS CONCERNS A 45-year-old woman working at an assembly line packing boxes presented with tingling pain at her middle and ring fingers that started 2 months ago. She had positive Tinel sign at the medial side of the distal arm. DIAGNOSIS Electrodiagnostic inching study on median nerve was conducted and the conduction velocity at the segment between 3 cm to 5 cm proximal to the elbow crease was decreased to 27m/s. Following imaging studies revealed supracondylar process at 4.2 cm proximal to the medial epicondyle. She was successfully treated with conservative treatment. INTERVENTIONS Oral medications including Non-steroidal anti-inflammatory drug and pregabalin were prescribed along with superficial and deep heat modalities. The extent of manual labor was modified. Additionally, self-massage and stretching/nerve-gliding exercises were delivered. OUTCOMES The symptoms substantially improved and she could sleep without trouble, however, complete resolution was not achieved. After a year, she was nearly symptom-free after changing occupations with only occasional tingling after manual labor of unusual intensity. LESSONS This case report enlightens the versatility of electrodiagnostic inching study in localizing median neuropathy at the distal arm and the effectiveness of conservative treatment in supracondylar process syndrome.
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Affiliation(s)
- Se-Woong Chun
- Department of Rehabilitation Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
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Caetano EB, Sabongi JJ, Vieira LA, Caetano MF, de Bona JE, Simonatto TM. STRUTHERS' LIGAMENT AND SUPRACONDYLAR HUMERAL PROCESS: AN ANATOMICAL STUDY AND CLINICAL IMPLICATIONS. ACTA ORTOPEDICA BRASILEIRA 2017; 25:137-142. [PMID: 28955169 PMCID: PMC5608727 DOI: 10.1590/1413-785220172504168330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/24/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to determine the frequency and anatomical characteristics of Struthers' ligament and the supracondylar humeral process and evaluate the clinical implications in compressive neuropathy of the median nerve . METHOD We dissected 60 arms from 30 cadavers (26 males and 4 females): 15 were previously preserved in formalin and glycerin and 15 were dissected fresh in the Anatomy Laboratory for this paper. The relationships between Struthers' ligament and the median nerve and brachial artery and veins were documented with drawings and photos . RESULTS The supracondylar humeral process was not found in any of the 60 dissected arms. Struthers' ligament was identified in six arms (two bilateral); in all cases high insertion of the pronator teres muscle was observed . CONCLUSION Struthers' ligament is an aponeurotic structure that may or may not be associated with the supracondylar humeral process, and is an important potential site of median nerve compression in the lower third of the arm. Level of Evidence IV, Case Series.
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Affiliation(s)
- Edie Benedito Caetano
- . Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Sorocaba, SP, Brazil
| | - João José Sabongi
- . Conjunto Hospitalar de Sorocaba, Department of Hand Surgery, Sorocaba, SP, Brazil
| | - Luiz Angelo Vieira
- . Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Sorocaba, SP, Brazil
| | | | - José Eduardo de Bona
- . Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Sorocaba, SP, Brazil
| | - Thais Mayor Simonatto
- . Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Sorocaba, SP, Brazil
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Lessard Bonaventure P, Khuong HT. Struthers' ligament and traumatic median nerve injury: case illustration. J Neurosurg 2016; 126:938-939. [PMID: 27177170 DOI: 10.3171/2016.3.jns152159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Paule Lessard Bonaventure
- Department of Neurological Sciences, Division of Neurosurgery, CHU de Québec-Université Laval, Québec, Canada
| | - Hélène T Khuong
- Department of Neurological Sciences, Division of Neurosurgery, CHU de Québec-Université Laval, Québec, Canada
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Meda N, Verma H, Tripathi RK. Ischemic brachial artery entrapment syndrome by supracondylar humeral bony spur. J Vasc Surg Cases 2015; 1:116-119. [PMID: 31724601 PMCID: PMC6849887 DOI: 10.1016/j.jvsc.2015.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 03/01/2015] [Indexed: 11/17/2022] Open
Abstract
Medial supracondylar spur from the humerus is a rare cause of neurovascular pain of the upper extremity. The spur typically entraps the brachial artery and median nerve, resulting in compression-related symptoms. In advance stages, compression could lead to endothelial damage and thrombotic occlusion of brachial artery. Spur is also associated with an anomalous higher insertion of the pronator teres muscle, which could result in multilevel entrapment of the brachial artery. We report a patient with acute upper limb ischemia secondary to brachial artery compression and distal embolization from a medial supracondylar spur and anomalous attachment of the pronator teres. The entrapped brachial artery and median nerve were released by resection of the spur and of the anomalous belly of the pronator teres with thrombectomy of brachial artery.
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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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Abstract
Peripheral nerve entrapments are frequent. They usually appear in anatomical tunnels such as the carpal tunnel. Nerve compressions may be due to external pressure such as the fibular nerve at the fibular head. Malignant or benign tumors may also damage the nerve. For each nerve from the upper and lower limbs, detailed clinical, electrophysiological, imaging, and therapeutic aspects are described. In the upper limbs, carpal tunnel syndrome and ulnar neuropathy at the elbow are the most frequent manifestations; the radial nerve is less frequently involved. Other nerves may occasionally be damaged and these are described also. In the lower limbs, the fibular nerve is most frequently involved, usually at the fibular head by external compression. Other nerves may also be involved and are therefore described. The clinical and electrophysiological examination are very important for the diagnosis, but imaging is also of great use. Treatments available for each nerve disease are discussed.
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Affiliation(s)
- P Bouche
- Department of Clinical Neurophysiology Salpêtrière Hospital, Paris, France.
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Voisin JL. Les caractères discrets des membres supérieurs : un essai de synthèse des données. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s13219-011-0050-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Abstract
Acute and chronic elbow pain is common, particularly in athletes. Although plain radiographs, ultrasound, and computed tomography all have a role to play in the investigation of elbow pain, magnetic resonance imaging (MRI) has emerged as the imaging modality of choice for diagnosis of soft tissue disease and osteochondral injury around the elbow. The high spatial resolution, excellent soft-tissue contrast, and multiplanar imaging capabilities of MRI make it ideal for evaluating the complex joint anatomy of the elbow. This article reviews imaging of common disease conditions occurring around the elbow in athletes, with an emphasis on MRI.
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Affiliation(s)
- Kathryn J Stevens
- Department of Radiology, Stanford University Medical Center, Stanford University School of Medicine, Room S-062A Grant Building, 300 Pasteur Drive, Stanford, CA 94305-5105, USA.
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Escámez Pérez A, Salcedo Cánovas C, Alarcón Zamora A, Martínez Herrada J. [Median nerve compression neuropathies: Struthers ligament and carpal tunnel]. An Pediatr (Barc) 2009; 71:584-5. [PMID: 19836320 DOI: 10.1016/j.anpedi.2009.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 07/28/2009] [Accepted: 08/26/2009] [Indexed: 10/20/2022] Open
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Abstract
Several tunnel syndromes are responsible for substantial functional impairment. The diagnosis has to be made and treatment is most often very simple--nerve decompression--with excellent results. Of these syndromes, the most common are median and ulnar tunnel syndromes of the wrist and ulnar tunnel syndrome of the elbow, but other syndromes must be identified at the risk of therapy failure due to poorly adapted treatment. Finally, good knowledge of this pathology must lead to prevention of the iatrogenic forms (sequelae of inguinal hernia treatment, ileac crest graft harvesting) by educating all surgeons interested in peripheral nerve surgery.
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Natsis K. Supracondylar process of the humerus: Study on 375 Caucasian subjects in Cologne, Germany. Clin Anat 2008; 21:138-41. [DOI: 10.1002/ca.20601] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Varlam H, St Antohe D, Chistol RO. [Supracondylar process and supratrochlearforamen of the humerus: a case report and a review of the literature]. Morphologie 2006; 89:121-5. [PMID: 16444940 DOI: 10.1016/s1286-0115(05)83248-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED The authors present a case where the main variants of the humerus were associated on the same specimen: the supracondylar process and the supratrochlear foramen. The supracondylar process, a bony prominence situated on the anteromedial surface of the humerus in the vicinity of the medial epicondyle, could be at the origin of ulnar or median nerve and brachial artery compression syndromes, especially when associated with Struthers' ligament. MATERIAL AND METHOD The anatomic specimen was discovered accidentally during a larger study aimed at establishing a current norma anatomica and morphometry of the humerus. The supracondylar process and the supratrochlear foramen were morphologically and morphometrically analyzed. RESULTS AND DISCUSSION The supracondylar process was situated on the anteromedial surface of a left humerus, roughly 5 cm above the medial epicondyle. It was 12.4 mm in length, mediodistally directed. The supratrochlear foramen was situated above the lateral part of the humeral trochlea, just adjacent to the middle branch of trifurcation of the anterior border of the humerus. It was ovoid in shape with the long axis transversally (6.3/3.7 mm). CONCLUSIONS Presentation of such variants contributes to increasing the anatomical data capital and might be important for diagnosis of peripheral neurovascular compression syndromes.
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Affiliation(s)
- H Varlam
- Département d'Anatomie, Université de Médecine et de Pharmacie Gr. T. Popa, 16, Rue Universitáţii, 700115-Iasi, Roumanie.
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Lordan J, Rauh P, Spinner RJ. The clinical anatomy of the supracondylar spur and the ligament of Struthers. Clin Anat 2005; 18:548-51. [PMID: 16134126 DOI: 10.1002/ca.20132] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jeffrey Lordan
- Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, United Kingdom.
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Abstract
The purpose of this clinical commentary is to provide a comprehensive review of compressive neuropathies that may mimic carpal tunnel syndrome, provide the clinician with information to differentially diagnose these median nerve compression sites, and provide an evidence-based opinion regarding conservative intervention techniques for the various compression syndromes. While rare in comparison to carpal tunnel syndrome, pronator syndrome and anterior interosseous nerve syndrome are proximal median nerve compressions that may be suspected if a patient with carpal tunnel syndrome fails to respond to conservative or surgical intervention. Differential diagnosis is based largely on the symptoms, patterns of paresthesia, and specific patterns of muscle weakness. Due to the relative rarity of pronator syndrome and anterior interosseous nerve syndrome, few controlled studies exist to determine the most effective treatment techniques. Based on sound anatomical and biomechanical considerations, anecdotal experience, and available research, however, treatment strategies for pronator syndrome and anterior interosseous nerve syndrome compression neuropathies can be divided into 4 major categories: (1) rest/immobilization, (2) modalities, (3) nerve gliding, and (4) nonconservative treatment.
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Affiliation(s)
- Michael J Lee
- Physical Therapist, Sonoran Shoulder, Elbow & Hand Rehabilitation, PC, Tucson, AZ 85704, USA.
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