Struthers’ Ligament and Supracondylar Humeral Process: An Anatomical Study and Clinical Implications

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.

A Meta-Analysis of the Supracondylar Process of the Humerus with Clinical and Surgical Applications to Orthopedics

“…A total of twentyfour studies in twenty articles (Gruber, 1865;Testut, 1889;Terry, 1921;Cady, 1922;Hrdlicka;Pieper, 1925;Cady & Francis, 1927;Sibata, 1941;Parkinson, 1954;Newman, 1969;Dellon, 1986;Oluyemi et al, 2007;Kumar & Mehta, 2008;Natsis, 2008;Aydinlioglu et al, 2010;Shivaleela et al;Hema & Tanuja, 2015;Caetano et al) were included in this meta-analysis. The largest number of studies were from the United States of America (8 in total), followed by 5 from India.…”

“…The SP is also known as the supracondyloid process, supratrochlear spur or the supraepitrochlear process. It was first described by Tiedmann in 1818 (Shivaleela et al, 2014;Caetano et al, 2017).…”

“…The SP is sometimes accompanied by a fibrous (sometimes osseous or osteofibrous) arcade known as the Struther's ligament ( Fig. 1), which connects the apex of the SP to the medial epicondyle, thus, forming a tunnel in which the ulnar artery and nerve traverses (the supracondylar foramen) -a disposition also present in cats and in lower primates (De Jesus & Dellon, 2003;Caetano et al).…”

Apófise supracondilar do úmero: Causa rara de compressão alta do nervo mediano

“…Esta entidade representa um desafio diagnóstico dada a apresentação clínica semelhante à neuropatia mais comum do membro superior -Síndrome do túnel do carpo e também pelos múltiplos locais possíveis de compressão do nervo mediano ao nível do cotovelo, que incluem: entre as cabeças do pronador redondo, na arcada aponeurótica formada pela inserção proximal dos músculos flexores do antebraço, e no lacertus fibrosus. 5 Também deve fazer parte dos diagnósticos diferenciais a possibilidade de se tratar de ossificação heterotópica ou osteocondroma, sendo que este apresenta características diferenciadoras que passam pela orientação da espicula óssea-não apontando em direção à articulação e continuando com a cortical do úmero. 6 Alguns casos clínicos de compressão neurovascular associados a esta estrutura estão descritos na literatura: Aydinlioglu et al 7 descreveram um caso de compressão bilateral do nervo mediano pela ASC; May-Miller et al 8 reportaram um caso raríssimo de compressão do nervo cubital, e existem também relatos de fratura desta estrutura.…”

Common Entrapment Neuropathies

“…In addition, pronation and/or supination with extended elbow may aggravate the symptoms and even reduce the radial pulse. 12,13 Moving distally, the median nerve can be entrapped by either the FDS, bicipital aponeurosis, or PT muscle itself. This will lead to a pronator syndrome (PS).…”