Anatomical basis for a technique of ulnar nerve transposition

Amadio, Peter C.

doi:10.1007/bf02427843

Cited by 59 publications

(12 citation statements)

References 44 publications

(42 reference statements)

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“…[2223] Interestingly, Struthers never mentioned an “arcade” in his writings,[16] and such a structure was only later attributed to him in 1973 by Kane et al .,[14] who identified this structure in 70% of their cadaveric dissections, and these were located 8 cm proximal to the medial epicondyle of the humerus. In 1986, Amadio[2] identified an arcade of Struthers in 100% of 20 cadaveric arm dissections and localized this structure 6–10 cm proximal to the medial epicondyle. Al-Qattan and Murray[1] in their anatomical studies reported the existence of an arcade of Struthers in 68% of cadaveric specimens (17 of 25 specimens), which is similar to the 70% incidence reported by Kane et al .…”

Section: Discussionmentioning

confidence: 99%

The arcade of Struthers: An anatomical study with potential neurosurgical significance

Tubbs

Deep²,

Shoja³

et al. 2011

Surg Neurol Int

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Background:Significant controversy exists regarding the existence of the so-called arcade of Struthers and whether this structure is involved in some cases of proximal ulnar nerve entrapment. Therefore, the aim of the present study was to further elucidate this anatomy.Methods:Fifteen cadavers (30 sides) underwent dissection of the medial arm with special attention to the course of the ulnar nerve and its relationships to the soft tissues of this region.Results:We identified a thickening in the inferior medial arm that crosses the ulnar nerve and is consistent with the so-called arcade of Struthers in 86.7% of sides. On 57.7% of the sides, the arcade was found to be due to a thickening of the brachial fascia and was classified as a type I arcade. On 19.2% of the sides, the arcade was due to the internal brachial ligament and these were classified as type II arcades. On 23.1% of the sides, the arcade was due to a thickened medial intermuscular septum and these were classified as type III arcades. The mean length of the arcade was 4.3 cm and the distal end of the arcade was, on average, 6.8 cm above the medial epicondyle. Although the presence of an arcade of Struthers was slightly more common in female specimens, this did not reach statistical significance. However, arcades were found more often on right side (P < 0.001).Conclusions:Based on our findings, the arcade of Struthers is an anatomical band of connective tissue in the medial distal arm that crosses the ulnar nerve. This structure was found in the majority of our specimens and may need to be evaluated in proximal ulnar neuropathies. We believe that past studies that have not observed the arcade and past studies with varied findings are due to the various definitions used for this anatomical structure. Using the classification system as demonstrated in the present study may make future communications regarding the arcade of Struthers more exact.

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Section: Discussionmentioning

confidence: 99%

The arcade of Struthers: An anatomical study with potential neurosurgical significance

Tubbs

Deep²,

Shoja³

et al. 2011

Surg Neurol Int

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“…A fibrous tunnel surrounding the ulnar nerve at the transition between compartments is a relatively constant feature, found in 67-100% in several anatomic series (Kane et al 1973;Amadio 1986;Al-Qattan and Murray 1991;Gonzalez et al 2001;Wehrli and Oberlin 2005;Tubbs et al 2011a). Others have concluded differently however, finding that the ulnar nerve crossed from the anterior to posterior without passing through the medial intermuscular septum or that the passage had a non-constraining "roof " (Dellon 1986;Won et al 2011).…”

Section: Regional Relationshipsmentioning

confidence: 99%

Nerves of the Upper Extremity

Mahan

Spinner

2016

Bergman's Comprehensive Encyclopedia of Human Anatomic Variation

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“…The ulnar nerve then continues down the forearm within the enveloping fascia of the FDS, separate from the FCU. 2,18,23,26 The narrow aperture of these structures may participate as a primary cause of cubital tunnel syndrome, as a distinct location from the retrocondylar retinaculum. 8,9 Similar to the retrocondylar retinaculum, the ulnar nerve is compressed by the fascial structures of the FCU in elbow flexion.…”

Section: Consistent Anatomy Of the Fibrous Arcadementioning

confidence: 99%

Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited

Mahan

Gasco

Mokhtee³

et al. 2015

JNS

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OBJECT Surgical transposition of the ulnar nerve to alleviate entrapment may cause otherwise normal structures to become new sources of nerve compression. Recurrent or persistent neuropathy after anterior transposition is commonly attributable to a new distal compression. The authors sought to clarify the anatomical relationship of the ulnar nerve to the common aponeurosis of the humeral head of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) muscles following anterior transposition of the nerve. METHODS The intermuscular septa of the proximal forearm were explored in 26 fresh cadaveric specimens. The fibrous septa and common aponeurotic insertions of the flexor-pronator muscle mass were evaluated in relation to the ulnar nerve, with particular attention to the effect of transposition upon the nerve in this region. RESULTS An intermuscular aponeurosis associated with the FCU and FDS muscles was present in all specimens. Transposition consistently resulted in angulation of the nerve during elbow flexion when this fascial septum was not released. The proximal site at which the nerve began to traverse this fascial structure was found to be an average of 3.9 cm (SD 0.7 cm) from the medial epicondyle. CONCLUSIONS The common aponeurosis encountered between the FDS and FCU muscles represents a potential site of posttransposition entrapment, which may account for a subset of failed anterior transpositions. Exploration of this region with release of this structure is recommended to provide an unconstrained distal course for a transposed ulnar nerve.

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Anatomical basis for a technique of ulnar nerve transposition

Cited by 59 publications

References 44 publications

The arcade of Struthers: An anatomical study with potential neurosurgical significance

The arcade of Struthers: An anatomical study with potential neurosurgical significance

Nerves of the Upper Extremity

Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited

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