Endoscopic Excision of Supracondylar Humeral Spur for Decompression of the Median Nerve and Brachial Artery

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.

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

“…This bony prominence may be appreciated by clinicians and surgeons, as it can cause brachial artery, median nerve, ulnar artery or ulnar nerve compression thus causing neuropathies or vaso occlusive diseases (Thompson & Edwards;Tzaveas et al, 2010;Bain et al, 2016).…”

Upper Extremity Entrapment Neuropathy

“…The neurovascular structures that are most compressed in this entrapment site are the median nerve and the brachial artery (Figure 6). [32,33] Description: It is a condition characterized by the compression of the median nerve between the Struther's ligament and the bony prominence in the distal humerus. [32][33][34] Causes: Congenital bone spur in beak-shaped form located in the distal part of the humerus called the supracondylar process.…”

“…[32][33][34] Causes: Congenital bone spur in beak-shaped form located in the distal part of the humerus called the supracondylar process. [32,33]…”

Elbow arthroscopy: state of the art

“…The principles of ulnar nerve surgery developed for open techniques are being transferred to the endoscopic procedure, including resection of the medial intramuscular septum (figure 21). Endoscopic surgical releases have also been described for the anterior interosseous nerve and the median nerve beneath the Struthers ligament95 (figure 22). …”