The sublime bridge: anatomy and implications in median nerve entrapment

Abstract

Based on the authors' study, pronator syndrome is an incorrect term applied to compression of the median nerve at the sublime bridge. This potential site of median nerve compression is distinct and has characteristics that can clinically differentiate it from compression of the median nerve between the heads of the pronator teres. The authors hope that these data will be of use to the surgeon in the evaluation and treatment of patients with proximal median nerve entrapment.

Skin, fascias, and scars: symptoms and systemic connections

“…The arcade of Struthers, the Frohse’s arcade, and the sublime bridge are connective structures that correlate the brachial fascia anteriorly and posteriorly at the level of the elbow 95–97. The brachial fascia arrives at the deltoid fascia, which derives from the pectoral fascia 81,98,99.…”

Sonography of the Pronator Teres: Normal and Pathologic Appearances

“…The nerve innervates the pronator teres through 1 or 2 long branches that originate approximately 4 cm distal to the medial epicondyle. These branches may be used for neurotization of the radial nerve . The brachial artery runs parallel to the lateral side of the pronator teres.…”

MR Imaging of the Nerves of the Upper Extremity

“…26,27 Patients present typically with aching forearm pain with tenderness to palpation or a Tinel's sign localized to the proximal margin of the pronator teres, and symptoms may increase with pronation and supination of the forearm. 26,28 An additional potential site of median nerve entrapment in the proximal forearm is at the tendinous arch between the radial and humeral heads of the flexor digitorum superficialis that is volar to the median nerve referred to as the "sublimis bridge." 28 Additional potential etiologies of compression of the median nerve in the proximal forearm include masses, accessory muscles (Gantzer's muscle, accessory head of the flexor pollicis longus), and the bicipital aponeurosis.…”

“…26,28 An additional potential site of median nerve entrapment in the proximal forearm is at the tendinous arch between the radial and humeral heads of the flexor digitorum superficialis that is volar to the median nerve referred to as the "sublimis bridge." 28 Additional potential etiologies of compression of the median nerve in the proximal forearm include masses, accessory muscles (Gantzer's muscle, accessory head of the flexor pollicis longus), and the bicipital aponeurosis. [28][29][30] The ligament of Struthers and associated supracondylar process is a site of median nerve entrapment that is located above the elbow with similar clinical features as entrapment in the proximal forearm.…”

“…28 Additional potential etiologies of compression of the median nerve in the proximal forearm include masses, accessory muscles (Gantzer's muscle, accessory head of the flexor pollicis longus), and the bicipital aponeurosis. [28][29][30] The ligament of Struthers and associated supracondylar process is a site of median nerve entrapment that is located above the elbow with similar clinical features as entrapment in the proximal forearm. An anatomic study by Natsis 31 found that, when present, the supracondylar process located an average of 59.8 mm proximal to the medial epicondyle with 79.0 mm being the furthest location proximal to the epicondyle.…”