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Topographic anatomy of structures liable to compress the median nerve at the elbow and proximal forearm
- Source :
- Orthopaedicstraumatology, surgeryresearch : OTSR. 107(2)
- Publication Year :
- 2019
-
Abstract
- Introduction Several structures liable to compress the median nerve have been described around the elbow and proximal forearm. Signs of deficit justify surgical exploration and decompression by exoneurolysis. Better knowledge of the locations of these structures would ensure reliable and effective exploration. Hypothesis The study hypothesis was that compressive structures show precise topography, with few variations in distance along the median nerve course. Material and methods The study was performed on 36 upper-limb cadaver specimens. The measurement reference level was the humeral bi-epicondylar line. Proximal-to-distal dissection located: (1) Struthers’ ligament, (2) the pronator teres bellies (PT) with their anatomic particularities of structure and insertion, (3) the lacertus fibrosus, (4) the fibrous arcade of the flexor digitorum superficialis (FDS), (5) the accessory muscles, (6) the origin of the anterior interosseous nerve (AIN), (7) and the vascular arches. Results Struthers’ ligament was not located, but 1 case of medial bicipital fibrous arcade was found. The lacertus fibrosus crossed the median nerve at +1.5 ± 0.6 cm. PT insertion was high in 19 cases (53%). The humeral PT belly was thin in 21 cases (58%), crossing the median nerve more distally (+1.8 ± 0.8 cm) than the thicker muscles (+1 ± 1.1 cm) (p = 0.016). The ulnar PT belly was fibrous in 14 cases (39%). A fibrous arcade was found between the 2 PT bellies in 23 cases (64%). The FDS arcade was located at 4.5–7 cm from the bi-epicondylar line. An accessory flexor pollicis longus belly was found in 11% of cases. The AIN origin was at +4 ± 1.6 cm from the reference. A vascular pedicle crossed the median nerve in 3 cases. Discussion The present study inventoried and mapped 6 potentially compressive structures neighboring or crossing the median nerve. Except for the FDS arcade, they showed very precise proximal-to-distal location, with variations of 0.5 to 1.5 cm. Level of evidence IV; case series.
- Subjects :
- medicine.medical_specialty
Elbow
Tendons
03 medical and health sciences
0302 clinical medicine
Forearm
Cadaver
Elbow Joint
medicine
Humans
Orthopedics and Sports Medicine
Muscle, Skeletal
030222 orthopedics
biology
business.industry
030229 sport sciences
Anatomy
biology.organism_classification
Anterior interosseous nerve
Median nerve
Surgery
Median Nerve
Muscles of respiration
medicine.anatomical_structure
Ligament
business
Lacertus
Subjects
Details
- ISSN :
- 18770568
- Volume :
- 107
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Orthopaedicstraumatology, surgeryresearch : OTSR
- Accession number :
- edsair.doi.dedup.....4f288a9ddc1d1712ed82664c828bc99f