Tosin Davide, Antoniadis Gregor, Wirtz Christian Rainer, Pedro Maria Teresa
Neurochirurgie, Bezirkskrankenhaus Günzburg, Günzburg, Germany.
Klinik für Neurochirurgie, Universitatsklinikum Ulm, Ulm, Germany.
Handchir Mikrochir Plast Chir. 2024 Feb;56(1):101-105. doi: 10.1055/a-2234-4636. Epub 2024 Feb 15.
A supracondylar process is a bony spur on the distal anteromedial surface of the humerus, and it is considered an anatomical variant with a prevalence of 0.4-2.7% according to anatomical studies. In almost all cases, it is associated with a fibrous, sometimes ossified ligament, which extends from the supracondylar process to the medial epicondyle. This ligament is known in the literature as the ligament of Struthers, named after the Scottish anatomist who first described it in detail in 1854. In rare cases, the supracondylar process can be a clinically relevant finding as a cause of nerve compression syndrome. The median and ulnar nerve can be trapped by the ring-shaped structure formed by the ligament of Struthers and the supracondylar process.
A 59-year-old patient with symptoms of a cubital tunnel syndrome and additional ipsilateral sensory deficits in his thumb was referred to our clinic. Electroneurography showed no signs of an additional carpal tunnel syndrome. Preoperative x-ray and CT scans of the upper arm revealed a supracondylar process, which led us to suspect an associated entrapment of the median nerve. An MRI scan of the upper arm showed a ligament of Struthers and signs of a related median nerve compression as we initially assumed. We performed a surgical decompression of the median nerve in the distal upper arm and of the ulnar nerve in the cubital tunnel. Intraoperatively, there was evidence of compression of the median nerve due to the supracondylar process and the ligament of Struthers. The latter was cleaved and then resected along with the supracondylar process. Three months after surgery, the patient had no motor or sensory deficits.
The ring-shaped structure formed by the supracondylar process and ligament of Struthers represents a rare cause of compression syndrome of the median and ulnar nerve. Its incidence remains unknown so far. This anatomical variant should be considered a differential diagnosis in case of possibly related nerve entrapment symptoms after ruling out other, more frequent nerve compression causes. Moreover, the supracondylar process should be completely resected including the periosteum during surgery to minimise the risk of recurrence.
髁上突是肱骨远端前内侧表面的骨质增生，根据解剖学研究，它被认为是一种解剖变异，发生率为0.4 - 2.7%。在几乎所有病例中，它都与一条纤维性、有时会骨化的韧带相关，该韧带从髁上突延伸至内上髁。这条韧带在文献中被称为斯特鲁瑟斯韧带，以1854年首次详细描述它的苏格兰解剖学家命名。在罕见情况下，髁上突作为神经压迫综合征的病因可能具有临床相关性。正中神经和尺神经可能被斯特鲁瑟斯韧带和髁上突形成的环形结构卡压。
一名59岁患者因出现肘管综合征症状且同侧拇指有额外感觉缺失被转诊至我院。神经电生理检查未显示合并腕管综合征的迹象。术前上臂的X线和CT扫描显示有髁上突，这使我们怀疑正中神经存在相关卡压。上臂的MRI扫描显示存在斯特鲁瑟斯韧带以及如我们最初所推测的相关正中神经受压迹象。我们对上臂远端的正中神经和肘管内的尺神经进行了手术减压。术中，有证据表明正中神经因髁上突和斯特鲁瑟斯韧带而受压。将后者劈开，然后与髁上突一并切除。术后三个月，患者无运动或感觉缺失。
髁上突和斯特鲁瑟斯韧带形成的环形结构是正中神经和尺神经压迫综合征的罕见病因。其发生率目前尚不清楚。在排除其他更常见的神经压迫原因后，如果出现可能相关的神经卡压症状，应将这种解剖变异考虑为鉴别诊断。此外，手术中应将髁上突包括骨膜完全切除，以尽量降低复发风险。
