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Vol 80, No 2 (2021)
Original article
Submitted: 2020-03-04
Accepted: 2020-03-30
Published online: 2020-05-04
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An anatomical investigation of rare upper limb neuropathies due to the Struthers’ ligament or arcade: a meta-analysis

E. Mizia1, M. P. Zarzecki12, J. R. Pekala12, A. Baginski1, L. N. Kaythampillai1, M. Golebiowska1, P. A. Pekala12, J. A. Walocha12, K. A. Tomaszewski12
DOI: 10.5603/FM.a2020.0050
·
Pubmed: 32394418
·
Folia Morphol 2021;80(2):255-266.
Affiliations
  1. Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
  2. International Evidence-Based Anatomy Working Group, Krakow, Poland

open access

Vol 80, No 2 (2021)
ORIGINAL ARTICLES
Submitted: 2020-03-04
Accepted: 2020-03-30
Published online: 2020-05-04

Abstract

Background: The Struthers’ ligament (SL) is a fibrous band that originates fromthe supracondylar humeral process and inserts into the medial humeral epicondyle, potentially compressing both the median nerve and brachial artery. The controversial Struthers’ arcade (SA) is a musculotendinous band found in the distal end of the arm that might compress the ulnar nerve. This study aimed to evaluate the pooled prevalence estimate of the SL and SA, and their anatomical features. Materials and methods: A meticulous search of major electronic medical databases was carried out regarding both structures. Applicable articles (and all relevant references) were analysed. Data from the eligible articles was extracted and evaluated. The quality and the potential risk of bias in the included studies were assessed using the AQUA tool. Results: The arcade was reported in 13 studies (510 arms), whereas the ligament in 6 studies (513 arms). The overall pooled prevalence estimate of the ligament was 1.8%, and 52.6% for the arcade. Most frequently, the ulnar nerve was covered by a tendinous arcade (42.2%). In all cases, the ligament inserted into the medial humeral epicondyle, but had various origins. Only 1 study reported compression of the median nerve by the ligament, whilst another contradicted this view. Conclusions: Although the SL is rare, and the SA is a valid anatomical entity (though with a variable presentation), clinically meaningful neurovascular entrapments caused by these structures are infrequent. Nonetheless, a better understanding of each may be beneficial for the best patient outcomes.

Abstract

Background: The Struthers’ ligament (SL) is a fibrous band that originates fromthe supracondylar humeral process and inserts into the medial humeral epicondyle, potentially compressing both the median nerve and brachial artery. The controversial Struthers’ arcade (SA) is a musculotendinous band found in the distal end of the arm that might compress the ulnar nerve. This study aimed to evaluate the pooled prevalence estimate of the SL and SA, and their anatomical features. Materials and methods: A meticulous search of major electronic medical databases was carried out regarding both structures. Applicable articles (and all relevant references) were analysed. Data from the eligible articles was extracted and evaluated. The quality and the potential risk of bias in the included studies were assessed using the AQUA tool. Results: The arcade was reported in 13 studies (510 arms), whereas the ligament in 6 studies (513 arms). The overall pooled prevalence estimate of the ligament was 1.8%, and 52.6% for the arcade. Most frequently, the ulnar nerve was covered by a tendinous arcade (42.2%). In all cases, the ligament inserted into the medial humeral epicondyle, but had various origins. Only 1 study reported compression of the median nerve by the ligament, whilst another contradicted this view. Conclusions: Although the SL is rare, and the SA is a valid anatomical entity (though with a variable presentation), clinically meaningful neurovascular entrapments caused by these structures are infrequent. Nonetheless, a better understanding of each may be beneficial for the best patient outcomes.

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Keywords

Struthers’ arcade, Struthers’ ligament, meta-analysis

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About this article
Title

An anatomical investigation of rare upper limb neuropathies due to the Struthers’ ligament or arcade: a meta-analysis

Journal

Folia Morphologica

Issue

Vol 80, No 2 (2021)

Article type

Original article

Pages

255-266

Published online

2020-05-04

Page views

1967

Article views/downloads

1657

DOI

10.5603/FM.a2020.0050

Pubmed

32394418

Bibliographic record

Folia Morphol 2021;80(2):255-266.

Keywords

Struthers’ arcade
Struthers’ ligament
meta-analysis

Authors

E. Mizia
M. P. Zarzecki
J. R. Pekala
A. Baginski
L. N. Kaythampillai
M. Golebiowska
P. A. Pekala
J. A. Walocha
K. A. Tomaszewski

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