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Original article
Published online: 2020-05-04
Submitted: 2020-03-04
Accepted: 2020-03-30
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An anatomical investigation of rare upper limb neuropathies due to the Struthers’ ligament or arcade: a meta-analysis

E. Mizia, M. P. Zarzecki, J. R. Pekala, A. Baginski, L. N. Kaythampillai, M. Golebiowska, P. A. Pekala, J. A. Walocha, K. A. Tomaszewski
DOI: 10.5603/FM.a2020.0050
·
Pubmed: 32394418

open access

Ahead of Print
ORIGINAL ARTICLES
Published online: 2020-05-04
Submitted: 2020-03-04
Accepted: 2020-03-30

Abstract

The Struthers’ ligament is a fibrous band that originates from the supracondylar humeral process and inserts into the medial humeral epicondyle, potentially compressing both the median nerve and brachial artery. The controversial Struthers’ arcade 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 Struthers’ ligament and arcade, and their anatomical features. A meticulous search of major electronic medical databases was carried out regarding both structures. Applicable articles (and all relevant references) were analyzed. Data from the eligible articles was extracted and evaluated. The quality and the potential risk of bias in the included studies was assessed using the AQUA tool. The arcade was reported in 13 studies (510 arms), whereas the ligament in six 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 one study reported compression of the median nerve by the ligament, whilst another contradicted this view. Although the Struthers’ ligament is rare, and the Struthers’ arcade 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

The Struthers’ ligament is a fibrous band that originates from the supracondylar humeral process and inserts into the medial humeral epicondyle, potentially compressing both the median nerve and brachial artery. The controversial Struthers’ arcade 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 Struthers’ ligament and arcade, and their anatomical features. A meticulous search of major electronic medical databases was carried out regarding both structures. Applicable articles (and all relevant references) were analyzed. Data from the eligible articles was extracted and evaluated. The quality and the potential risk of bias in the included studies was assessed using the AQUA tool. The arcade was reported in 13 studies (510 arms), whereas the ligament in six 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 one study reported compression of the median nerve by the ligament, whilst another contradicted this view. Although the Struthers’ ligament is rare, and the Struthers’ arcade 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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Title

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

Journal

Folia Morphologica

Issue

Ahead of Print

Article type

Original article

Published online

2020-05-04

DOI

10.5603/FM.a2020.0050

Pubmed

32394418

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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