Journal
FOLIA MORPHOLOGICA
Volume 80, Issue 2, Pages 255-266Publisher
VIA MEDICA
DOI: 10.5603/FM.a2020.0050
Keywords
Struthers' arcade; Struthers' ligament; meta-analysis
Categories
Funding
- Polish Ministry of Science and Higher Education
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The study evaluated the pooled prevalence estimate of the Struthers' ligament (SL) and arcade (SA), finding a prevalence of 1.8% for the ligament and 52.6% for the arcade, with the ulnar nerve most commonly covered by a tendinous arcade. While some studies reported compression of the median nerve by the ligament, clinically meaningful neurovascular entrapments caused by these structures are infrequent. A better understanding of each may contribute to improved patient outcomes.
Background: The Struthers' ligament (SL) 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 (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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