Median Nerve Compression within the Humeral Head of Pronator Teres

We describe a case of the pronator syndrome caused by compression of the median nerve by a fibrous band as the nerve passed through the humeral head of origin of pronator teres. This rare anatomical arrangement resulted in displacement of the median nerve to the anterior aspect of the medial humeral epicondyle and, as far as we are aware, has not previously been described as a site of compression neuropathy.

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Morphology and morphometry of the ulnar head of the pronator teres muscle in relation to median nerve compression at the proximal forearm

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2016.08.016 ◽

2016 ◽

Vol 102 (8) ◽

pp. 1005-1008 ◽

Cited By ~ 3

Author(s):

I.A. Gurses ◽

L. Altinel ◽

O. Gayretli ◽

T. Akgul ◽

I. Uzun ◽

...

Keyword(s):

Median Nerve ◽

Nerve Compression ◽

Median Nerve Compression ◽

Ulnar Head ◽

Pronator Teres ◽

Morphology And Morphometry ◽

Proximal Forearm

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Compression Neuropathy of the Palmar Cutaneous Branch of the Median Nerve by the Antebrachial Fascia

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(96)80156-2 ◽

1996 ◽

Vol 21 (5) ◽

pp. 666-667 ◽

Cited By ~ 5

Author(s):

N. SEMER ◽

C. CRIMMINS ◽

N. FORD JONES

Keyword(s):

Median Nerve ◽

Thenar Eminence ◽

Surgical Exploration ◽

Compression Neuropathy ◽

Anterior Aspect ◽

Palmar Cutaneous Branch ◽

Cutaneous Branch ◽

Tender Mass ◽

Ulnar Aspect ◽

Antebrachial Fascia

An isolated compression neuropathy of the palmar cutaneous branch of the median nerve is described in a woman who presented with a small tender mass over the anterior aspect of her distal forearm and complete numbness over the thenar eminence. Surgical exploration revealed thickening of the palmar cutaneous nerve as it passed upwards through the antebrachial fascia on the ulnar aspect of the flexor carpi radialis tendon. Neurolysis of two separate fascicles of the palmar cutaneous branch of the median nerve and excision of a window of antebrachial fascia resulted in complete return of sensation over the thenar eminence.

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The sublime bridge: anatomy and implications in median nerve entrapment

Journal of Neurosurgery ◽

10.3171/2009.10.jns091251 ◽

2010 ◽

Vol 113 (1) ◽

pp. 110-112 ◽

Cited By ~ 9

Author(s):

R. Shane Tubbs ◽

Tyler Marshall ◽

Marios Loukas ◽

Mohammadali M. Shoja ◽

Aaron A. Cohen-Gadol

Keyword(s):

Range Of Motion ◽

Median Nerve ◽

Nerve Entrapment ◽

Pronator Teres ◽

The Sublime ◽

Potential Site ◽

Mean Width ◽

Pronator Syndrome ◽

Relationship Of ◽

The Relationship

Object The sublime bridge is a potential site of entrapment of the median nerve in the forearm. To the authors' knowledge, this structure and its relationship to the median nerve have not been studied. The aim of the present study was to quantitate this structure and elucidate its relationship to the median nerve. Methods Sixty adult cadaveric forearms underwent dissection of the sublime bridge. Relationships of this structure were observed, and measurements of its anatomy were made. The relationship of the median nerve to the sublime bridge was observed with range of motion about the forearm. Results The sublime bridge was found to be tendinous in the majority (45 [75%]) of specimens and muscular in the remaining forearms (15 [25%]). The maximal mean width of the sublime bridge was 7 cm proximally, and the minimal mean width was 3 cm distally. The mean distance from the medial epicondyle to the apex of the sublime bridge was found to be 8.1 cm. The relation of the median nerve to the bridge was always intimate. On 2 sides (1 left and 1 right) from different male specimens, the median nerve was attached to the deep aspect of the sublime bridge by a strong connective tissue band, thus forming a tunnel on the deep aspect of this structure. With range of motion of the forearm, increased compression of the median nerve by the overlying sublime bridge was seen with extension but no other movement. Conclusions Based on the authors' study, pronator syndrome is an incorrect term applied to compression of the median nerve at the sublime bridge. This potential site of median nerve compression is distinct and has characteristics that can clinically differentiate it from compression of the median nerve between the heads of the pronator teres. The authors hope that these data will be of use to the surgeon in the evaluation and treatment of patients with proximal median nerve entrapment.

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Median Nerve Compression Secondary to a High Insertion of Pronator Teres

Shoulder & Elbow ◽

10.1111/j.1758-5740.2010.00051.x ◽

2010 ◽

Vol 2 (2) ◽

pp. 124-126 ◽

Cited By ~ 3

Author(s):

Robert A. Mcculloch ◽

Simon B. M. Maclean ◽

Jag Dhaliwal ◽

Adrian W. Simons

Keyword(s):

Median Nerve ◽

Nerve Compression ◽

Surgical Removal ◽

X Rays ◽

Upper Arm ◽

Median Nerve Compression ◽

Pronator Teres ◽

History Of ◽

History Of Pain ◽

Supracondylar Process

We present a case of a 46-year-old male presenting with a 10 year history of pain and paraesthesia in the median nerve distribution together with a palpable lump in the upper arm. X-rays confirmed a supracondylar process of the humerus. Intra-operatively it was found that there was an aberrant insertion of one of the heads of pronater teres from the process. After surgical removal of the process and release of the head of pronator teres his symptoms improved.

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Proximal Median Nerve Compression: Pronator Syndrome

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2020.07.006 ◽

2020 ◽

Vol 45 (12) ◽

pp. 1157-1165

Author(s):

Jeremy A. Adler ◽

Jennifer Moriatis Wolf

Keyword(s):

Median Nerve ◽

Nerve Compression ◽

Median Nerve Compression ◽

Pronator Syndrome

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STRUTHERS’ LIGAMENT AND SUPRACONDYLAR HUMERAL PROCESS: AN ANATOMICAL STUDY AND CLINICAL IMPLICATIONS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172504168330 ◽

2017 ◽

Vol 25 (4) ◽

pp. 137-142 ◽

Cited By ~ 2

Author(s):

Edie Benedito Caetano ◽

João José Sabongi Neto ◽

Luiz Angelo Vieira ◽

Maurício Ferreira Caetano ◽

José Eduardo de Bona ◽

...

Keyword(s):

Median Nerve ◽

Brachial Artery ◽

Case Series ◽

Anatomical Study ◽

Nerve Compression ◽

Clinical Implications ◽

Level Of Evidence ◽

Pronator Teres ◽

Compressive Neuropathy ◽

Anatomy Laboratory

ABSTRACT Objective: The objective of this study was to determine the frequency and anatomical characteristics of Struthers’ ligament and the supracondylar humeral process and evaluate the clinical implications in compressive neuropathy of the median nerve . Method: We dissected 60 arms from 30 cadavers (26 males and 4 females): 15 were previously preserved in formalin and glycerin and 15 were dissected fresh in the Anatomy Laboratory for this paper. The relationships between Struthers’ ligament and the median nerve and brachial artery and veins were documented with drawings and photos . Results: The supracondylar humeral process was not found in any of the 60 dissected arms. Struthers’ ligament was identified in six arms (two bilateral); in all cases high insertion of the pronator teres muscle was observed . Conclusion: Struthers’ ligament is an aponeurotic structure that may or may not be associated with the supracondylar humeral process, and is an important potential site of median nerve compression in the lower third of the arm. Level of Evidence IV, Case Series.

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Musculoaponeurotic Variations along the Course of the Median Nerve in the Proximal Forearm

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_87_90189-6 ◽

1987 ◽

Vol 12 (3) ◽

pp. 359-363

Author(s):

A. L. DELLON ◽

SUSAN E. MACKINNON

Keyword(s):

Median Nerve ◽

Nerve Compression ◽

Flexor Digitorum Superficialis ◽

Flexor Pollicis Longus ◽

Pronator Teres ◽

Proximal Forearm ◽

Flexor Digitorum

31 cadaver arms have been dissected to study the variations in the anatomy of the muscles and fibrous arches which might cause compression of the median nerve in the forearm. Pronator teres always had a superficial head and usually a deep head. Flexor digitorum superficialis varied greatly in its site of origin. The median nerve might be crossed by two, one or no fibro-aponeurotic arches. Gantzer’s muscle, an accessory head of flexor pollicis longus, was present in 45% of cadavers. No ligament of Struthers was found. Possible sites and causes of nerve compression are discussed.

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