The Study of Morphology of supinator muscle and the arcade of Frohse

Paralysis of the posterior interosseous nerve (PIN) secondary to compression is a rare clinical condition. Entrapment neuropathy may occur at fibrous bands at the proximal, middle, or distal edge of the supinator. Tumors are a relatively rare but well-known potential cause. The authors present 2 cases of PIN lesions in which compression by a benign lipoma at the level of the elbow resulted in near transection (discontinuity) of the nerve. They hypothesize a mechanism—a “sandwich effect”—by which compression was produced from below by the mass and from above by a fibrous band in the supinator muscle (i.e., the leading edge of the proximal supinator muscle [arcade of Fröhse] in one patient and the distal edge of the supinator muscle in the other). A Grade V Sunderland nerve lesion resulted from the advanced, chronic compression. The authors are unaware of a similar case with such an advanced pathoanatomical finding.

Download Full-text

Morphological Classification of Arch of Frohse and Its Implication in Compression of Deep Branch of Radial Nerve

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/494 ◽

2021 ◽

Vol 10 (31) ◽

pp. 2412-2415

Author(s):

Syed Rehan Hafiz Daimi ◽

Srinivasa Rao Bolla ◽

Moizuddin Jawaduddin Khwaja ◽

Sanket Dadarao Hiware ◽

Shajiya Sarwar Moosa ◽

...

Keyword(s):

Radial Nerve ◽

Inferior Margin ◽

Deep Branch ◽

Supinator Muscle ◽

Essential Components ◽

Arcade Of Frohse ◽

Tunnel Syndrome ◽

Supinator Syndrome ◽

Superior Margin ◽

Radial Tunnel Syndrome

BACKGROUND Arcade of Frohse (AF) is a tendinous superior margin of superficial layer of supinator muscle which was first described by Frohse and Frankel in 1908. Since then it has been studied by many authors and held accountable as one of the essential components for compression of deep branch of radial nerve (DBRN) which leads to radial tunnel syndrome. Considering AF as an important element of compression, we made an attempt to classify it on the basis of its shape and to find out if any particular shape has a predominant role in compression of the nerve. We also observed the structure of superior and inferior margin of the supinator muscle. METHODS This study was conducted among 80 (70 males and 10 females) formalin fixed upper limbs present in the Department of Anatomy. The limbs were maintained in supine with slightly flexed position and dissection was performed to expose the supinator muscle. The proximal and distal borders of supinator muscles were examined meticulously with the help of magnified lens. The morphometric measurements were taken with the help of a digital caliper. RESULTS The FA is classified into four categories as loop, high arc, low arch and linear shaped. The most frequent shape observed was arch shaped (high and low arch) about 66%, followed by loop shaped (30%) and least was linear shaped (2.5%). On the basis of structure, the proximal and distal margin of supinator muscle was reported to be tendinous in majority of the cases. The distance of the AF from the fixed reproducible anatomical landmark like inter epicondylar line (IEL) was measured and the average distance found was 3.36 cm. CONCLUSIONS Knowledge of different shapes would aid surgeons and radiologists for better approach towards diagnosis and management of supinator syndrome. The morphometric finding can be useful for surgeons to locate the superior margin of supinator (AF) in surgical procedures for decompression of DBRN in supinator syndrome. KEY WORDS Arcade of Frohse, Inter Epicondylar Line, Supinator Muscle, Deep Branch of Radial Nerve and Radial Tunnel Syndrome

Download Full-text

A rare case of posterior interosseous nerve palsy due to ganglion cyst arising from supinator muscle

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2020.01.012 ◽

2020 ◽

Vol 11 (4) ◽

pp. 665-667

Author(s):

Shaligram Purohit ◽

Akil Prabhakar ◽

Aditya Raj ◽

Nandan Marathe ◽

Swapneel Shah

Keyword(s):

Rare Case ◽

Nerve Palsy ◽

Ganglion Cyst ◽

Posterior Interosseous Nerve ◽

Supinator Muscle ◽

Posterior Interosseous Nerve Palsy

Download Full-text

Constructive Paralysis of the Posterior Interosseous Nerve without External Compression

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(96)80091-x ◽

1996 ◽

Vol 21 (2) ◽

pp. 164-168 ◽

Cited By ~ 13

Author(s):

G. INOUE ◽

K. SHIONOYA

Keyword(s):

Motor Function ◽

Tendon Transfer ◽

Posterior Interosseous Nerve ◽

External Compression ◽

Elbow Pain ◽

History Of ◽

Arcade Of Frohse

Four cases of constrictive neuropathy of the posterior interosseous nerve (PIN) in the absence of external compression are reported. All patients presented with a history of severe elbow pain with no apparent cause, followed by paralysis of the PIN. There were one or two well-localized constrictions on the PIN proximal to the arcade of Frohse where no obvious external compressive structure was observed. After epineurotomy with or without neurorrhaphy, three patients had a complete return of motor function within 1 year. The remaining patient required tendon transfer after resection of the abnormal segment of nerve.

Download Full-text

MRI diagnosis of occult ganglion compression of the posterior interosseous nerve and associated supinator muscle pathology

Clinical Imaging ◽

10.1016/s0899-7071(03)00019-6 ◽

2005 ◽

Vol 29 (5) ◽

pp. 362-363 ◽

Cited By ~ 9

Author(s):

Justin Q. Ly ◽

Terrence J. Barrett ◽

Douglas P. Beall ◽

Reono Bertagnolli

Keyword(s):

Muscle Pathology ◽

Posterior Interosseous Nerve ◽

Supinator Muscle ◽

Mri Diagnosis

Download Full-text

MYOSITIS OSSIFICANS OF THE SUPINATOR MUSCLE CAUSING POSTERIOR INTEROSSEOUS NERVE PALSY: A CASE REPORT

Hand Surgery ◽

10.1142/s0218810410004679 ◽

2010 ◽

Vol 15 (02) ◽

pp. 115-117 ◽

Cited By ~ 2

Author(s):

Yasuyuki Kitagawa ◽

Takuya Sawaizumi ◽

Hiromoto Ito

Keyword(s):

Case Report ◽

Nerve Palsy ◽

Myositis Ossificans ◽

Posterior Interosseous Nerve ◽

Supinator Muscle ◽

Posterior Interosseous Nerve Palsy

Some tumors or tumorous conditions causing posterior interosseous nerve palsy are well documented, but myositis ossificans causing the palsy of this nerve has not been described. We present a case of posterior interosseous nerve palsy caused by myositis ossificans of the supinator muscle.

Download Full-text

Pronation can increase the pressure on the posterior interosseous nerve under the arcade of Frohse: A possible mechanism of palsy after two-incision repair for distal biceps rupture—Clinical experience and a cadaveric investigation

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2008.07.001 ◽

2009 ◽

Vol 18 (1) ◽

pp. 64-68 ◽

Cited By ~ 7

Author(s):

Annie C. Links ◽

Kyle S. Graunke ◽

Christopher Wahl ◽

John R. Green ◽

Frederick A. Matsen

Keyword(s):

Clinical Experience ◽

Posterior Interosseous Nerve ◽

Distal Biceps ◽

Biceps Rupture ◽

Arcade Of Frohse ◽

Distal Biceps Rupture

Download Full-text

Early involvement of the supinator muscle in Duchenne muscular dystrophy

Neuromuscular Disorders ◽

10.1016/j.nmd.2017.09.011 ◽

2018 ◽

Vol 28 (1) ◽

pp. 62-63 ◽

Cited By ~ 1

Author(s):

Tommaso Tartaglione ◽

Claudia Brogna ◽

Lara Cristiano ◽

Tommaso Verdolotti ◽

Marika Pane ◽

...

Keyword(s):

Duchenne Muscular Dystrophy ◽

Muscular Dystrophy ◽

Supinator Muscle

Download Full-text

Radial Tunnel Syndrome

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(05)80152-4 ◽

1995 ◽

Vol 20 (4) ◽

pp. 454-459 ◽

Cited By ~ 52

Author(s):

T. LAWRENCE ◽

P. MOBBS ◽

Y. FORTEMS ◽

J. K. STANLEY

Keyword(s):

Radial Nerve ◽

Tennis Elbow ◽

Free Edge ◽

Wrist Pain ◽

Duration Of Symptoms ◽

Supinator Muscle ◽

Prolonged Duration ◽

Tunnel Syndrome ◽

Manual Tasks ◽

Radial Tunnel Syndrome

Radial tunnel syndrome results from compression of the radial nerve by the free edge of the supinator muscle or closely related structures in the vicinity of the elbow joint. Despite numerous reports on the surgical management of this disorder, it remains largely unrecognized and often neglected. The symptoms of radial tunnel syndrome can resemble those of tennis elbow, chronic wrist pain or tenosynovitis. Reliable objective criteria are not available to differentiate between these pathologies. These difficulties are discussed in relation to 29 patients who underwent 30 primary explorations and proximal decompressions of the radial nerve. Excellent or good results were obtained in 70%, fair results in 13% and poor results in 17% of patients. The results can be satisfactory despite the prolonged duration of symptoms. We believe that a diagnosis of radial tunnel syndrome should always be born in mind when dealing with patients with forearm and wrist pain that has not responded to more conventional treatment. Patients with occupations requiring repetitive manual tasks seem to be particularly at risk of developing radial tunnel syndrome and it is also interesting to note that 66% of patients with on-going medico-legal claims had successful outcomes following surgery.

Download Full-text

Transbrachioradialis Approach to the Radial Tunnel: An Anatomic Study of 5 Potential Compression Sites

Hand ◽

10.1177/1558944717750916 ◽

2018 ◽

Vol 14 (3) ◽

pp. 329-332 ◽

Cited By ~ 1

Author(s):

Jason R. Ummel ◽

John G. Coury ◽

Zachary C. Lum ◽

Marc A. Trzeciak

Keyword(s):

Single Incision ◽

Anatomic Study ◽

Muscle Belly ◽

Surgical Access ◽

Distal Edge ◽

Fresh Frozen ◽

Utilitarian Approach ◽

Arcade Of Frohse ◽

Tunnel Syndrome ◽

Single Approach

Background: Recent anatomic studies have failed to demonstrate a single utilitarian approach to intraoperative identification and surgical release of all 5 potential sites of posterior interosseous nerve (PIN) compression in the radial tunnel. This study examines if a single incision brachioradialis-splitting approach without the use of additional anatomic windows is capable of adequately exposing the entire length of the radial tunnel, including all 5 sites of PIN compression to allow for adequate release. Methods: Ten fresh frozen cadaver forearms (6 female, 4 male) were dissected utilizing a curvilinear 7 cm incision over the brachioradialis. The muscle belly was split via simple blunt retraction, exposing the radial tunnel. The PIN was identified and mobilized at 5 compression sites: radiocapitellar joint (RCJ), radial recurrent vessels (Leash of Henry), fibrous medioproximal edge of extensor carpe radialis brevis, arcade of Frohse, and distal edge of supinator. Results: The PIN was identified and effectively released in all specimens without difficulty from this single approach. All 5 sites of compression were visible and accessible through the brachioradialis-split approach. Specifically, there was no difficulty in identifying and releasing the PIN at the distal edge of supinator. Conclusions: Radial tunnel syndrome is defined as PIN compression within the radial tunnel spanning from the fibrous RCJ to the distal edge of the supinator. A single brachioradialis-splitting approach is adequate for complete visualization and release of all compression sites of the radial tunnel. Utilizing this technique allows for surgical access and ease as well as minimizing necessity for additional windows or multiple incisions.

Download Full-text