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Erschienen in: Surgical and Radiologic Anatomy 3/2020

01.03.2020 | Anatomic Variations

Coexistence of variant pronator teres muscle and variant course of the neurovascular structures in the arm: clinical significance

verfasst von: Suresh Narayanan, Priyadharshini Nattalam Adikesavan

Erschienen in: Surgical and Radiologic Anatomy | Ausgabe 3/2020

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Abstract

In literature, the presence of the supracondylar process, fibrous band enclosing the neurovascular structures, and the additional head of pronator teres have been reported as isolated reports. In this article, we describe three unique variations observed in the left upper limb of a 63-year-old female cadaver, (1) the variant origin of pronator teres from the supracondylar process, (2) the variant course of the median nerve and brachial artery passing through a fibrous tunnel in the lower third of the arm, later behind the supracondylar process and the variant pronator teres, and (3) the higher origin of radial artery from the brachial artery in the arm. The knowledge of such rare variants could be resourceful for surgeons in localizing the median nerve entrapment, interpreting arteriograms of the upper limb and avoiding accidental damage to the radial artery.
Literatur
1.
Zurück zum Zitat Alvarez-Tostado JA, Moise MA, Bena JF, Pavkov ML, Greenberg RK, Clair DG, Kashyap VS (2009) The brachial artery: a critical access for endovascular procedures. J Vasc Surg 49:378–385CrossRef Alvarez-Tostado JA, Moise MA, Bena JF, Pavkov ML, Greenberg RK, Clair DG, Kashyap VS (2009) The brachial artery: a critical access for endovascular procedures. J Vasc Surg 49:378–385CrossRef
2.
Zurück zum Zitat Beale EW, Behnam A (2012) Injection injury of an aberrant superficial radial artery requiring surgical intervention. J Hand Microsurg 4:39–42CrossRef Beale EW, Behnam A (2012) Injection injury of an aberrant superficial radial artery requiring surgical intervention. J Hand Microsurg 4:39–42CrossRef
3.
Zurück zum Zitat Birch R (2005) Pectoral girdle and upper limb. In: Standring S (ed) Gray’s anatomy. The anatomical basis of clinical practice, 39th edn. Elsevier, Edinburgh, pp 776–894 Birch R (2005) Pectoral girdle and upper limb. In: Standring S (ed) Gray’s anatomy. The anatomical basis of clinical practice, 39th edn. Elsevier, Edinburgh, pp 776–894
4.
Zurück zum Zitat Chiak R (1972) Ontogenesis of the skeleton and intrinsic muscles of the human hand and foot. Adv Anat Embryol Cell Biol 46:1–194 Chiak R (1972) Ontogenesis of the skeleton and intrinsic muscles of the human hand and foot. Adv Anat Embryol Cell Biol 46:1–194
5.
Zurück zum Zitat Horak BT, Kuz JE (2008) An unusual case of pronator syndrome with ipsilateral supracondylar process and abnormal muscle mass. J Hand Surg 33:79–82CrossRef Horak BT, Kuz JE (2008) An unusual case of pronator syndrome with ipsilateral supracondylar process and abnormal muscle mass. J Hand Surg 33:79–82CrossRef
6.
Zurück zum Zitat Koshy S, Rabi S, Indrasingh I, Vettivel S (2003) Two anatomical variations associated with potential vascular entrapment in the upper limb. Eur J Anat 7:97–100 Koshy S, Rabi S, Indrasingh I, Vettivel S (2003) Two anatomical variations associated with potential vascular entrapment in the upper limb. Eur J Anat 7:97–100
7.
Zurück zum Zitat Kumar N, Padur AA, Prabhu G, Shanthakumar SR, Bhaskar R (2019) Rare case of median nerve and brachial artery entrapment by an abnormal musculofascial tunnel in the arm: possible cause of neurovascular compression syndrome. Anat Cell Biol 52:84–86CrossRef Kumar N, Padur AA, Prabhu G, Shanthakumar SR, Bhaskar R (2019) Rare case of median nerve and brachial artery entrapment by an abnormal musculofascial tunnel in the arm: possible cause of neurovascular compression syndrome. Anat Cell Biol 52:84–86CrossRef
8.
Zurück zum Zitat Lee MJ, LaStayo PC (2004) Pronator syndrome and other nerve compressions that mimic carpal tunnel syndrome. J Orthop Sports Phys Ther 34:601–609CrossRef Lee MJ, LaStayo PC (2004) Pronator syndrome and other nerve compressions that mimic carpal tunnel syndrome. J Orthop Sports Phys Ther 34:601–609CrossRef
9.
Zurück zum Zitat Lordan J, Rauh P, Spinner RJ (2005) The clinical anatomy of the supracondylar spur and the ligament of Struthers. Clin Anat 18:548–551CrossRef Lordan J, Rauh P, Spinner RJ (2005) The clinical anatomy of the supracondylar spur and the ligament of Struthers. Clin Anat 18:548–551CrossRef
10.
Zurück zum Zitat Martin-Schütz GO, Arcoverde M, Barros GR, Babinski MA, Manaia JHM, Silva CRCM, Chagas CAA, Pires LAS (2019) A meta-analysis of the supracondylar process of the humerus with clinical and surgical applications to orthopedics. Int J Morphol 37:43–47CrossRef Martin-Schütz GO, Arcoverde M, Barros GR, Babinski MA, Manaia JHM, Silva CRCM, Chagas CAA, Pires LAS (2019) A meta-analysis of the supracondylar process of the humerus with clinical and surgical applications to orthopedics. Int J Morphol 37:43–47CrossRef
11.
Zurück zum Zitat Meda N, Verma H, Tripathi RK (2015) Ischemic brachial artery entrapment syndrome by supracondylar humeral bony spur. J Vasc Surg Cases 1:116–119CrossRef Meda N, Verma H, Tripathi RK (2015) Ischemic brachial artery entrapment syndrome by supracondylar humeral bony spur. J Vasc Surg Cases 1:116–119CrossRef
12.
Zurück zum Zitat Olewnik L, Podgorski M, Polguj M, Wysiadecki G, Mirosław T (2018) Anatomical variations of the pronator teres muscle in a Central European population and its clinical significance. Anat Sci Int 93:299–306CrossRef Olewnik L, Podgorski M, Polguj M, Wysiadecki G, Mirosław T (2018) Anatomical variations of the pronator teres muscle in a Central European population and its clinical significance. Anat Sci Int 93:299–306CrossRef
13.
Zurück zum Zitat Ray B, Rai AL, Roy TS (2004) Unusual insertion of the coracobrachialis muscle to the brachial fascia associated with high division of brachial artery. Clin Anat 17:672–676CrossRef Ray B, Rai AL, Roy TS (2004) Unusual insertion of the coracobrachialis muscle to the brachial fascia associated with high division of brachial artery. Clin Anat 17:672–676CrossRef
14.
Zurück zum Zitat Rodriguez-Niedenfuhr M, Sanudo JR, Vazquez T, Nearn L, Logan B, Parkin I (2000) Anastomosis at the level of the elbow joint connecting the deep, or normal, brachial artery with major arterial variations of the upper limb. J Anat 196:115–119CrossRef Rodriguez-Niedenfuhr M, Sanudo JR, Vazquez T, Nearn L, Logan B, Parkin I (2000) Anastomosis at the level of the elbow joint connecting the deep, or normal, brachial artery with major arterial variations of the upper limb. J Anat 196:115–119CrossRef
15.
Zurück zum Zitat Rodriguez-Niedenfuhr M, Vazquez T, Nearn L, Ferreira B, Parkin I, Sanudo JR (2001) Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. J Anat 199:547–566CrossRef Rodriguez-Niedenfuhr M, Vazquez T, Nearn L, Ferreira B, Parkin I, Sanudo JR (2001) Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. J Anat 199:547–566CrossRef
16.
Zurück zum Zitat Shon HC, Park JK, Kim DS, Kang SW, Kim KJ, Hong SH (2018) Supracondylar process syndrome: two cases of median nerve neuropathy due to compression by the ligament of Struthers. J Pain Res 11:803–807CrossRef Shon HC, Park JK, Kim DS, Kang SW, Kim KJ, Hong SH (2018) Supracondylar process syndrome: two cases of median nerve neuropathy due to compression by the ligament of Struthers. J Pain Res 11:803–807CrossRef
17.
Zurück zum Zitat Wadhwa S, Mehra S, Khan RQ, Kapur V (2004) Abnormal musculoaponeurotic tunnel in the arm: possible entrapment of the median nerve and brachial artery with high origin of nerve to pronator teres within the tunnel. Clin Anat 17(4):360–363CrossRef Wadhwa S, Mehra S, Khan RQ, Kapur V (2004) Abnormal musculoaponeurotic tunnel in the arm: possible entrapment of the median nerve and brachial artery with high origin of nerve to pronator teres within the tunnel. Clin Anat 17(4):360–363CrossRef
18.
Zurück zum Zitat Yazar F, Acar HI (2006) Supracondylar process with a high origin of the radial artery. Clin Anat 19:730–731CrossRef Yazar F, Acar HI (2006) Supracondylar process with a high origin of the radial artery. Clin Anat 19:730–731CrossRef
Metadaten
Titel
Coexistence of variant pronator teres muscle and variant course of the neurovascular structures in the arm: clinical significance
verfasst von
Suresh Narayanan
Priyadharshini Nattalam Adikesavan
Publikationsdatum
01.03.2020
Verlag
Springer Paris
Erschienen in
Surgical and Radiologic Anatomy / Ausgabe 3/2020
Print ISSN: 0930-1038
Elektronische ISSN: 1279-8517
DOI
https://doi.org/10.1007/s00276-019-02413-6

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