Elsevier

The Journal of Hand Surgery

Volume 28, Issue 6, November 2003, Pages 1018-1021
The Journal of Hand Surgery

Redefining the “Arcade of Struthers”1

https://doi.org/10.1016/S0363-5023(03)00421-0Get rights and content

Abstract

Purpose

To define the anatomy and presence of the arcade of Struthers, its anatomic variations, and potential sites of compression of the ulnar nerve.

Methods

In 11 fresh specimen dissections, the ulnar nerve was followed from the brachial plexus through the anterior compartment into the posterior compartment through the intermuscular septum and the arcade of Struthers on to the cubital tunnel. The arcade was identified, dissected, measured, and photographed. All anatomic variations were documented.

Results

The arcade of Struthers and intermuscular septum were present in all 11 specimens. The arcade was not merely an opening in the septum nor was it a short band as typically described: the arcade was better described as a fibrous canal with an average length of 5.7 cm. Its openings at either end were 3.9 and 9.6 cm proximal to the medial epicondyle. The structural components of the canal consisted of the fibrous tissue of the intermuscular septum, the internal brachial ligament, the deep fascia of the triceps, and the epimysium of the triceps muscle itself. The ulnar nerve was bound tightly within the entire canal in one case. In all specimens the nerve had an hourglass indentation at the proximal opening of the canal between the intermuscular septum and the internal brachial ligament.

Conclusions

The arcade of Struthers consists of a fibrous canal. The tightest point is the proximal end of the canal at the intermuscular septum that represents the clinically relevant site of entrapment or compression of the ulnar nerve.

Section snippets

Materials and methods

An initial pilot study consisting of 3 fresh cadaver dissections was carried out to familiarize us with the regional anatomy on the medial aspect of the arm. This was followed by a formal dissection of 11 fresh cadavers (8 women, 3 men; average age, 74 y) using loupe magnification. The medical history of all cadavers was reviewed. None had a history of ulnar neuropathy, joint disease, or trauma to the extremity. A posteromedial skin incision was made and a large skin flap was raised to expose

Results

The opening formed by the intermuscular septum and the internal brachial ligament (the arcade of Struthers) was present on the medial aspect of the arm in all 11 dissected cadaver specimens dissected as well as the 3 cadavers dissected in the pilot study. This point of the arcade was in fact the opening to a fibrous canal (Fig. 1) that consisted of the intermuscular septum anteriorly and the fascia and epimysium of the triceps on the medial, posterior, and lateral aspects of the canal.

Discussion

Sir John Struthers’ name is applied incorrectly3 to the arcade that is best defined as a canal through which the ulnar nerve travels from the anterior to the posterior compartments of the arm. The proximal opening of the canal is a V-shaped window made up of the intermuscular septum that divides the anterior and posterior compartments, and the internal brachial ligament. The ulnar nerve takes a slight change in course at this point and this was the tightest part of the canal. The septum makes

Acknowledgements

Dr. von Schroeder is the Roscoe Reid Graham Surgical Scholar at the Department of Surgery, University of Toronto.

References (7)

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