Redefining the “Arcade of Struthers”1
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.
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2018, KinesitherapieThe arcade of Struthers: an anatomical study and clinical implications
2017, Revista Brasileira de OrtopediaUltrasonic Observation and Clinical Application of Arcade of Struthers in the Mid-Arm
2016, World NeurosurgeryCitation Excerpt :Gonzalez et al.12 reported an incidence of 67%. Siqueira and Martins13 reported the presence as 13.5% in their dissected cadavers (8 of 60 specimens), and von Schroeder and Scheker14 identified this arcade in all of their 11 cadavers. Tubbs et al.15 reported the presence of this structure in 86.7% of 15 cadavers.
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2014, Neuroimaging Clinics of North AmericaCitation Excerpt :At the mid-arm level, the nerve penetrates the medial intermuscular septum and courses adjacent to the epimysium of the medial head of the triceps and deep fascia before reaching the cubital tunnel, where it passes between the medial epicondyle of the humerus and the olecranon at the condylar groove. Here, it lies deep to the cubital tunnel retinaculum (CTR), also known as the Osborne fascia, and aponeurosis formed between the 2 heads of the flexor carpi ulnaris.18–20 The nerve courses straight between superficial and deep compartments of the forearm along its medial side and at the wrist, and passes through a fibro-osseous tunnel known as the Guyon canal (Fig. 2).21,22
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