Anatomical variants complicating the posterior approaches towards the elbow joint.
Accessory bones
Chondroepitrochlearis
Dorsoepitrochlearis
Epitrochleoanconeus
Posterior approach
Subanconeus
Ulnar nerve
Variability around elbow joint
Journal
Surgical and radiologic anatomy : SRA
ISSN: 1279-8517
Titre abrégé: Surg Radiol Anat
Pays: Germany
ID NLM: 8608029
Informations de publication
Date de publication:
May 2023
May 2023
Historique:
received:
03
02
2023
accepted:
02
03
2023
medline:
17
5
2023
pubmed:
16
3
2023
entrez:
15
3
2023
Statut:
ppublish
Résumé
Anatomical variants observed during the posterior approach to the elbow joint require special attention due to their clinical relevance. We aim to present a compendious review of described variants potentially encountered during the posterior approach towards the elbow joint to the experts in the elbow surgery. A narrative review of surgical and anatomical textbooks, as well as search of scientific databases was carried out. Variability of the subcutaneous nerves is important during incision planning. Accessory muscles such as dorsoepitrochlearis, chondroepitrochlearis, epitrochleoanconeus, subanconeus or supernumerary flexor carpi ulnaris may confuse even the senior surgeon during the dissection and possibly complicate the fracture reduction. Some bony variants such as supratrochlear foramen may lead to fracture or possibly interfere with the osteosynthesis placement. Accessory bones are also present in the region of the elbow joint. Those situated intra-articular may present with symptoms. Many variants can be encountered in the area of the elbow joint and their knowledge is essential to truly understand its anatomy. The presented review enables easier orientation in the current literature with the aim on the posterior approach towards the elbow joint.
Identifiants
pubmed: 36920516
doi: 10.1007/s00276-023-03124-9
pii: 10.1007/s00276-023-03124-9
pmc: PMC10130116
doi:
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
587-592Subventions
Organisme : Masaryk Hospital (Ústí nad Labem) grant agency
ID : IGA-KZ-2022-1-6
Informations de copyright
© 2023. The Author(s).
Références
Afshar A (2011) Os supratrochleare dorsale. J Hand Surg Eur 36(9):821–822. https://doi.org/10.1177/1753193411419948
doi: 10.1177/1753193411419948
Bando K (1956) Musculus epitrochleo-anconeus. Hirosaki-Igaku 7:192
Bhardwaj P, Bhandari L, Sabapathy SR (2013) Supernumerary flexor carpi ulnaris—case report and review. Hand Surg 18(3):393–397. https://doi.org/10.1142/S0218810413720222
doi: 10.1142/S0218810413720222
pubmed: 24156584
Caetano EB, Neto JJS, Vieira LA, Caetano MF (2017) The arcade of Struthers: an anatomical study and clinical implication. Rev Bras Ortop 52(3):331–336. https://doi.org/10.1016/j.rboe.2016.07.006
doi: 10.1016/j.rboe.2016.07.006
pubmed: 28702393
pmcid: 5497011
Cassebaum WH (1952) Operative treatment of T and Y fractures of the lower end of the humerus. Am J Surg 83(3):265–270. https://doi.org/10.1016/0002-9610(52)90254-7
doi: 10.1016/0002-9610(52)90254-7
pubmed: 14903375
Cheema P, Singla R (2011) Four headed triceps brachii muscle. Int J Anat Var 4:43–44
Cheung EV, Sarkissian EJ (2017) Surgical approaches to the elbow. In: Tashjina RZ (ed) The unstable elbow. Springer Cham, Switzerland, pp 27–38
Chow JCY, Papachristos AA, Ojeda A (2006) An aberrant anatomic variation along the course of the ulnar nerve above the elbow with coexistent cubital tunnel syndrome. Clin Anat 19(7):661–664. https://doi.org/10.1002/ca.20351
doi: 10.1002/ca.20351
pubmed: 16683248
Clemens HJ (1957) Zur Morphologie des Ligamentum epitrochle-anconeum. Anat Anz 104:343
pubmed: 13509197
Dellon AL (1986) Musculotendinous variations about the medial humeral epicondyle. J Hand Surg Br 11(2):175–181
doi: 10.1016/0266-7681_86_90254-8
pubmed: 3734552
Dowdy PA, Bain GI, King GJ, Patterson SD (1995) The midline posterior elbow incision: an anatomical appraisal. J Bone Joint Surg Br 77(5):696–699
doi: 10.1302/0301-620X.77B5.7559692
pubmed: 7559692
Eisler P (1912) Die Muskeln des Stammes. Fischer, Jena
Erdogmus S, Guler M, Erogli S, Duran N (2014) The importance of the supratrochlear foramen of the humerus in humans: an anatomical study. Med Sci Monit 20:2643–2650. https://doi.org/10.12659/MSM.892074
doi: 10.12659/MSM.892074
pubmed: 25515544
pmcid: 4267125
Fabrizio PA, Clemente FR (1997) Variation in the triceps brachii muscle: a fourth muscular head. Clin Anat 10(4):259–263. https://doi.org/10.1002/(SICI)1098-2353(1997)10:4%3c259::AID-CA8%3e3.0.CO;2-N
doi: 10.1002/(SICI)1098-2353(1997)10:4<259::AID-CA8>3.0.CO;2-N
pubmed: 9213044
Gonzalez MH, Lofti P, Bendre A, Mandelbroyt Y, Lieska N (2001) The ulnar nerve at the elbow and its local branching: an anatomic study. J Hand Surg Br 26(2):142–144. https://doi.org/10.1054/jhsb.2000.0532
doi: 10.1054/jhsb.2000.0532
pubmed: 11281666
Haninec P, Tomas R, Kaiser R, Cihak R (2009) Development and clinical significance of the musculus dorsoepitrochlearis in men. Clin Anat 22(4):481–488. https://doi.org/10.1002/ca.20799
doi: 10.1002/ca.20799
pubmed: 19373904
Hirasawa Y, Sawamura H, Sakakida K (1979) Entrapment neuropathy due to bilateral epitrochleoanconeus muscles: A case report. J Hand Surg 4(2):181–184. https://doi.org/10.1016/S0363-5023(79)80139-2
doi: 10.1016/S0363-5023(79)80139-2
Iliev AL, Dandov A, Jelev L, Hinova-Palova D (2015) An abberant fourth head of the triceps brachii muscle. Praem 30(1):9–12
Kalaci A, Dogramaci Y, Sevinc TT, Yanat AN (2009) Unusual origin of the motor branch of the ulnar nerve to the flexor carpi ulnaris. J Shoulder Elbow Surg 18(3):e38–e39. https://doi.org/10.1016/j.jse.2008.07.015
doi: 10.1016/j.jse.2008.07.015
pubmed: 19036610
Kunc V, Kunc V, Cerny V, Polovincak M, Kachlik D (2020) Accessory bones of the elbow: prevalence, localization and modified classification. J Anat 237(4):618–622. https://doi.org/10.1111/joa13233
doi: 10.1111/joa13233
pubmed: 32839981
pmcid: 7495298
Kunc V, Stulpa M, Feigl G, Kachlík D (2019) Accessory flexor carpi ulnaris muscle with associated anterior interosseous artery variation: case report with the definition of a new type and review of concomitant variants. Surg Radiol Anat 41(11):1315–1318. https://doi.org/10.1007/s00276-019-02261-4
doi: 10.1007/s00276-019-02261-4
pubmed: 31144008
Linnel EA (1921) The distribution of nerves in the upper limb with reference to variabilities and their clinical significance. J Anat 55:79–112
Lowe JB, Maggi SP, Mackinnon SE (2004) The position of crossing branches of the medial antebrachial cutaneous nerve during cubital tunnel surgery in humans. Plas Reconst Surg 114(3):692–696. https://doi.org/10.1097/01.prs.0000130966.16460.3c
doi: 10.1097/01.prs.0000130966.16460.3c
Marur T, Akkin SM, Alp M, Demirci S, Yalcin L, Ogüt T, Akgün I (2005) The muscular branching patterns of the ulnar nerve to the flexor carpi ulnaris and flexor digitorum profundus muscles. Surg Radiol Anat 27(4):322–326. https://doi.org/10.1007/S00276-005-0325-8
doi: 10.1007/S00276-005-0325-8
pubmed: 15977022
Mermenthaler M (1958) Die luxation des Nervus ulnaris am Ellenbogen. Dtsch Z Nervenheilkunde 178:163–198
Mittal R, Kumar VS, Gupta T (2014) Patella cubiti: a case report and literature review. Arch Orthop Trauma Surg 134:467–471. https://doi.org/10.1007/s00402-014-1926-7
doi: 10.1007/s00402-014-1926-7
pubmed: 24493466
Mori M (1964) Statistics on the musculature of the Japanese. Okajimas Folia Anat Jpn 40:195–300. https://doi.org/10.2535/ofaj1936.40.3_195
doi: 10.2535/ofaj1936.40.3_195
pubmed: 14213705
Natsis K, Totlis T, Vlasis K, Sofidis G, Lazaridis N, Tsitouridis I (2011) Dorsoepitrochlearis muscle: an uknown cause of shoulder motion limitation and axilla deformity. J Orthop Sci 17(2):186–188. https://doi.org/10.1007/s00776-011-0079-6
doi: 10.1007/s00776-011-0079-6
pubmed: 21598028
Ng ZY, Mitchell JH, Fogg QA, Hart AM (2013) The anatomy of ulnar nerve branches in anterior transposition. Hand Surg 18(3):301–306. https://doi.org/10.1142/S0218810413500305
doi: 10.1142/S0218810413500305
pubmed: 24156569
Obermann WR, Loose HW (1983) The os supratrochleare dorsale: a normal variant that may cause symptoms. Am J Roentegenol 141(1):123–127. https://doi.org/10.2214/ajr.141.1.123
doi: 10.2214/ajr.141.1.123
Paulos R, Leclercq C (2015) Motor branches of the ulnar nerve to the forearm: an anatomical study and guidelines for selective neurectomy. Surg Radiol Anat 37:1043–1048. https://doi.org/10.1007/s00276-015-1448-1
doi: 10.1007/s00276-015-1448-1
pubmed: 25724941
Sahajpal DT, Pichora D (2006) Septal aperture: an anatomic variant predisposing to bilateral low-energy fractures of the distal humerus. Can J Surg 49(5):363–364
pubmed: 17152577
pmcid: 3207585
Singhal S, Rao V (2007) Supratrochlear foramen of the humerus. Anat Sci Int 82(2):105–107. https://doi.org/10.1111/j.1447-073x.2007.00172.x
doi: 10.1111/j.1447-073x.2007.00172.x
pubmed: 17585566
Siqueira MG, Martins RS (2005) The controversial arcade of Struthers. Surg Neurol 64(1):S17-20. https://doi.org/10.1016/j.surneu.2005.04.017
doi: 10.1016/j.surneu.2005.04.017
Soubhagya RN, Aswin K, Madhan SJK, Latha VP, Vasudha S, Merin MT (2008) Four-headed biceps and triceps brachii muscles, with neurovascular variation. Anat Sci Int 83:107–111. https://doi.org/10.1111/j.1447-073x.2007.00171.x
doi: 10.1111/j.1447-073x.2007.00171.x
Spinner RJ, Carmichael SW, Spinner M (1991) Infraclavicular ulnar nerve entrapment due to a chondroepitrochlearis muscle. J Hand Surg 16(3):315–317. https://doi.org/10.1016/0266-7681(91)90060-2
doi: 10.1016/0266-7681(91)90060-2
Sunderland S, Hughes ESR (1946) Metrical and non-metrical features of the muscular branches of the ulnar nerve. J Comp Neurol 85:113–125. https://doi.org/10.1002/cne.900850109
doi: 10.1002/cne.900850109
pubmed: 20999134
Sunderland S (1968) Nerves and nerve injuries. Williams and Wilkins, Baltimore
Suwannakhan A, Chaiyamoon A, Yammine K, Yurasakpong L, Janta S, Limpanuparb T, Meemon K (2021) The prevalence of anconeus epitrochlearis muscle and Osborne’s ligament in cubital tunnel syndrome patients and healthy individuals: an anatomical study with meta-analysis. Surgeon 19(6):e402–e411. https://doi.org/10.1016/j.surge.2020.12.006
doi: 10.1016/j.surge.2020.12.006
pubmed: 33551294
Tountas CP, Bergman RA (1993) Anatomic variations of the upper extremity. Churchill Livingstone, New York
Tubbs RS, Oakes WJ, Salter EG (2006) The subanconeus muscle. Folia Morphol 65(1):22–25
Tubbs RS, Salter EG, Oakes WJ (2006) Triceps brachii muscle demonstrating a fourth head. Clin Anat 19(7):657–660. https://doi.org/10.1002/ca.20326
doi: 10.1002/ca.20326
pubmed: 16583379
Wachsmuth W, Wilhelm A (1968) Der Musculus epitrochleo-anconaeus und seine klinische Bedeutung. Monatsschr Unfallheilkd 71:1–22
pubmed: 4235947
Wilkinson JM, Stanley D (2001) Posterior surgical approaches to the elbow: A comparative anatomic study. J Shoulder Elbow Surg 10(4):380–382. https://doi.org/10.1067/mse.2001.1165517
doi: 10.1067/mse.2001.1165517
pubmed: 11517370
Wood VE, Campbell GS (1994) The supratrochleare dorsale accessory ossicle in the elbow. J Shoulder Elbow Surg 3(6):395–398. https://doi.org/10.1016/s1058-2746(09)80026-8
doi: 10.1016/s1058-2746(09)80026-8
pubmed: 22958845