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

  • Anatomic Variations
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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.

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References

  1. 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 49:378–385

    Article  Google Scholar 

  2. Beale EW, Behnam A (2012) Injection injury of an aberrant superficial radial artery requiring surgical intervention. J Hand Microsurg 4:39–42

    Article  Google Scholar 

  3. 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

    Google Scholar 

  4. Chiak R (1972) Ontogenesis of the skeleton and intrinsic muscles of the human hand and foot. Adv Anat Embryol Cell Biol 46:1–194

    Google Scholar 

  5. Horak BT, Kuz JE (2008) An unusual case of pronator syndrome with ipsilateral supracondylar process and abnormal muscle mass. J Hand Surg 33:79–82

    Article  Google Scholar 

  6. 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

    Google Scholar 

  7. 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 52:84–86

    Article  Google Scholar 

  8. Lee MJ, LaStayo PC (2004) Pronator syndrome and other nerve compressions that mimic carpal tunnel syndrome. J Orthop Sports Phys Ther 34:601–609

    Article  Google Scholar 

  9. Lordan J, Rauh P, Spinner RJ (2005) The clinical anatomy of the supracondylar spur and the ligament of Struthers. Clin Anat 18:548–551

    Article  Google Scholar 

  10. 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 37:43–47

    Article  Google Scholar 

  11. Meda N, Verma H, Tripathi RK (2015) Ischemic brachial artery entrapment syndrome by supracondylar humeral bony spur. J Vasc Surg Cases 1:116–119

    Article  Google Scholar 

  12. 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 93:299–306

    Article  CAS  Google Scholar 

  13. 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 17:672–676

    Article  Google Scholar 

  14. 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 196:115–119

    Article  Google Scholar 

  15. 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 199:547–566

    Article  CAS  Google Scholar 

  16. 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 11:803–807

    Article  Google Scholar 

  17. 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):360–363

    Article  CAS  Google Scholar 

  18. Yazar F, Acar HI (2006) Supracondylar process with a high origin of the radial artery. Clin Anat 19:730–731

    Article  Google Scholar 

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SN: dissected the specimen, prepared the manuscript and took photographs. PNA: dissected the specimen and took photographs.

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Correspondence to Suresh Narayanan.

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Narayanan, S., Adikesavan, P.N. Coexistence of variant pronator teres muscle and variant course of the neurovascular structures in the arm: clinical significance. Surg Radiol Anat 42, 249–252 (2020). https://doi.org/10.1007/s00276-019-02413-6

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  • DOI: https://doi.org/10.1007/s00276-019-02413-6

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