MRI findings of supracondylar process syndrome

Year 2014, , 281 - 285, 01.09.2014

Betül Kızıldağ Yavuz Yıldız Şule Koşar Erkam Kömürcü Emine Dağıstan Arzu Canan

https://doi.org/10.5505/abantmedj.2014.44366

Abstract

Bony spur that projects from distal antermedial aspect of humerus like a beak is known as supracondylar spur or process. It commonly extends with a fibrous structure called Struthers ligament that has an insertion of medial epicondyle of humerus. This congenital variant has an incidence of nearly 0.1-2.7 % of human species and is commonly diagnosed as an incidental finding on plain graphs of arm achieved for other reasons. This bony project may be symthomathic if a fracture occurs or if it compresses adjacent brachial vessels or median nerve. Familiarity of radiologists and clinicians to clinical findings and particulary MRI appearence of supracondylar process related nerve entrapment should be helpful for differential diagnosis and treatment approach. Herein we presented a case report of a 25-year old woman having a pain in distal arm diagnosed as supracondylar process syndrome, and discussed clinical and radiological findings of supracondylar process syndrome as well as differential diagnosis and management strategies.

Keywords

Humerus, Supracondylar process, MRI

Suprakondiler proses sendromunda MRG bulguları

Abstract

Humerus distal kesiminde anteromediyal yüzeyde gelişen gaga şeklinde kemik çıkıntı ‘suprakondiler spur ya da proçes olarak adlandırılır. Çoğu kez medial epikondile insersiyosu olan Struthers ligamanı ile sonlanmaktadır Humerus distalinde insan türünde yaklaşık %0.1-2.7 sıklıkla gözlenen bu konjenital anatomik varyasyon diğer nedenlerle çekilen radyogramlarda rastlantısal olarak saptanır. Suprakondiler proses kırılması ya da damar sinir basısına yol açması sonucunda nadiren semptomatik hale gelmektedir. Suprakondiler prosesle ilişkili sinir tuzaklanma sendromunun klinik ve elektromyelografi bulguları yanında manyetik rezonans MR görünümünün bilinmesi, ayırıcı tanı ve tedaviyi yönlendirme açısından faydalı olacaktır. Suprakondiler proses sendromlu olguların MR bulguları literatürde az tanımlanmıştır.Bu sunumda 25 yaşında kol ağrısı şikayeti ile ortopedi kliniğine baş vuran ve direkt grafi ve MR bulguları eşliğinde tanısı konan suprakondiler proses sendromlu olgunun klinik ve radyolojik bulguları, ayırıcı tanıdaki ipuçları, tedavi yaklaşımı literatür eşliğinde tartışılacaktır.

Keywords

Humerus, Suprakondiler proses, MRG

References

• De Jesus R, Dellon AL. Historic origin of the “Ar- cade of Struthers.“ J Hand Surg [Am] 2003;28:528–
• Pecina M, Boric I, Anticevic D. Intraoperativelyp- roven anomalous Struthers’ ligament diagnosed by MRI. Skeletal Radiol 2002;31:532–535.
• Sener E, Takka S, Cila E. Supracondylar pro- cesssyndrome. Arch Orthop Trauma Surg ;117:418–419. Natsisi K. Suprakondiler process of the humerus study on Caucasian subjects in Cologne, Germany. Clin Anat 2008;21:138
• Gupta RK, Mehta CD. A study of the incidence of supracondylar process of the humerus. J Anat Soc India 2008;57:111
• Straub G. Bilateral supracondylar process of thehumeri with unilateral median nerve compressi- onin an 8-year-old child: a case report [in German]. Miyake J, Kawabata H, Takeuchi. Rapid growth of supracondylar process: a case report. J Pediatr Ort- hop B. 2013 Mar;22(2):141-3.
• Lordan J, Rauh P, Spinner RJ. The clinical anatomy of the supracondylar spur and ligament of struthers. Clinical Anatomy 18:548-551
• Gunther SF, Dipasquale D, Martin R. Struthers ligament and associated median nevre variations in a cadaveric specimen. Yale J Biol Med 1993;66:203
• Beltran J, Rosenberg ZS. Diagnosis of compressi- ve and entrapment neuropathies of the upper extremity:value of MR imaging. AJR Am J Roentge- nol1994;163:525–531.
• Andreisek G, Crook DW, Burg D, Marincek B, Weishaupt D. Peripheral neuropathies of the me- dian, radial, and ulnar nerves: MR imaging features. Radiographics. 2006 Sep-Oct;26(5):1267-87. Review
• Sallomi D, Janzen DL, Munk PL, Connell DG,Tirman PF. Muscle denervation patterns in up- perlimb nerve injuries: MR imaging findings and anatomic basis. AJR Am J Roentgenol ;171:779–784.
• Jacobson JA. Elbow Ultrasound. In: Jacobson JA,editor. Fundamentals of Musculoskeletal Ultra- sound.Philadelphia, PA: Saunders/Elsevier; 2007,p
• Martinoli C, Bianchi S. Arm. In: Bianchi S, Marti- noliC, editors. Ultrasound of the Musculoskeletal System. Berlin; New York: Springer; 2007, 336.
• Camerlinck M, Vanhoenacker FM, Kiekens G. Ultrasound demonstration of Struthers' ligament. J Clin Ultrasound. 2010 Nov-Dec;38(9):499-502. doi: 1002/jcu.20700
• Newman A. The supracondylar process and its fracture. Am J Roentgenol ; 105:844–849.
• Subasi M, Kesemenli C, Necmioglu S. Supra- condylar process of the humerus. Acta Orthop Belg ; 68-1:72–75.