ABSTRACT
BACKGROUND: The Struthers' ligament (SL) is a fibrous band that originates fromthe supracondylar humeral process and inserts into the medial humeral epicondyle, potentially compressing both the median nerve and brachial artery. The controversial Struthers' arcade (SA) is a musculotendinous band found in the distal end of the arm that might compress the ulnar nerve. This study aimed to evaluate the pooled prevalence estimate of the SL and SA, and their anatomical features. MATERIALS AND METHODS: A meticulous search of major electronic medical databases was carried out regarding both structures. Applicable articles (and all relevant references) were analysed. Data from the eligible articles was extracted and evaluated. The quality and the potential risk of bias in the included studies were assessed using the AQUA tool. RESULTS: The arcade was reported in 13 studies (510 arms), whereas the ligament in 6 studies (513 arms). The overall pooled prevalence estimate of the ligament was 1.8%, and 52.6% for the arcade. Most frequently, the ulnar nerve was covered by a tendinous arcade (42.2%). In all cases, the ligament inserted into the medial humeral epicondyle, but had various origins. Only 1 study reported compression of the median nerve by the ligament, whilst another contradicted this view. CONCLUSIONS: Although the SL is rare, and the SA is a valid anatomical entity (though with a variable presentation), clinically meaningful neurovascular entrapments caused by these structures are infrequent. Nonetheless, a better understanding of each may be beneficial for the best patient outcomes.
Subject(s)
Ligaments , Nervous System Diseases , Ulnar Nerve , Arm , Humans , Humerus , Ligaments/anatomy & histology , Median Nerve , Nervous System Diseases/diagnosisABSTRACT
[This corrects the article DOI: 10.1302/2046-3758.67.BJR-2016-0340.R1.].
ABSTRACT
OBJECTIVES: Inflammation of the retrocalcaneal bursa (RB) is a common clinical problem, particularly in professional athletes. RB inflammation is often treated with corticosteroid injections however a number of reports suggest an increased risk of Achilles tendon (AT) rupture. The aim of this cadaveric study was to describe the anatomical connections of the RB and to investigate whether it is possible for fluid to move from the RB into AT tissue. METHODS: A total of 20 fresh-frozen AT specimens were used. In ten specimens, ink was injected into the RB. The remaining ten specimens were split into two groups to be injected with radiological contrast medium into the RB either with or without ultrasonography guidance (USG). RESULTS: In specimens injected with ink, diffusion outside the RB was observed with staining of the anterior portion of the AT. In eight contrast-injected specimens (five USG, three non-USG), a similar localised diffusion pattern was observed, with the contrast identified superiorly and anteriorly. In two contrast-injected specimens (non-USG), the diffusion pattern was more extensive. CONCLUSION: This study confirmed the existence of connections between the RB and the AT, especially rich in the anteroinferior portion of the tendon, which should be considered a weak zone for substances injected into the RB. We hypothesise that this part of the AT might be most vulnerable to rupture after corticosteroid injections.Cite this article: P. A. Pekala, B. M. Henry, J. R. Pekala, K. Piska, K. A. Tomaszewski. The Achilles tendon and the retrocalcaneal bursa: An anatomical and radiological study. Bone Joint Res 2017;6:446-451. DOI:10.1302/2046-3758.67.BJR-2016-0340.R1.
