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CASE REPORT
Year : 2014  |  Volume : 3  |  Issue : 2  |  Page : 134-136

Study of supracondylar process of humerus


Department of Anatomy, Navodaya Medical College, Raichur, Karnataka, India

Date of Web Publication19-May-2014

Correspondence Address:
Ravi Vandana
Department of Anatomy, Navodaya Medical College, Raichur 584 103, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.132708

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  Abstract 

The supra condylar process is occasional beak like projection from anteromedial surface of distal 1/3 rd of humerus. It appears to be phylogenetic remnant of complete osseous bridge found in reptiles, marsupials, cats, lemurs and new world monkeys. Among 133 dried humeri studied only one right humerus showed SCP (incidence 0.75%) whose dimensions were recorded and photographed. SCP is usually clinically silent but can be the cause for median or ulnar nerve and brachial artery compression syndrome especially when associated with Struthers ligament. Therefore the knowledge of presence of SCP is important for clinicians and radiologists along with anatomists and anthropologists.

Keywords: Humerus, struthers ligament, supracondylar process


How to cite this article:
Vandana R, Patil SP. Study of supracondylar process of humerus. Int J Health Allied Sci 2014;3:134-6

How to cite this URL:
Vandana R, Patil SP. Study of supracondylar process of humerus. Int J Health Allied Sci [serial online] 2014 [cited 2019 Oct 22];3:134-6. Available from: http://www.ijhas.in/text.asp?2014/3/2/134/132708


  Introduction Top


Supracondylar process (SCP) is a hook-like process of bone which varies from 2 to 20 mm in length, occasionally projects from the anteromedial surface of the shaft of the humerus, about 5 cm proximal to the medial epicondyle. It is curved, directed downwards and forwards, and its pointed apex sometimes connected to the medial border just above the medial epicondyle by fibrous band to which part of pronator teres is attached. [1] This fibrous band is known as ligament of Struthers, which represents the lower head or third head of coracobrachialis. [2] This bony projection of humerus was first noted by Tiedemann in 1822 who described it as pathological exostosis. [3] It has also been referred to as the SCP, supraepitrochlear, supracondyloid, epicondyloid, or supratrochlear spur by various authors. [4],[5] According to Kessel and Rang, the ligament actually represents lower part of tendon of a vestigial muscle latissimus condyloidieus, which is found in climbing animals and extends from latissimus dorsi to the medial epicondyle. [6] The reported incidence of SCP varies from 0.1 % to 2.7% in different races .[7] Till now very few studies have been done on SCP in Indian population.


  Case report Top


Observations

The SCP was projecting from distal one-third of shaft of humerus on anteromedial surface and was directed downwards, forwards, and medially. Dimensions of projection were recorded with vernier calipers and photographs were taken [Figure 1] and [Figure 2].
Figure 1: Showing right humerus with supratrochlear process

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Figure 2: Showing distal part of humerus with supratrochlear process

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The following observation were recorded

  1. Length of SCP was 8 mm
  2. Breadth at the base was 12 mm
  3. It was located at 53 mm distance from medial epicondyle
  4. It was at a distance of 38 mm from the nutrient foramen [Figure 3]
  5. Distance between the process and anterior border was 3 mm
  6. Distance between the process and medial border was 5 mm.
Figure 3: Showing distance between nutrient foramen (NF) and supratrochlear process

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  Discussion Top


The SCP of humerus has been mentioned in 16 th century by Coiter as cited by Marquis et al., [8] but it was first described in apes and monkeys by Tiedemann [9] and later in human by Knox. [10] The SCP is rarely found bilaterally (Subasi et al., 2002), [11] it is more common on left side (90%) and in males (60%) (Natsis et al., 2008) .[12] The incidence of SCP is low in Indian population and very few studies have been done on SCP till now as shown in [Table 1]. The present study shows that the incidence of SPC is low in Indian race.
Table 1: Incidence and measurements of supracondylar process among Indian population


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Race estimation from skeletal data has always been a central focus in anthropology. [13] Gray's anatomy states that its presence may aid in assessing racial affinities. [14]

According to Danforth, differences in racial incidence of particular variation are probably due to differential distribution of genes with reference to race. He also proposed the idea of somatic mutation as a general cause these small variations, at least in human material. [15] The incidence of SCP of humerus varies in different races which is shown in [Table 2]. [7]
Table 2: Incidence of supracondylar process in different races


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The length of SCP in our study (8 mm) is nearer to the studies done by Natsis et al., (9 mm), Prabahita et al., (11 mm) [16] as against the study by Gupta and Mehta in which they reported very short process measuring 3 mm and Oluyemi et al., reported longer SCP (16 mm) compared to our study. The average distance of SCP from medial epicondyle in our study was 53 mm, which was almost similar to the studies done by Oluyemi et al., (55 mm), Natsis et al., (59.8 mm), Gupta and Mehta (65 mm), and Prabahita et al., (44 mm).

Last RJ states that pressure from the ligament on the artery or nerve may very rarely cause an irritative spasm of the vessel or a median nerve palsy. Such palsy can be readily distinguished from "carpal tunnel syndrome", because weakness of relevant forearm muscles and paresthesia over the thenar eminence are added to simpler picture loss of median nerve conduction at the wrist. [17] There is high incidence of unilateral SCP of humerus in "Cornelia de Lange Syndrome", an autosomal recessive trait, occurring in approximately one in every 10,000 live births. [18]

SCP rarely causes any clinical symptoms, it can be found incidentally during plain radiographic examination or palpation of the region by physician. The clinical symptoms associated with SCP are median nerve entrapment with or without brachial artery compression, ulnar nerve entrapment, and fracture of the process. The symptoms are exacerbated by pronation of forearm or by extension and pronation/supination of forearm as in repetitive action of catching baseball. Nerve compression usually causes intense pain, paresthesia, sensory loss, and muscular weakness in the area of median nerve distribution. [7] Although ulnar nerve lies posterior to the SCP, it may be compressed over the spur during flexion of elbow originating symptoms of ulnar neuropathy. [19] In rare cases of localized brachial artery compression due to SCP, ischemic symptoms such as claudication and coldness, and reduced radial and ulnar pulses can be detected. In symptomatic cases, the nerve or arterial impingement caused by the presence or fracture of SCP known as SCP syndrome can be relieved after surgical resection along with underlying periosteum to prevent the recurrence of SCP. [20]

 
  References Top

1.In: Williams PL, Warwick R, Dyson M, Bannister LH, editors. Gray' Anatomy. 39 th ed. Edinburgh London: Churchill Livingstone; 2005. p. 850.  Back to cited text no. 1
    
2.Datta AK. Essentials of human Anatomy. In: Superior and inferior extremity. 3 rd ed. Kolkatta: Current Books International; 2004. p. 60.  Back to cited text no. 2
    
3.Tiedmann F. Tabulae arterium corporis humani. Carlsruhae: Muller;   1822.  Back to cited text no. 3
    
4.Struthers J. On a peculiarity of the humerus and humeral artery. Mon J Med Sci (new series 28) 1848;8:264-7.  Back to cited text no. 4
    
5.Oluyemi KA, Okwuonu UC, Adesanya OA, Akinola OB, Ofusori DA, Ukwenya VO, et al. Upracondylar and infratubercular processes observed in the humeri of Nigerians. Afr J Biotechnol 2007;6:2439-41.  Back to cited text no. 5
    
6.Kessel L , Rang M. Supracodylar spur of the humerus.J Bone Joint Surg Br 1966;48:765-769.  Back to cited text no. 6
    
7.Gupta RK, Mehta CD. A study of the incidence of supracondylar process of the humerus. J Anat Soc India 2008;57:111-115.  Back to cited text no. 7
    
8.Marquis JW, Bruwer AJ, Keith HM Supracondyloid process of humerus. Proc Staff Meet Mayo Clin 1957;32:691-697.  Back to cited text no. 8
    
9.Tiedemann F Ueber einen am Oberarmbein bei Mehreren Geschwanzten Affen Vorkommenden Kanal und eine Damit in Verbindung Stehende Besondere Anordnung der Arterien und Nervus des Arms. Deutsches Archiv fur die Physiologie.1818;4:544-549.  Back to cited text no. 9
    
10.Knox R. On the occasional presence of the supracondylar process in the human humerus. Edinb Med Surg J 1841;56:125-128.  Back to cited text no. 10
    
11.Subasi M, Kesemenli C, Necmioglu S,Kapukaya A Demirtas M. Supracondylar process of the humerus. Acta Orthop Belg 2002;68:72-75.  Back to cited text no. 11
    
12.Natsis K. Supracondylar process of the humerus: Study on 375 Caucasian subjects in Cologne,Germany. Clin Anat 2008;21:138-141.  Back to cited text no. 12
    
13.Natsis K, Paraskevas GK. Anastasopoulos N, Ioannidis O, Kitsoulis P. Humeral septal aperature associated with supracondylar process: A case report and review of literature. Italian journal of Anatomy and embryology 2012;117:135-141.  Back to cited text no. 13
    
14.Williams PL, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, Ferguson MW editors Gray' Anatomy 38 th ed. Newyork: Churchill Livingstone;1999: p.626.  Back to cited text no. 14
    
15.Danforth CH. The Heredity of Unilateral Variations in Man.Genetics. 1924;9:199.  Back to cited text no. 15
    
16.Prabahita Baruah,Choudhury PR, Talukdar KL.A study of supracondylar process of humerus. journal of evolution of medical and dental sciences 2012;1:817-822.  Back to cited text no. 16
    
17.Last J,Anatomy regional and applied. 7 th ed. Edinburgh (UK).ELBS/Churchill Living stone 1984.73-74.  Back to cited text no. 17
    
18.Peters FL. Radiologic manifestations of the Cornelia de Lange syndrome. Pediatr .Radiol. 1975;3:41-46.  Back to cited text no. 18
    
19.Ay S,Bektas U,Yilmaz C, Diren B. An unusual supracondylar process syndrome. J Hand Surg Am 2002;27A:913-915.  Back to cited text no. 19
    
20.Thompson JK, Edwards JD. Supracondyalar process of the humerus causing brachial artery compression and digital embolisation in fast pitch soft ball player. A case report. Vasc Endovasc.Surg 2005;39:445-448.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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