Simultaneous Compression of the Neurovascular Bundle of Both Arms by a Bilateral Supracondylar Humeral Process: A Rare Case of Bilateral Nerve Entrapment of the Elbow in a Child

Abstract

The supracondylar process is a beak-shaped bone spur arising from the anteromedial area of the distal humerus and in the majority of cases, it is connected to the medial epicondyle with a band of connective tissue which is known as ligament of Struthers. The complex of bone spur and ligament creates a ring that may compress the median nerve causing soreness and paresthesia of the hand and fingers. We present a rare case of bilateral supracondylar process compressing the neurovascular bundles in both arms and causing simultaneous bilateral upper limb pain, numbness, and weakness in an otherwise healthy young child. Surgical excision of the bone spurs and release of Struthers' ligaments provided immediate pain relief and complete resolution of symptoms. Three years after the index surgery, no limitations of activities or signs of recurrence were reported. Median nerve compression neuropathy in a child or a young adult should always raise the suspicion of the presence of supracondylar process particularly when bilateral symptoms exist. Although there are limited data about the incidence of recurrence and the extent of bone resection, the supracondylar process should be excised together with the overlying periosteum to minimize the theoretical risk of local regrowth.

Three-Headed Biceps Brachii Muscle: A Rare Site of Proximal Median Nerve Entrapment

“…The median nerve courses medial to the short head of the biceps brachii with the brachial artery, passes deep to the BA, commonly courses between the two heads of the pronator teres, and then courses deep to flexor digitorum superficialis toward the carpal tunnel. While the carpal tunnel is the most common site of entrapment of the median nerve, there are several reports of more proximal entrapments of this nerve due to its relationship with the BA and flexor digitorum superficialis, but also from anatomical variants in the distal arm such as the ligament of Struthers [ 7 , 9 , 10 ]. Herein, we report a rare variant of the biceps brachii muscle that bridged over the median nerve and brachial artery, forming a rare supracondylar entrapment of these structures.…”