Sir John Struthers (1823–1899) and His Ligament and Arcade

Abstract

Sir John Struthers, Scottish anatomist, professor, and surgeon, was an early advocate of clinical training in medical education, and his impact is still visible today. He was one of the first prominent anatomists in the United Kingdom to endorse Charles Darwin's controversial theory of natural selection, and his research reflected a desire to illustrate these ideas in cadaveric specimens. Struthers is remembered eponymously for 2 connective tissue condensations in the arm, an arcade and ligament, which may entrap the ulnar and median nerves, respectively. He studied medicine at the University of Edinburgh, received a Doctor of Laws degree from the University of Glasgow, served on the General Medical Council from 1883 to 1891, was president of the Royal College of Surgeons from 1895 to 1897, and was knighted by Queen Victoria in 1898. Struthers' devotion to medical education and insistence on the importance of clinical training laid the foundation for current medical curricula around the world. His observations of sites of potential nerve entrapment in the arm are still taught to neurosurgical trainees today.

The arcade of Struthers: An anatomical study with potential neurosurgical significance

“…[2223] Interestingly, Struthers never mentioned an “arcade” in his writings,[16] and such a structure was only later attributed to him in 1973 by Kane et al .,[14] who identified this structure in 70% of their cadaveric dissections, and these were located 8 cm proximal to the medial epicondyle of the humerus. In 1986, Amadio[2] identified an arcade of Struthers in 100% of 20 cadaveric arm dissections and localized this structure 6–10 cm proximal to the medial epicondyle.…”

Sonography of the Pronator Teres: Normal and Pathologic Appearances

“…It consists of a myofibrous thickening of the medial intermuscular septum at the distal humerus, creating a myofibrous sheath around the ulnar nerve, which may be potentially compressive after ulnar nerve transposition surgery. The median nerve is most commonly affected, but the brachial artery, a variant ulnar artery, or, rarely, the ulnar nerve may be also compressed . Sonographic detection of a supracondylar process, eventually associated with the Struthers ligament, can be difficult.…”

“…Anteroposterior and lateral radiographs are the reference standards for an inexpensive evaluation of this anatomic variant (Figure ). Clinically, a reduction or suppression of radial artery pulsations during supination‐extension of the forearm, due to compression of the brachial artery which accompanies the median nerve under this ligament, can be noted . The lacertus fibrosus, an aponeurotic band located between the bicipital tendon and pronator teres fascia, may also compress the median nerve and brachial artery (Figure ) .…”

“…The median nerve is most commonly affected, but the brachial artery, a variant ulnar artery, or, rarely, the ulnar nerve may be also compressed. [18][19][20] Sonographic detection of a supracondylar process, eventually associated with the Struthers ligament, can be difficult. Anteroposterior and lateral radiographs are the reference standards for an inexpensive evaluation of this anatomic variant (Figure 8).…”

“…Clinically, a reduction or suppression of radial artery pulsations during supination-extension of the forearm, due to compression of the brachial artery which accompanies the median nerve under this ligament, can be noted. [16][17][18][19][20] The lacertus fibrosus, an aponeurotic band located between the bicipital tendon and pronator teres fascia, may also compress the median nerve and brachial artery (Figure 9). 21,22 Variations of the median nerve may also be reported by sonographers.…”