Osborne's ligament

Last updated
Osborne's ligament
Osborne's band.jpg
Details
SynonymOsborne's band, Osborne's fascia
LocationDorsal medial of the elbow
Identifiers
FMA 85450
Anatomical terminology

Osborne's ligament, also Osborne's band, Osborne's fascia, Osborne's arcade, arcuate ligament of Osborne, or the cubital tunnel retinaculum, refers to either the connective tissue which spans the humeral and ulnar heads of the flexor carpi ulnaris (FCU) or another distinct tissue located between the olecranon process of the ulna and the medial epicondyle of the humerus. It is named after Geoffrey Vaughan Osborne, a British orthopedic surgeon, who described the eponymous tissue in 1957. [1]

Contents

Definition

Due to inconsistent definitions in the literature, Osborne's ligament can be classified as the fibrous band bridging the two heads of the FCU as originally described by Osborne [2] or the ligamentous tissue connecting the olecranon and the medial epicondyle. [3] Different terminologies have also been used to describe the tissues, including ligamentum epitrochleo-anconeum [4] and epitrochleo-olecranal ligament, [5] further contributing to the problem of clarifying the definitions.

Structure

Under the first definition, Osborne's ligament is a band of fibrous tissue which connects the humeral and the ulnar heads of the FCU. It can be classified as being thin or thick and thought to be a separate structure from the aponeurosis of the FCU. [6]

Under the second definition, Osborne's ligament is a ligamentous tissue with one end attached to the olecranon and the other to the medial epicondyle. It is generally believed to be analogous to the anatomically variant epitrochleoanconeus muscle which is attached to the olecranon and the medial epicondyle in the same manner, meaning that people possessing Osborne's ligament do not have the epitrochleoanconeus and vice versa. [7] [8] It can be categorized into two types: [9]

Under both definitions, Osborne's ligament forms the roof of the cubital tunnel, an opening between the muscles through which the ulnar nerve passes.[ citation needed ]

Prevalence

The prevalence of Osborne's ligament has been inconsistently reported, ranging from 8% through 77% to 100% in cadavers across different studies. [10] [11] [12] The inconsistency can be attributed to the unestablished definition of the tissue. [8]

Clinical significance

Osborne's ligament can be visualized via ultrasound and MRI. [13] [14]

Cubital tunnel syndrome

One of the possible sites of ulnar nerve entrapment is the cubital tunnel which is where Osborne's ligament is located. [15] When Osborne's ligament is present, the volume of the cubital tunnel decreases when the elbow is flexed. [16] This contributes to chronic compression of the ulnar nerve which causes numbness and weakness in the fingers and can lead to intrinsic paralysis of the hand in untreated severe cases. [17] [18] Decompression of the ulnar nerve can be achieved through surgery. [19] Alternatively, in mild cases of the entrapment, non-operative conservative treatment, which includes nerve gliding and wearing a splint at night, may be used to alleviate the nerve compression. [20]

A scratch collapse test can be utilized to evaluate the condition as well as pinpoint the location of the nerve entrapment by Osborne's ligament. [21] [22] The test begins with the patient sitting with their elbow flexed at 90° and their fingers pointing toward the examiner. The examiner then rotates the patient's forearm medially or inward towards the patient's torso. The patient is asked to resist the motion, and the examiner gauges the resulting resistance. Following this, the examiner strokes the area on the patient's arm that is thought to be the site of impingement. The examiner then rotates the patient's forearm medially again. If there is a noticeable reduction in the resistance, the test's result is considered positive, and the stroked area is likely confirmed to be the site of the nerve entrapment.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Median nerve</span> Nerve of the upper limb

The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus.

<span class="mw-page-title-main">Ulnar nerve</span> Nerve which runs near the ulna bone

In human anatomy, the ulnar nerve is a nerve that runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, innervating the palmar aspect of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.

<span class="mw-page-title-main">Ulnar collateral ligament of elbow joint</span> Ligament on the elbow

The ulnar collateral ligament (UCL) or internal lateral ligament is a thick triangular ligament at the medial aspect of the elbow uniting the distal aspect of the humerus to the proximal aspect of the ulna.

<span class="mw-page-title-main">Cubital tunnel</span>

The cubital tunnel is a space of the dorsal medial elbow which allows passage of the ulnar nerve around the elbow. It is bordered medially by the medial epicondyle of the humerus, laterally by the olecranon process of the ulna and the tendinous arch joining the humeral and ulnar heads of the flexor carpi ulnaris. The roof of the cubital tunnel is elastic and formed by a myofascial trilaminar retinaculum. In 14% of individuals, the roof of this tunnel is covered by epitrochleoanconeus muscle, a variant muscle.

<span class="mw-page-title-main">Flexor carpi ulnaris muscle</span>

The flexor carpi ulnaris (FCU) is a muscle of the forearm that flexes and adducts at the wrist joint.

The pronator teres is a muscle that, along with the pronator quadratus, serves to pronate the forearm. It has two origins, at the medial humeral supracondylar ridge and the ulnar tuberosity, and inserts near the middle of the radius.

<span class="mw-page-title-main">Flexor retinaculum of the hand</span> Thickened fascia over the carpal tunnel

The flexor retinaculum is a fibrous band on the palmar side of the hand near the wrist. It arches over the carpal bones of the hands, covering them and forming the carpal tunnel.

<span class="mw-page-title-main">Ulnar canal</span>

The ulnar canal or ulnar tunnel (also known as Guyon's canal or tunnel) is a semi-rigid longitudinal canal in the wrist that allows passage of the ulnar artery and ulnar nerve into the hand. The roof of the canal is made up of the superficial palmar carpal ligament, while the deeper flexor retinaculum and hypothenar muscles comprise the floor. The space is medially bounded by the pisiform and pisohamate ligament more proximally, and laterally bounded by the hook of the hamate more distally. It is approximately 4 cm long, beginning proximally at the transverse carpal ligament and ending at the aponeurotic arch of the hypothenar muscles.

<span class="mw-page-title-main">Medial epicondyle of the humerus</span> Rounded eminence on the medial side of the humerus

The medial epicondyle of the humerus is an epicondyle of the humerus bone of the upper arm in humans. It is larger and more prominent than the lateral epicondyle and is directed slightly more posteriorly in the anatomical position. In birds, where the arm is somewhat rotated compared to other tetrapods, it is called the ventral epicondyle of the humerus. In comparative anatomy, the more neutral term entepicondyle is used.

<span class="mw-page-title-main">Golfer's elbow</span> Tendon inflammation disease of the elbow

Golfer's elbow, or medial epicondylitis, is tendinosis of the medial common flexor tendon on the inside of the elbow. It is similar to tennis elbow, which affects the outside of the elbow at the lateral epicondyle. The tendinopathy results from overload or repetitive use of the arm, causing an injury similar to ulnar collateral ligament injury of the elbow in "pitcher's elbow".

<span class="mw-page-title-main">Ulnar tunnel syndrome</span> Medical condition

Ulnar tunnel syndrome, also known as Guyon's canal syndrome or Handlebar palsy, is ulnar neuropathy at the wrist where it passes through the Guyon canal. The most common presentation is a palsy of the deep motor branch of the ulnar nerve causing weakness of the interosseous muscles. Many are associated with a ganglion cyst pressing on the ulnar nerve, but most are idiopathic. Long distance bicycle rides are associated with transient alterations in ulnar nerve function. Sensory loss in the ring and small fingers is usually due to ulnar nerve entrapment at the cubital tunnel near the elbow, which is known as cubital tunnel syndrome, although it can uncommonly be due to compression at the wrist.

<span class="mw-page-title-main">Ulnar nerve entrapment</span> Medical condition

Ulnar nerve entrapment is a condition where pressure on the ulnar nerve as it passes through the cubital tunnel causes nerve dysfunction (neuropathy). The symptoms of neuropathy are paresthesia (tingling) and numbness primarily affecting the little finger and ring finger of the hand. Ulnar neuropathy can progress to weakness and atrophy of the muscles in the hand. Symptoms can be alleviated by attempts to keep the elbow from flexing while sleeping, such as sticking one’s arm in the pillow case, so the pillow restricts flexion.

<span class="mw-page-title-main">Radial tunnel syndrome</span> Medical condition

Radial tunnel syndrome (RTS) is caused by increased pressure on the radial nerve as it travels from the upper arm to the hand and wrist.

<span class="mw-page-title-main">Ulnar neuropathy</span> Medical condition

Ulnar neuropathy is a disorder involving the ulnar nerve. Ulnar neuropathy may be caused by entrapment of the ulnar nerve with resultant numbness and tingling. It may also cause weakness or paralysis of the muscles supplied by the nerve.

<span class="mw-page-title-main">Elbow</span> Joint between the upper and lower parts of the arm

The elbow is the region between the upper arm and the forearm that surrounds the elbow joint. The elbow includes prominent landmarks such as the olecranon, the cubital fossa, and the lateral and the medial epicondyles of the humerus. The elbow joint is a hinge joint between the arm and the forearm; more specifically between the humerus in the upper arm and the radius and ulna in the forearm which allows the forearm and hand to be moved towards and away from the body. The term elbow is specifically used for humans and other primates, and in other vertebrates forelimb plus joint is used.

Anterior interosseous syndrome is a medical condition in which damage to the anterior interosseous nerve (AIN), a distal motor and sensory branch of the median nerve, classically with severe weakness of the pincer movement of the thumb and index finger, and can cause transient pain in the wrist.

<span class="mw-page-title-main">Struthers' ligament</span>

Struthers' ligament is a feature of human anatomy consisting of a band of connective tissue at the medial aspect of the distal humerus. It courses from the supracondylar process of the humerus to the medial humeral epicondyle. It is not a constant ligament, and can be acquired or congenital. The structure was highlighted by John Struthers, who discussed the feature's evolutionary significance with Charles Darwin. Struthers originally reported that the ligament usually arose at a position 3.2 to 6.4 cm from the medial condyle, being 1.2 to 1.9 cm in length, and nearer to the anterior than the medial border of the humerus.

<span class="mw-page-title-main">Median nerve palsy</span> Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

<span class="mw-page-title-main">Ulnar collateral ligament injury of the elbow</span> Medical condition

Ulnar collateral ligament injuries can occur during certain activities such as overhead baseball pitching. Acute or chronic disruption of the ulnar collateral ligament result in medial elbow pain, valgus instability, and impaired throwing performance. There are both non-surgical and surgical treatment options.

<span class="mw-page-title-main">Epitrochleoanconeus muscle</span>

The epitrochleoanconeus muscle is a small accessory muscle of the arm which runs from the back of the inner condyle of the humerus over the ulnar nerve to the olecranon. The average prevalence of this muscle is 14.2% in healthy individuals.

References

  1. ↑ Granger, A; Sardi, JP; Iwanaga, J; Wilson, TJ; Yang, L; Loukas, M; Oskouian, RJ; Tubbs, RS (6 March 2017). "Osborne's Ligament: A Review of its History, Anatomy, and Surgical Importance". Cureus. 9 (3): e1080. doi: 10.7759/cureus.1080 . PMC   5383373 . PMID   28405530.
  2. ↑ Osborne, Geoffrey (1957). "The surgical treatment of tardy ulnar neuritis: Proceedings and reports of councils and associations". J Bone Joint Surg. 39B: 782.
  3. ↑ Wali, AR; Gabel, B; Mitwalli, M; Tubbs, RS; Brown, JM (1 May 2017). "Clarification of Eponymous Anatomical Terminology: Structures Named After Dr Geoffrey V. Osborne That Compress the Ulnar Nerve at the Elbow". Hand. 13 (3): 355–359. doi:10.1177/1558944717708030. PMC   5987985 . PMID   28503939.
  4. ↑ Clemens, HJ (30 November 1957). "On the morphology of the epitrochleo-anconeum ligament". Anatomischer Anzeiger. 104 (17–20): 343–4. PMID   13509197.
  5. ↑ Matsuzaki, A (December 2001). "Membranous tissue under the flexor carpi ulnaris muscle as a cause of cubital tunnel syndrome". Hand Surgery. 6 (2): 191–7. doi:10.1142/s0218810401000710. PMID   11901466.
  6. ↑ Green JR, Jr; Rayan, GM (September 1999). "The cubital tunnel: anatomic, histologic, and biomechanical study". Journal of Shoulder and Elbow Surgery. 8 (5): 466–70. doi:10.1016/s1058-2746(99)90078-2. PMID   10543601.
  7. ↑ Vanderpool, DW; Chalmers, J; Lamb, DW; Whiston, TB (November 1968). "Peripheral compression lesions of the ulnar nerve". The Journal of Bone and Joint Surgery. British Volume. 50 (4): 792–803. doi:10.1302/0301-620X.50B4.792. PMID   4303276.
  8. 1 2 Suwannakhan, A; et al. (4 February 2021). "The prevalence of anconeus epitrochlearis muscle and Osborne's ligament in cubital tunnel syndrome patients and healthy individuals: An anatomical study with meta-analysis". The Surgeon. 19 (6): e402–e411. doi:10.1016/j.surge.2020.12.006. PMID   33551294.
  9. ↑ O'Driscoll, SW; Horii, E; Carmichael, SW; Morrey, BF (July 1991). "The cubital tunnel and ulnar neuropathy". The Journal of Bone and Joint Surgery. British Volume. 73 (4): 613–7. doi:10.1302/0301-620X.73B4.2071645. PMID   2071645.
  10. ↑ Karatas, A; Apaydin, N; Uz, A; Tubbs, R; Loukas, M; Gezen, F (July 2009). "Regional anatomic structures of the elbow that may potentially compress the ulnar nerve". Journal of Shoulder and Elbow Surgery. 18 (4): 627–31. doi:10.1016/j.jse.2009.03.004. PMID   19481960.
  11. ↑ Dellon, AL (June 1986). "Musculotendinous variations about the medial humeral epicondyle". Journal of Hand Surgery, British Volume. 11 (2): 175–81. doi:10.1016/0266-7681(86)90254-8. PMID   3734552.
  12. ↑ Gonzalez, MH; Lotfi, P; Bendre, A; Mandelbroyt, Y; Lieska, N (April 2001). "The Ulnar Nerve at the Elbow and its Local Branching: An Anatomic Study". Journal of Hand Surgery, British Volume. 26 (2): 142–144. doi:10.1054/jhsb.2000.0532. PMID   11281666. S2CID   45169622.
  13. ↑ De Maeseneer, M; Brigido, MK; Antic, M; Lenchik, L; Milants, A; Vereecke, E; Jager, T; Shahabpour, M (April 2015). "Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves". European Journal of Radiology. 84 (4): 671–81. doi: 10.1016/j.ejrad.2014.12.007 . PMID   25638576.
  14. ↑ Simonson, S; Lott, K; Major, NM (July 2010). "Magnetic resonance imaging of the elbow". Seminars in Roentgenology. 45 (3): 180–93. doi:10.1053/j.ro.2010.01.002. PMID   20483114.
  15. ↑ Osborne, G (March 1970). "Compression neuritis of the ulnar nerve at the elbow". The Hand. 2 (1): 10–3. doi:10.1016/0072-968x(70)90027-6. PMID   4328789. S2CID   7186537.
  16. ↑ James, J; Sutton, LG; Werner, FW; Basu, N; Allison, MA; Palmer, AK (December 2011). "Morphology of the cubital tunnel: an anatomical and biomechanical study with implications for treatment of ulnar nerve compression". Journal of Hand Surgery, American Volume. 36 (12): 1988–95. doi:10.1016/j.jhsa.2011.09.014. PMID   22051231.
  17. ↑ Palmer, BA; Hughes, TB (January 2010). "Cubital tunnel syndrome". Journal of Hand Surgery, American Volume. 35 (1): 153–63. doi:10.1016/j.jhsa.2009.11.004. PMID   20117320.
  18. ↑ Osborne, G (July 1959). "Ulnar neuritis". Postgraduate Medical Journal. 35 (405): 392–6. doi: 10.1136/pgmj.35.405.392 . PMC   2501979 . PMID   14429192.
  19. ↑ Simsek, S; Er, U; Demirci, A; Sorar, M (2011). "Operative illustrations of the Osborne's ligament". Turkish Neurosurgery. 21 (2): 269–70. doi: 10.5137/1019-5149.JTN.3764-10.1 . PMID   21534217.
  20. ↑ Dellon, AL (July 1989). "Review of treatment results for ulnar nerve entrapment at the elbow". Journal of Hand Surgery, American Volume. 14 (4): 688–700. doi:10.1016/0363-5023(89)90192-5. PMID   2666496.
  21. ↑ Cheng, CJ; Mackinnon-Patterson, B; Beck, JL; Mackinnon, SE (November 2008). "Scratch collapse test for evaluation of carpal and cubital tunnel syndrome". Journal of Hand Surgery, American Volume. 33 (9): 1518–24. doi:10.1016/j.jhsa.2008.05.022. PMID   18984333.
  22. ↑ Brown, JM; Mokhtee, D; Evangelista, MS; Mackinnon, SE (June 2010). "Scratch Collapse Test Localizes Osborne's Band as the Point of Maximal Nerve Compression in Cubital Tunnel Syndrome". Hand. 5 (2): 141–7. doi:10.1007/s11552-009-9225-4. PMC   2880669 . PMID   19774420.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.