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Osborne's ligament
Details
LocationDorsal medial of the elbow
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]

Definition

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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 unclear definitions.

Structure

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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 and 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]

  • Type Ia: thin; lax when the elbow is extended and becomes taut when the elbow is flexed.
  • Type Ib: thick; taut even when the elbow is not fully flexed (90°–120°).

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

Prevalence

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

Clinical significance

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

Cubital tunnel syndrome

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Main article: Ulnar nerve entrapment

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 toward 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]

Scratch collapse test can be utilized to evaluate the condition as well as pinpoint the location of the nerve entrapment by Osborne's ligament.[20][21] 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 to 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.

References

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  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. PMID 28405530.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  2. ^ Osborne, Geoffrey (1957). "The surgical treatment of tardy ulnar neuritis: Proceedings and reports of councils and associations". J Bone Joint Surg. 39: 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 (New York, N.Y.): 1558944717708030. doi:10.1177/1558944717708030. 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 : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand. 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. PMID 4303276.
  8. ^ a b 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 : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland. 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 (Edinburgh, Scotland). 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. 26 (2): 142–144. doi:10.1054/jhsb.2000.0532.
  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.
  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". The Journal of hand surgery. 36 (12): 1988–95. doi:10.1016/j.jhsa.2011.09.014. PMID 22051231.
  17. ^ Palmer, BA; Hughes, TB (January 2010). "Cubital tunnel syndrome". The Journal of hand surgery. 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: 392–6. doi:10.1136/pgmj.35.405.392. 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. ^ Cheng, CJ; Mackinnon-Patterson, B; Beck, JL; Mackinnon, SE (November 2008). "Scratch collapse test for evaluation of carpal and cubital tunnel syndrome". The Journal of hand surgery. 33 (9): 1518–24. doi:10.1016/j.jhsa.2008.05.022. PMID 18984333.
  21. ^ 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 (New York, N.Y.). 5 (2): 141–7. doi:10.1007/s11552-009-9225-4. PMID 19774420.

Test

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