Some patients have a congenital supracondylar spur on the distal humerus, and there may be a fibrous band between this spur and the medial epicondyle (ligament of Struthers). These structures may compress the median nerve, resulting in the Supracondylar Process Syndrome.


Clinical features:

(1) paresthesia and/or numbness in the hand in the distribution of the median nerve

(2) variable muscle weakness and/or muscle atrophy

(3) extension of the elbow may trigger or worsen the symptoms

(4) palpable mass on the distal humerus


Radiographic finding:

(1) supracondylar process on the anteromedial surface of the distal humerus


Electrophysiological findings:

(1) evidence of nerve compression

(2) may be normal


A supracondylar process may be unilateral or bilateral. If unilateral, then the opposite side can be used for comparison. If bilateral, then the opposite side may also show evidence of median nerve compression.


Differential diagnosis - other causes of median nerve compression:

(1) more proximal bifurcation of the brachial artery

(2) pronator syndrome

(3) anomalous insertion of the coracobrachialis muscle

(4) trauma to the distal humerus


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