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Inner Synovial Membrane Footprint of the Anterior Elbow Capsule: An Arthroscopic Boundary.

Kamineni S, Bachoura A, Sasaki K, Reilly D, Harris KN, Sinai A, Deane A - Anat Res Int (2015)

Bottom Line: Results.The humeral footprint of the synovial membrane of the anterior elbow capsule is more complex and not as capacious as commonly understood from the current literature.Alternatively, stripping the synovial attachment from the anterior humerus does not constitute an anterior capsular release.

View Article: PubMed Central - PubMed

Affiliation: Elbow Shoulder Research Centre (ESRC), Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, 740 South Limestone Street, K-412 Kentucky Clinic, Lexington, KY 40536-0284, USA.

ABSTRACT
Introduction. The purpose of this study is to describe the inner synovial membrane (SM) of the anterior elbow capsule, both qualitatively and quantitatively. Materials and Methods. Twenty-two cadaveric human elbows were dissected and the distal humerus and SM attachments were digitized using a digitizer. The transepicondylar line (TEL) was used as the primary descriptor of various landmarks. The distance between the medial epicondyle and medial SM edge, SM apex overlying the coronoid fossa, the central SM nadir, and the apex of the SM insertion overlying the radial fossa and distance from the lateral epicondyle to lateral SM edge along the TEL were measured and further analyzed. Gender and side-to-side statistical comparisons were calculated. Results. The mean age of the subjects was 80.4 years, with six male and five female cadavers. The SM had a distinctive double arched attachment overlying the radial and coronoid fossae. No gender-based or side-to-side quantitative differences were noted. In 18 out of 22 specimens (81.8%), an infolding extension of the SM was observed overlying the medial aspect of the trochlea. The SM did not coincide with the outer fibrous attachment in any specimen. Conclusion. The humeral footprint of the synovial membrane of the anterior elbow capsule is more complex and not as capacious as commonly understood from the current literature. The synovial membrane nadir between the two anterior fossae may help to explain and hence preempt technical difficulties, a reduction in working arthroscopic volume in inflammatory and posttraumatic pathologies. This knowledge should allow the surgeon to approach this aspect of the anterior elbow compartment space with the confidence that detachment of this synovial attachment, to create working space, does not equate to breaching the capsule. Alternatively, stripping the synovial attachment from the anterior humerus does not constitute an anterior capsular release.

No MeSH data available.


Related in: MedlinePlus

The outline of the synovial membrane's (SM) insertion on the 3D image (a) and the corresponding two-dimensional cross sectional cuts at the apex of the SM's attachment overlying the coronoid (b) and radial fossae (c); the SM attachment is marked “capsule edge.”
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fig5: The outline of the synovial membrane's (SM) insertion on the 3D image (a) and the corresponding two-dimensional cross sectional cuts at the apex of the SM's attachment overlying the coronoid (b) and radial fossae (c); the SM attachment is marked “capsule edge.”

Mentions: The most medial and lateral points on the medial and lateral epicondyles, respectively, were identified in the axial and coronal planes and marked. These points were then linked to create a transepicondylar line (TEL), which was subsequently used as the primary reference feature to describe different landmarks of the anterior capsule (Figure 2). The horizontal distance along the TEL between the medial epicondyle and the medial edge of the SM, apex of the SM overlying the coronoid fossa, the central SM nadir, and the apex of the SM insertion overlying the radial fossa was measured in millimeters and expressed as a proportion of the total length of the TEL. The distance from the lateral epicondyle to the lateral edge of the SM was measured along the TEL in the anteroposterior plane (Figure 3). The vertical height from the TEL to the apices of SM's insertions overlying the coronoid and radial fossae as well as the nadir in between the fossae was measured in a plane perpendicular to the TEL (Figure 3). The total surface area of the distal humerus encompassed within the inner lining of the capsule was also measured (Figure 4). Two-dimensional sagittal cross sections were constructed along the planes perpendicular to the TEL at the apices of the coronoid and radial fossae and the locations of the SM's attachments marked (Figure 5), to offer a better understanding of the capsular attachment relative to the anterior elbow fossae.


Inner Synovial Membrane Footprint of the Anterior Elbow Capsule: An Arthroscopic Boundary.

Kamineni S, Bachoura A, Sasaki K, Reilly D, Harris KN, Sinai A, Deane A - Anat Res Int (2015)

The outline of the synovial membrane's (SM) insertion on the 3D image (a) and the corresponding two-dimensional cross sectional cuts at the apex of the SM's attachment overlying the coronoid (b) and radial fossae (c); the SM attachment is marked “capsule edge.”
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4561978&req=5

fig5: The outline of the synovial membrane's (SM) insertion on the 3D image (a) and the corresponding two-dimensional cross sectional cuts at the apex of the SM's attachment overlying the coronoid (b) and radial fossae (c); the SM attachment is marked “capsule edge.”
Mentions: The most medial and lateral points on the medial and lateral epicondyles, respectively, were identified in the axial and coronal planes and marked. These points were then linked to create a transepicondylar line (TEL), which was subsequently used as the primary reference feature to describe different landmarks of the anterior capsule (Figure 2). The horizontal distance along the TEL between the medial epicondyle and the medial edge of the SM, apex of the SM overlying the coronoid fossa, the central SM nadir, and the apex of the SM insertion overlying the radial fossa was measured in millimeters and expressed as a proportion of the total length of the TEL. The distance from the lateral epicondyle to the lateral edge of the SM was measured along the TEL in the anteroposterior plane (Figure 3). The vertical height from the TEL to the apices of SM's insertions overlying the coronoid and radial fossae as well as the nadir in between the fossae was measured in a plane perpendicular to the TEL (Figure 3). The total surface area of the distal humerus encompassed within the inner lining of the capsule was also measured (Figure 4). Two-dimensional sagittal cross sections were constructed along the planes perpendicular to the TEL at the apices of the coronoid and radial fossae and the locations of the SM's attachments marked (Figure 5), to offer a better understanding of the capsular attachment relative to the anterior elbow fossae.

Bottom Line: Results.The humeral footprint of the synovial membrane of the anterior elbow capsule is more complex and not as capacious as commonly understood from the current literature.Alternatively, stripping the synovial attachment from the anterior humerus does not constitute an anterior capsular release.

View Article: PubMed Central - PubMed

Affiliation: Elbow Shoulder Research Centre (ESRC), Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, 740 South Limestone Street, K-412 Kentucky Clinic, Lexington, KY 40536-0284, USA.

ABSTRACT
Introduction. The purpose of this study is to describe the inner synovial membrane (SM) of the anterior elbow capsule, both qualitatively and quantitatively. Materials and Methods. Twenty-two cadaveric human elbows were dissected and the distal humerus and SM attachments were digitized using a digitizer. The transepicondylar line (TEL) was used as the primary descriptor of various landmarks. The distance between the medial epicondyle and medial SM edge, SM apex overlying the coronoid fossa, the central SM nadir, and the apex of the SM insertion overlying the radial fossa and distance from the lateral epicondyle to lateral SM edge along the TEL were measured and further analyzed. Gender and side-to-side statistical comparisons were calculated. Results. The mean age of the subjects was 80.4 years, with six male and five female cadavers. The SM had a distinctive double arched attachment overlying the radial and coronoid fossae. No gender-based or side-to-side quantitative differences were noted. In 18 out of 22 specimens (81.8%), an infolding extension of the SM was observed overlying the medial aspect of the trochlea. The SM did not coincide with the outer fibrous attachment in any specimen. Conclusion. The humeral footprint of the synovial membrane of the anterior elbow capsule is more complex and not as capacious as commonly understood from the current literature. The synovial membrane nadir between the two anterior fossae may help to explain and hence preempt technical difficulties, a reduction in working arthroscopic volume in inflammatory and posttraumatic pathologies. This knowledge should allow the surgeon to approach this aspect of the anterior elbow compartment space with the confidence that detachment of this synovial attachment, to create working space, does not equate to breaching the capsule. Alternatively, stripping the synovial attachment from the anterior humerus does not constitute an anterior capsular release.

No MeSH data available.


Related in: MedlinePlus