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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

Medial extension of the synovial membrane's insertion overlying the trochlea was present in 81.8% of the specimens. This is an anterior view.
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fig7: Medial extension of the synovial membrane's insertion overlying the trochlea was present in 81.8% of the specimens. This is an anterior view.

Mentions: A summary of the qualitative results is presented in Table 1. The SM inserts on a bony segment anteriorly and posteriorly and wraps around the trochlea medially and the capitellum laterally, in one continuous lining (Figure 4). In all the specimens, the anterior capsule's SM insertion had a double arched structure encompassing the coronoid and radial fossae. The nadir of the arches was at the lateral end of the trochlea in all cases. In 18 (81.8%) cases, the arches were clearly observed to have a medially rotated axis or in valgus relative to the axis perpendicular to the TEL (Figure 6). In 18 out of 22 specimens (81.8%), an infolding extension of the SM was observed overlying the medial aspect of the trochlea (Figure 7). The apex of the SM's insertion overlying the coronoid fossa attached to a relatively flat or a mildly convex portion of the distal humeral surface in 18/22 specimens is shown in Figure 5(b). The capsule was inserted on the curvature of the coronoid fossa in two specimens, while two more specimens had a bony anomaly in the coronoid fossa that distorted the true location of the capsular insertion. With regard to the apex of the SM's insertion overlying the radial fossa, the insertion was on a relatively flat portion of the distal humeral surface in 21/22 (95.5%) of specimens (Figure 5(c)).


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)

Medial extension of the synovial membrane's insertion overlying the trochlea was present in 81.8% of the specimens. This is an anterior view.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig7: Medial extension of the synovial membrane's insertion overlying the trochlea was present in 81.8% of the specimens. This is an anterior view.
Mentions: A summary of the qualitative results is presented in Table 1. The SM inserts on a bony segment anteriorly and posteriorly and wraps around the trochlea medially and the capitellum laterally, in one continuous lining (Figure 4). In all the specimens, the anterior capsule's SM insertion had a double arched structure encompassing the coronoid and radial fossae. The nadir of the arches was at the lateral end of the trochlea in all cases. In 18 (81.8%) cases, the arches were clearly observed to have a medially rotated axis or in valgus relative to the axis perpendicular to the TEL (Figure 6). In 18 out of 22 specimens (81.8%), an infolding extension of the SM was observed overlying the medial aspect of the trochlea (Figure 7). The apex of the SM's insertion overlying the coronoid fossa attached to a relatively flat or a mildly convex portion of the distal humeral surface in 18/22 specimens is shown in Figure 5(b). The capsule was inserted on the curvature of the coronoid fossa in two specimens, while two more specimens had a bony anomaly in the coronoid fossa that distorted the true location of the capsular insertion. With regard to the apex of the SM's insertion overlying the radial fossa, the insertion was on a relatively flat portion of the distal humeral surface in 21/22 (95.5%) of specimens (Figure 5(c)).

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