Osborne's ligament

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]

Osborne's ligament
Details
SynonymOsborne's band, Osborne's fascia
LocationDorsal medial of the elbow
Identifiers
FMA85450
Anatomical terminology

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]

  • 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

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
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 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.

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. 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. 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.
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