A history of trauma and pain over the elbow joint.
The patient presented with a history of trauma and pain over his elbow joint.
Plain radiographs of the humerus and elbow were performed. These revealed a supracondylar fracture and a bony process arising from the anterio-medial surface of the humerus and pointing towards the elbow joint. This supracondylar process was an incidentally finding.
A supracondylar process is a small bony/osseous protrusion arising anteriomedially in the distal aspect of the humerus, 5cm above the medial epicondyle. It usually extends inferiorly into the arm. They are a normal variant occurring in 1% of the general population, seen incidentally (as in this case) and rarely of any clinical significance. It may form an accessory origin for pronator teres, through the ligament of Struthers. The ligament creates a functional foramen that surrounds the median nerve. The ligament connects the process to the medial epicondyle of the humerus. The median nerve may be displaced laterally and compressed against the humeral shaft. The compression is worsened with extension and supination. These spurs have been known to fracture following trivial trauma, resulting in median nerve palsy. If large, they can be palpable as a bony swelling.
The supracondylar process must be differentiated from a benign osteochondroma, which usually points away from the joint, while the process is oriented towards the joint.MR is helpful in many cases,as a distinct cartilaginous cap is demonstrated in osteochondroma and not in a supracondylar process.If the process is surgically removed,histologically it is different from an osteochondroma.
Supracondylar process
Based on the provided anteroposterior and lateral X-ray images of the elbow, a small protrusion can be observed on the medial side of the distal humerus, approximately 5 cm above the condyle, extending toward the ulnar side (the joint). The margin is clear, and the cortical continuity is maintained, primarily with bony structures. The protrusion is relatively slender in shape, with no obvious cartilaginous cap changes, no cortical destruction, and no abnormal signals. The local alignment of the elbow joint is good, with no definite signs of acute fracture.
This protrusion is a small bony structure on the anteromedial side of the distal humerus, considered a rare normal variant that is observed in about 1% of the population. It is angled toward the joint compared to the humeral shaft, can form a ligament known as Struthers’ ligament, and can potentially compress the median nerve.
Osteochondromas typically grow away from the joint and present with a distinct cartilaginous cap. If a bony protrusion is found near a joint, it should be considered in differential diagnoses.
Based on the patient’s age, history of trauma, and imaging characteristics, given that the bony protrusion is located on the medial side of the humerus and projects toward the joint, with no obvious cartilaginous cap or other malignant features on the X-ray, the most likely diagnosis is a supracondylar process of the humerus.
If there is still concern, an MRI can be performed to assess for a cartilaginous cap or any surrounding soft tissue compression, in order to rule out osteochondroma.
Given the patient’s history of trauma and elbow pain, it is necessary to consider the stability of the elbow joint and soft tissue condition. To prevent further irritation and injury, the following progressive rehabilitation principles are recommended:
Throughout the rehabilitation phase, it is crucial to follow the FITT-VP principle (Frequency, Intensity, Time, Type, Volume, Progression) and make adjustments according to the patient’s pain and joint function status.
Special Note: If significant neurological symptoms (such as finger numbness, loss of sensation, or motor impairment) develop during rehabilitation, seek medical attention promptly to rule out possible nerve compression.
Disclaimer: This report is a reference analysis based on the current imaging and basic clinical information, and cannot replace an in-person consultation or professional medical advice. If symptoms persist or worsen, you should seek medical attention promptly for further examination or treatment.
Supracondylar process
