PURPOSE: Variations of the peripheral nervous system in the upper limb, especially of the musculocutaneous and median nerves, are common, but closer attention to the knowledge of the variant anatomy should be paid to avoid iatrogenic injury or to understand the unusual clinical signs. METHODS: During a routine dissection course, bilateral variations were observed in a Central European male cadaver. RESULTS: Variable branching of the musculocutaneous and median nerves associated with atypical innervation of the muscles in the anterior compartment of the arm and other concomitant variations were found bilaterally. In both cases, the musculocutaneous nerve innervated only the coracobrachialis muscle and terminated inside the muscle belly. Branches to the biceps brachii and brachialis muscles arose either directly from the median nerve or its branches. On the right side, two communicating branches between the roots of the median nerve were noted, and a common medial cutaneous trunk originated from the lateral cord. On the left side, a communicating branch extended from the lateral cord to the medial root of the median nerve and a tributary to the axillary vein passed through a window formed by the roots of the median nerve and the communicating branch. CONCLUSION: There exist only few cases in the literature describing similar variations, but the present arrangement has not yet been reported to the best of our knowledge. With the proposed extension to the existing classification system, we aim to provide clearer orientation in the variability of the musculocutaneous and median nerves.
- MeSH
- anatomická variace * MeSH
- disekce MeSH
- kosterní svaly inervace MeSH
- lidé MeSH
- mrtvola MeSH
- nervus medianus abnormality MeSH
- nervus musculocutaneus abnormality MeSH
- paže inervace MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Brachial Plexus is formed by the union of the anterior rami of cervical 5, 6, 7, 8 and thoracic 1 nerves. These nerves unite and divide to form the key nerves innervating the upper limb. Variations in the course of these nerves are clinically important to anesthetists, neurologists and orthopedicians. We report bilateral variations in the arterial and neural structures in the upper limb of a 65 year old cadaver. The muscles of the arm on one side were innervated by the median nerve with absence ofmusculocutaneous. While on the other side the musculocutaneous nerve contributed to the formation of the median nerve. There was a presence of high bifurcation of brachial artery on both sides. Knowledge of such variations in the innervations of muscles and the arterial supply of the limbs are important to remember before performing any reconstructive procedures or interventions on the limb.
- MeSH
- arteria brachialis abnormality inervace MeSH
- lidé MeSH
- nervus medianus abnormality MeSH
- nervus musculocutaneus abnormality MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Variant branching pattern of the cords of brachial plexus coupled with erroneous communications has been an area of concern for surgeons opting to explore this region. Anaesthetic blocks and surgical approaches are the highlights of these interventions, where a keen familiarization of the anatomy of this region is mandatory. The present case description reports a unilateral variant branching pattern of the posterior cord coexistent with a neural communication between lateral and medial cords in an adult male cadaver. This intercordal neural communication between lateral and medial cords was oriented obliquely and measured 2.2 cm in length. Furthermore, the posterior cord revealed a variant branching pattern. It branched into three upper subscapular nerves and a common trunk for the thoracodorsal and lower subscapular nerves. The lowest of the three upper subscapular nerves gave a communicating twig to the thoracodorsal nerve. Inspite of uncountable reports on variations of brachial plexus, descriptions regarding anomalous branching patterns hold enormous clinical significance for the radiologists, anesthetists and surgeons, besides being of academic interest for the anatomists.
