Anatomical Variations of the Brachial Plexus Terminal Branches in Ethiopian Cadavers
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Anatomical Variants of the Musculocutaneous Nerve- Report of Two Cases
Open Access CRIMSON PUBLISHERS C Wings to the Research Research in Anatomy ISSN: 2577-1922 Case Report Anatomical Variants of the Musculocutaneous Nerve- Report of Two Cases Fernando Martinez1,2 and Guzmán Ripoll1* 1Anatomy Department, Facultad de Medicina Universidad Claeh, Uruguay 2Neurosurgery Department, Universidad de la República, Uruguay *Corresponding author: Guzmán Ripoll, AnatomyDepartment, Facultad de Medicina Universidad Claeh, Maldonado, Uruguay, Email: Submission: February 22, 2018; Published: April 19, 2018 Abstract Introduction: The muscle-cutaneous nerve (MCN) is a mixed nerve, which is mainly responsible for shoulder flexion, elbow flexion and supinationMaterial of theand hand. method: The anatomical variations in this nerve are relatively frequent, fact with clinical and surgical implications. Results: Two variants were A retrospective found in the review 20 cases of 20studied patients (10% operated of the cases): on with anastomosis the Oberlin betweentechnique MCN was and made. median nerve, and absence of the MCN.Discussion: MCN variants are frequently described by the different authors. This has an embryological and phylogenetic explanation: the lateralConclusion: and medial cords form the flexor plane of the muscles of the upper limb. We present 2 cases: an unusual one of median nerve-MCN, and another absence of it. We emphasize that the knowledge of these variants have clinical, surgical and neuro-physiological applications. Introduction The musclecutaneous nerve (MCN) is a mixed nerve, which from basically the use of fascicles of the median nerve to reinforce the ulnar nerve (Figure 1). The modifications of this technique are the motor point of view is mainly responsible for shoulder flexion, brachial plexus injuries with involvement of the upper trunk (C5- the muscles that innervate: coracobrachial, biceps brachialis and anterior brachial muscle (Figure 2). -
Brachial-Plexopathy.Pdf
Brachial Plexopathy, an overview Learning Objectives: The brachial plexus is the network of nerves that originate from cervical and upper thoracic nerve roots and eventually terminate as the named nerves that innervate the muscles and skin of the arm. Brachial plexopathies are not common in most practices, but a detailed knowledge of this plexus is important for distinguishing between brachial plexopathies, radiculopathies and mononeuropathies. It is impossible to write a paper on brachial plexopathies without addressing cervical radiculopathies and root avulsions as well. In this paper will review brachial plexus anatomy, clinical features of brachial plexopathies, differential diagnosis, specific nerve conduction techniques, appropriate protocols and case studies. The reader will gain insight to this uncommon nerve problem as well as the importance of the nerve conduction studies used to confirm the diagnosis of plexopathies. Anatomy of the Brachial Plexus: To assess the brachial plexus by localizing the lesion at the correct level, as well as the severity of the injury requires knowledge of the anatomy. An injury involves any condition that impairs the function of the brachial plexus. The plexus is derived of five roots, three trunks, two divisions, three cords, and five branches/nerves. Spinal roots join to form the spinal nerve. There are dorsal and ventral roots that emerge and carry motor and sensory fibers. Motor (efferent) carries messages from the brain and spinal cord to the peripheral nerves. This Dorsal Root Sensory (afferent) carries messages from the peripheral to the Ganglion is why spinal cord or both. A small ganglion containing cell bodies of sensory NCS’s sensory fibers lies on each posterior root. -
Anastomotic Branch from the Median Nerve to the Musculocutaneous Nerve: a Case Report
Case Report www.anatomy.org.tr Recieved: February 10, 2008; Accepted: April 22, 2008; Published online: October 31, 2008 doi:10.2399/ana.08.063 Anastomotic branch from the median nerve to the musculocutaneous nerve: a case report Feray Güleç Uyaro¤lu1, Gülgün Kayal›o¤lu2, Mete Ertürk2 1Department of Neurology, Ege University Faculty of Medicine, Izmir, Turkey 2Department of Anatomy, Ege University Faculty of Medicine, Izmir, Turkey Abstract Anomalies of the brachial plexus and its terminal branches are not uncommon. Communicating branch arising from the mus- culocutaneous nerve to the median nerve is a frequent variation, whereas the presence of an anastomotic branch arising from the median nerve and joining the musculocutaneous nerve is very rare. During routine dissection of cadaver upper limbs, we observed an anastomotic branch arising from the median nerve running distally to join with the branches of the musculocutaneous nerve in a left upper extremity. The anastomotic branch originated from the median nerve 11.23 cm prox- imal to the interepicondylar line. After running distally and coursing between the biceps brachii and the brachialis muscles, this anastomotic branch communicated with two branches of the musculocutaneous nerve separately. The presence of the communicating branches between these nerves should be considered during surgical interventions and clinical investigations of the arm. Key words: anatomy; brachial plexus; communicating branch; upper limb; variation Anatomy 2008; 2: 63-66, © 2008 TSACA Introduction neous nerve (C5, C6, and C7) connects with the median nerve in the arm.2,3 The musculocutaneous nerve is the Variations of the brachial plexus and its terminal continuation of the lateral cord of the brachial plexus. -
Anatomical, Clinical, and Electrodiagnostic Features of Radial Neuropathies
Anatomical, Clinical, and Electrodiagnostic Features of Radial Neuropathies a, b Leo H. Wang, MD, PhD *, Michael D. Weiss, MD KEYWORDS Radial Posterior interosseous Neuropathy Electrodiagnostic study KEY POINTS The radial nerve subserves the extensor compartment of the arm. Radial nerve lesions are common because of the length and winding course of the nerve. The radial nerve is in direct contact with bone at the midpoint and distal third of the humerus, and therefore most vulnerable to compression or contusion from fractures. Electrodiagnostic studies are useful to localize and characterize the injury as axonal or demyelinating. Radial neuropathies at the midhumeral shaft tend to have good prognosis. INTRODUCTION The radial nerve is the principal nerve in the upper extremity that subserves the extensor compartments of the arm. It has a long and winding course rendering it vulnerable to injury. Radial neuropathies are commonly a consequence of acute trau- matic injury and only rarely caused by entrapment in the absence of such an injury. This article reviews the anatomy of the radial nerve, common sites of injury and their presentation, and the electrodiagnostic approach to localizing the lesion. ANATOMY OF THE RADIAL NERVE Course of the Radial Nerve The radial nerve subserves the extensors of the arms and fingers and the sensory nerves of the extensor surface of the arm.1–3 Because it serves the sensory and motor Disclosures: Dr Wang has no relevant disclosures. Dr Weiss is a consultant for CSL-Behring and a speaker for Grifols Inc. and Walgreens. He has research support from the Northeast ALS Consortium and ALS Therapy Alliance. -
Brachial Plexus Injury Investigation , Localization and Treatment
BRACHIAL PLEXUS INJURY INVESTIGATION , LOCALIZATION AND TREATMENT EMBRYOLOGY § Brachial plexus (BP) is developed at 5 weeks of gestation § Afferent fibers develop from neuroblast located alongside neural tube § Efferent fibers originate from neuroblast in the basal plate of tube from where they grow outside § Afferent and efferent fibers join to form the nerve § Nerves divide into anterior and posterior divisions § There are connections between these nerves in the brachial plexus commons.wikimedia.org/wiki/File:Brachial_plexus.jpg ANATOMY lFormed by ventral primary rami of lower four cervical and first thoracic nerve root. l Frequently have contributions from C4(pre-fixed) or T2 (post-fixed). PREFIXED BRACHIAL PLEXUS http://www.msdlatinamerica.com/ebooks/HandSurgery/sid744608.html Post-fixed plexus http://www.msdlatinamerica.com/ebooks/HandSurgery/sid744608.html RELATIONS OF BRACHIAL PLEXUS Fig. 4. The reIationship of the axillary artery to the cords is an important anatomic relationship. The cords surround the axiIIary artery and are named for their position with respect to the axillary artery. L.C. lateral cord MC. Medial cord: PC . posterior Cord. Levels § Roots § Real § Trunks § Texans § Divisions § Drink § Cords § Cold § Branches § Beer § C5 and C6 roots form upper trunk § C8 and T1 roots the lower trunk § C7 forms the middle trunk § Joining point of C5-C6 roots is ERB”S POINT § Each trunk divides into an anterior and a posterior division and passes beneath the clavicle § All 3 posterior divisions merge to form the posterior cord § Anterior division of the upper and middle trunk merge to form the lateral cord § Anterior division of lower trunk forms the medial cord § Lateral cord splits into 2 terminal branches: a) Musculocutaneous nerve b) Lateral cord contribution to median nerve (sensory) § Posterior cord splits into a)axillary nerve and b)radial nerve § Medial cord gives off a) medial cord contribution to the median nerve(motor) and b)ulnar nerve § There are few terminal branches of the roots trunks and cords. -
Pectoral Nerves – a Third Nerve and Clinical Implications Kleehammer, A.C., Davidson, K.B., and Thompson, B.J
Pectoral Nerves – A Third Nerve and Clinical Implications Kleehammer, A.C., Davidson, K.B., and Thompson, B.J. Department of Anatomy, DeBusk College of Osteopathic Medicine, Lincoln Memorial University Introduction Summary Table 1. Initial Dataset and Observations The textbook description of the pectoral nerves A describes a medial and lateral pectoral nerve arising A from the medial and lateral cords, respectively, to innervate the pectoralis major and minor muscles. Studies have described variations in the origins and branching of the pectoral nerves and even in the muscles they innervate (Porzionato et al., 2011, Larionov et al., 2020). There have also been reports of three pectoral nerves with distinct origins (Aszmann et Table 1: Initial Dataset and Observations Our initial dataset consisted of 31 anatomical donors, dissected bilaterally, Each side was considered an al., 2000) and variability of the spinal nerve fibers Independent observation. Of the 62 brachial plexuses, 50 met our inclusion criteria. contributing to these nerves (Lee, 2007). Given the Table 2. Branching Patterns of Pectoral Nerves frequency of reported variation from the textbook description, reexamining the origin, course and B branching of the pectoral nerves could prove useful for B students and clinicians alike. The pectoral nerves are implicated in a variety of cases including surgeries of the breast, pectoral, and axillary region (David et al., 2012). Additionally, the lateral pectoral nerve has recently gained attention for potential use as a nerve graft for other damaged nerves such as the spinal accessory nerve (Maldonado, et al., 2017). The objective of this study was to assess the frequency and patterns of pectoral nerve branching in order to more accurately describe their orientation and implications in clinical cases. -
Axilla & Brachial Plexus
Anatomy Guy Dissection Sheet Axilla & Brachial Plexus Dr. Craig Goodmurphy Anatomy Guy Major Dissection Objectives 1. Review some of the superficial veins and nerves and extrapolate skin incisions down the arm while sparing the cephalic and basilic veins 2. Secure the upper limb in an abducted position and review the borders of the axilla while reflecting pec major and minor. 3. You may need to remove the middle third of the clavicle with bone cutters or oscillating saw 4. Identify and open the axillary sheath to find the axillary vein and separate it away from the arteries and nerves 5. Once it is mobilized remove smaller veins and reflect the axillary vein medially Major Dissection Objectives Arteries 6. Locate and clean the subclavian artery as it becomes the axillary a. at the first rib. 7. Identifying part 1, 2 and 3 of the axillary artery as they relate to pectoralis minor 8. Identify & clean the thoracoacromial trunk and its branches along with the lateral thoracic artery 9. Clean the subscapular artery and follow it to the circumflex scapular and thoracodorsal branches removing the fat of the region and noting variations and lymph nodes that may be present. 10. Locate the posterior and anterior humeral circumflex arteries and the brachial artery Eastern Virginia Medical School 1 Anatomy Guy Dissection Sheet Axilla & Brachial Plexus Major Dissection Objectives Nerves 11. Review the parts of the brachial plexus with roots in the scalene gap, trunks superior to the clavicle, divisions posterior to the clavicle, cords and branches inferior to the clavicle. 12. Locate the musculocutaneous nerve laterally as it pierces the coracobrachialis m. -
Multiple Nerve Injuries Following Repair of a Distal Biceps Tendon Rupture Case Report and Review of the Literature
166 Bulletin of the Hospital for Joint Diseases 2013;71(2):166-9 Multiple Nerve Injuries Following Repair of a Distal Biceps Tendon Rupture Case Report and Review of the Literature Marc R. Fajardo, M.D., Zehava Rosenberg, M.D., Dimitrios Christoforou, M.D., and John A. I. Grossman, M.D., F.A.C.S. Abstract We present the case of a patient, with a surgically repaired Current repair of a distal biceps tendon rupture has reverted distal biceps tendon rupture performed through a single to the single incision technique. Postoperative complications incision, with injury to both the posterior interosseus and are rare, but the most common are due to neuropraxia. We lateral antebrachial cutaneous nerves. present the case of patient who sustained multiple nerve injuries following distal biceps repair. This case is presented Case Report with a review of the literature. A healthy, right-hand dominant 51-year-old man sustained injury to his right distal biceps while shoveling dirt. He was upture of the distal end of the biceps brachialis diagnosed with an acute right distal biceps rupture (con- tendon is a relatively uncommon injury that usually firmed by ultrasound, Fig. 1) and subsequently underwent Roccurs in active, middle-aged men after an eccentric operative repair within a week of the injury. muscle contracture (often during heavy lifting). Patients The surgery was performed via a single incision. Intra- often present with pain, ecchymosis, and swelling over operatively, it was found that 90% of the distal biceps ten- the antecubital region of the dominant arm. The physical don was avulsed from the radial tuberosity. -
Pectoral Region and Axilla Doctors Notes Notes/Extra Explanation Editing File Objectives
Color Code Important Pectoral Region and Axilla Doctors Notes Notes/Extra explanation Editing File Objectives By the end of the lecture the students should be able to : Identify and describe the muscles of the pectoral region. I. Pectoralis major. II. Pectoralis minor. III. Subclavius. IV. Serratus anterior. Describe and demonstrate the boundaries and contents of the axilla. Describe the formation of the brachial plexus and its branches. The movements of the upper limb Note: differentiate between the different regions Flexion & extension of Flexion & extension of Flexion & extension of wrist = hand elbow = forearm shoulder = arm = humerus I. Pectoralis Major Origin 2 heads Clavicular head: From Medial ½ of the front of the clavicle. Sternocostal head: From; Sternum. Upper 6 costal cartilages. Aponeurosis of the external oblique muscle. Insertion Lateral lip of bicipital groove (humerus)* Costal cartilage (hyaline Nerve Supply Medial & lateral pectoral nerves. cartilage that connects the ribs to the sternum) Action Adduction and medial rotation of the arm. Recall what we took in foundation: Only the clavicular head helps in flexion of arm Muscles are attached to bones / (shoulder). ligaments / cartilage by 1) tendons * 3 muscles are attached at the bicipital groove: 2) aponeurosis Latissimus dorsi, pectoral major, teres major 3) raphe Extra Extra picture for understanding II. Pectoralis Minor Origin From 3rd ,4th, & 5th ribs close to their costal cartilages. Insertion Coracoid process (scapula)* 3 Nerve Supply Medial pectoral nerve. 4 Action 1. Depression of the shoulder. 5 2. Draw the ribs upward and outwards during deep inspiration. *Don’t confuse the coracoid process on the scapula with the coronoid process on the ulna Extra III. -
Axillary Nerve Injury Associated with Sports
Neurosurg Focus 31 (5):E10, 2011 Axillary nerve injury associated with sports SANGKOOK LEE, M.D.,1 KRIANGSAK SAETIA, M.D.,2 SUPARNA SAHA, M.D.,1 DAVID G. KLINE, M.D.,3 AND DANIEL H. KIM, M.D.1 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; 2Division of Neurosurgery, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; and 3Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana Object. The aim of this retrospective study was to present and investigate axillary nerve injuries associated with sports. Methods. This study retrospectively reviewed 26 axillary nerve injuries associated with sports between the years 1985 and 2010. Preoperative status of the axillary nerve was evaluated by using the Louisiana State University Health Science Center (LSUHSC) grading system published by the senior authors. Intraoperative nerve action potential recordings were performed to check nerve conduction and assess the possibility of resection. Neurolysis, suture, and nerve grafts were used for the surgical repair of the injured nerves. In 9 patients with partial loss of function and 3 with complete loss, neurolysis based on nerve action potential recordings was the primary treatment. Two patients with complete loss of function were treated with resection and suturing and 12 with resection and nerve grafting. The minimum follow-up period was 16 months (mean 20 months). Results. The injuries were associated with the following sports: skiing (12 cases), football (5), rugby (2), base- ball (2), ice hockey (2), soccer (1), weightlifting (1), and wrestling (1). Functional recovery was excellent. Neurolysis was performed in 9 cases, resulting in an average functional recovery of LSUHSC Grade 4.2. -
Posterior Interosseous Neuropathy Supinator Syndrome Vs Fascicular Radial Neuropathy
Posterior interosseous neuropathy Supinator syndrome vs fascicular radial neuropathy Philipp Bäumer, MD ABSTRACT Henrich Kele, MD Objective: To investigate the spatial pattern of lesion dispersion in posterior interosseous neurop- Annie Xia, BSc athy syndrome (PINS) by high-resolution magnetic resonance neurography. Markus Weiler, MD Methods: This prospective study was approved by the local ethics committee and written Daniel Schwarz, MD informed consent was obtained from all patients. In 19 patients with PINS and 20 healthy con- Martin Bendszus, MD trols, a standardized magnetic resonance neurography protocol at 3-tesla was performed with Mirko Pham, MD coverage of the upper arm and elbow (T2-weighted fat-saturated: echo time/repetition time 52/7,020 milliseconds, in-plane resolution 0.27 3 0.27 mm2). Lesion classification of the radial nerve trunk and its deep branch (which becomes the posterior interosseous nerve) was performed Correspondence to Dr. Bäumer: by visual rating and additional quantitative analysis of normalized T2 signal of radial nerve voxels. [email protected] Results: Of 19 patients with PINS, only 3 (16%) had a focal neuropathy at the entry of the radial nerve deep branch into the supinator muscle at elbow/forearm level. The other 16 (84%) had proximal radial nerve lesions at the upper arm level with a predominant lesion focus 8.3 6 4.6 cm proximal to the humeroradial joint. Most of these lesions (75%) followed a specific somato- topic pattern, involving only those fascicles that would form the posterior interosseous nerve more distally. Conclusions: PINS is not necessarily caused by focal compression at the supinator muscle but is instead frequently a consequence of partial fascicular lesions of the radial nerve trunk at the upper arm level. -
THE FORMATION of LATERAL CORD of BRACHIAL PLEXUS and ITS BRANCHES – a CADAVERIC STUDY Naveen Kumar
International Journal of Anatomy and Research, Int J Anat Res 2018, Vol 6(1.1):4836-39. ISSN 2321-4287 Original Research Article DOI: https://dx.doi.org/10.16965/ijar.2017.478 THE FORMATION OF LATERAL CORD OF BRACHIAL PLEXUS AND ITS BRANCHES – A CADAVERIC STUDY Naveen Kumar. B 1, Sirisha. V *2, Udaya Kumar. P 3, Kalpana. T 4. 1 Associate Professor, Department of Anatomy, Mamata Medical College, Khammam, India. *2 Assistant Professor, Department of Anatomy, Mamata Medical College, Khammam, India. 3 Associate Professor, Department of Anatomy, Mamata Medical College, Khammam, India. 4 Associate Professor, Department of Anatomy, Mamata Medical College, Khammam, India. ABSTRACT Introduction: The lateral cord of brachial plexus is formed from the anterior divisions of upper and middle trunks, formed from roots C5, C6 and C7. Variations in the formation and branching of lateral cord are not uncommon. Considering its variations, a detailed knowledge is necessary to neurosurgeons, anaesthetists and orthopedicians to avoid complications. Materials and Methods: The present study was conducted in the Department of Anatomy, Mamata Medical College, Khammam. 70 formalin fixed upper limbs [35 cadavers] were dissected for a period of 5 years. Formation and branching of lateral cord of brachial plexus were observed and variations are taken into consideration. Observations: Out of 70 limbs dissected, we observed communication between the lateral cord and medial root of median nerve in 10 limbs. In 2 limbs musculo-cutaneous nerve was not formed. In 3 limbs musculo-cutaneous nerve did not pierce the coracobrachialis. In 7 limbs low union of medial and lateral roots of median nerve was observed.