DOCSLIB.ORG

Collateral Branches of the Brachial Plexus As Donors in Nerve Transfers Boþne Grane Brahijalnog Pleksusa – Donori U Transferima Nerava

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Collateral Branches of the Brachial Plexus As Donors in Nerve Transfers Boþne Grane Brahijalnog Pleksusa – Donori U Transferima Nerava Strana 594 VOJNOSANITETSKI PREGLED Vojnosanit Pregl 2012; 69(7): 594–603. UDC: 616.833-089 ORIGINAL ARTICLE DOI:10.2298/VSP110301007S Collateral branches of the brachial plexus as donors in nerve transfers Boþne grane brahijalnog pleksusa – donori u transferima nerava Miroslav Samardžiü*, Lukas Rasuliü*, Novak Lakiüeviü†, Vladimir Bašþareviü*, Irena Cvrkota*, Mirko Miüoviü*, Andrija Saviü* *Neurosurgical Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia, †Neurosurgical Clinic, Clinical Center of Montenegro, Podgorica, Montenegro Abstract Apstrakt Background/Aim. Nerve transfers in cases of directly ir- Uvod/Cilj. Za nervne transfere u sluÿajevima nemoguýno- reparable, or high level extensive brachial plexus traction inju- sti direktne rekonstrukcije visokih ekstenzivnih povreda ries are performed using a variety of donor nerves with vari- brahijalnog pleksusa koje ne podležu direktnoj reparaciji ko- ous success but an ideal method has not been established. riste se razliÿiti donorni nervi. Ovo istraživanje imalo je za The purpose of this study was to analyze the results of nerve cilj da analizira rezultate nervnih transfera kod bolesnika sa transfers in patients with traction injuries to the brachial trakcionom povredom brahijalnog pleksusa u kojima se kao plexus using the thoracodorsal and medial pectoral nerves as donori koriste torakodorzalni i medijalni pektoralni nervi. donors. Methods. This study included 40 patients with 25 Metode. Istraživanjem je bilo obuhvaýeno 40 bolesnika procedures using the thoracodorsal nerve and 33 procedures kod kojih je kao donor za reinervaciju muskulokutaneusa ili using the medial pectoral nerve as donors for reinnervation of aksilarisa u 25 postupaka korišýen torakodorzalni nerv i u 33 the musculocutaneous or axillary nerve. The results were postupka medijalni pektoralni nerv. Rezultati su analizirani analyzed according to the donor nerve, the age of the patient prema donornom nervu, uzrastu bolesnika i vremenu kada and the timing of surgery. Results. The total rate of recovery je operacija izvršena. Rezultati. Ukupna stopa oporavka iz- for elbow flexion was 94.1%, for shoulder abduction 89.3%, nosila je 94,1% za fleksiju podlaktice, 89,3% za abdukciju and for shoulder external rotation 64.3%. The corresponding ramena i 64,3% za spoljnu rotaciju ramena. Odgovarajuýe rates of recovery using the thoracodorsal nerve were 100%, stope oporavka pri korišýenju torakodorzalnog nerva bile su 93.7% and 68.7%, respectively. The rates of recovery with 100%, 93,7% i 68,7%, a pri korišýenju medijalnog pektoral- medial pectoral nerve transfers were 90.5%, 83.3% and nog nerva 90,5%, 83,3% i 58,3%, respektivno. Uprkos oÿi- 58.3%, respectively. Despite the obvious differences in the glednim razlikama u stopama oporavka, statistiÿki znaÿajne rates of recovery, statistical significance was found only be- korelacije ustanovljene su samo za stope i kvalitet oporavka tween the rates and quality of recovery for the musculocuta- muskulokutaneusa i aksilarisa u sluÿajevima kada je kao do- neous and axillary nerve using the thoracodorsal nerve as do- nor korišýen torakodorzalni nerv. Zakljuÿak. Prema našim nor. Conclusion. According to our findings, nerve transfers nalazima, nervni transferi u sluÿajevima gornje paralize u using collateral branches of the brachial plexus in cases with kojima se kao donori koriste boÿne grane brahijalnog plek- upper palsy offer several advantages and yield high rate and susa imaju nekoliko prednosti i daju visoku stopu i dobar good quality of recovery. kvalitet oporavka. Key words: Kljuÿne reÿi: brachial plexus; wounds and injuries; nerve transfer; plexus brachialis; rane i povrede; transfer živca; nn. thoracic nerves; neurosurgical procedures; treatment thoracici; neurohirurške procedure; outcome. leÿenje, ishod. Introduction ries without a nerve available for grafting. Recently, indica- tions for nerve transfers have been extended to high level In the past, nerve transfers were the treatment of choice nerve injuries with extensive gap for grafting and delayed in cases with spinal nerve root avulsion, or those with di- nerve repairs 1, significant bony or vascular injuries in the rectly irreparable proximal lesions, ie very proximal or inju- region of direct repair and previously failed proximal nerve Correspondence to: Miroslav Samardžiý. Neurosurgical Clinic, Clinical Center of Serbia, Koste Todoroviýa 4, 11 000 Belgrade, Serbia. Phone: +38111 3615 582; Fax: +38111 3615 577, Mob.: +381 63 205 591. E-mail: [email protected] Volumen 69, Broj 7 VOJNOSANITETSKI PREGLED Strana 595 repair 2. The main advantage of this procedure over nerve The preoperative diagnosis was made on the basis of grafting is a conversion of proximal high-level injury to a standard clinical, electrodiagnostic and radiologic tests. Us- low-level one 1. ing these methods we diagnosed a variety of injury patterns Nerve transfers have been attempted using a variety of to the C5, C6, and sometimes C7 spinal nerve roots or spinal donor nerves, but an ideal method has not been estabilshed. nerves. Extended upper brachial plexus palsy was present in In general, there are two types of donors: extraplexal, in- 11 patients. cluding intercostal, spinal accessory, phrenic, motor Indications for nerve transfer included preoperatively branches of the cervical plexus, or collateral C7 spinal nerve, documented avulsion of the C5 and C6 spinal nerve roots, or and intraplexal, including proximal spinal nerve stumps or intraoperatively demonstrated directly irreparable very collateral motor branches of the brachial plexus. In fact, the proximal lesion of the corresponding spinal nerves, and high latter presents a distal form of the classic intraplexal nerve lesions with a long nerve gap. Surgical procedures were per- transfer. formed 3 do 16 months (mean 5 months) after injuries, and Nerve transfers using these nerves were performed for 33 patients (82.5%) were treated within 6 months after in- the first time in 1920 by Vulipus and Stoffel (according to jury. Moreover, 17 patients (42.5%) were treated within 3 ref. 3 ), who transferred some of the branches to the pectoral months after the injury. muscles onto the musculocutaneous or axillary nerves. In The extent of surgical exploration was adopted to the 1929 Foerster performed transfer of nerves to the latissimus reliability of the preoperative diagnosis. In the majority of dorsi and subscapular muscles onto the axillary nerve, as re- cases the brachial plexus was explored only infraclavicularly. ported by Narakas 4, 5. Thereafter, in 1948 Lurja (according In diagnostically unclear cases, we performed an additional to ref. 3 ) reported transfer of the pectoral and thoracodorsal supraclavicular exploration limited to the C5 and C6 spinal nerves, particularly onto the musculocutaneous nerve in pa- nerves and upper trunk. tients with upper trunk injuries. In these 44 patients we performed 38 reinnervations of We used these two nerves in nerve transfer for the first the musculocutaneous nerve, 13 using the thoracodorsal time in 1980. Thoracodorsal to musculocutaneous and me- nerve and 25 using the medial pectoral nerve as donors, and dial pectoral to the axillary nerve transfers were performed in 33 reinnervations of the axillary nerve, 20 using the thoraco- a 24-year-old man four months after a motorcycle accident. dorsal nerve and 13 using the medial pectoral nerve as do- Good recovery of both functions was obtained one year after nors (Table 1). Both nerves were used simultaneously in 24 Table 1 Summary of nerve transfers using collateral branches of the brachial plexus as donors Recipient nerve Donor nerve Musculocutaneous Axillary Total Thoracodorsal 9 13 22 Thoracodorsal and intercostal 2 2 4 Thoracodorsal and subsapular or long thoracic 2 5a 7 Medial pectoral 21 9 30 Medial pectoral and spinal accessory or intercostal 4b 4c 8 Total 38 33 71 a – one case combined with the long thoracic nerve b – all combined with the spinal accessory nerve c – all combined with one intercostal nerve the surgery. The aim of this study was to analyze the results patients, and in the remaining cases nerve transfers using of nerve transfers in patients with traction injuries to the bra- these collateral branches were combined with the spinal ac- chial plexus using the thoracodorsal and medial pectoral cessory or intercostal nerve transfers. The choice of donor nerves as donors. and recipient nerve was based predominantly on the possi- bility for a direct nerve anastomosis. In seven nerve transfers Methods we combined the thoracodorsal nerve with the subscapular or long thoracic nerves, and in another four transfers with the During the past 30 years, since January 1980, we per- intercostal nerves. In eight nerve transfers the medial pecto- formed nerve transfer using collateral branches of the bra- ral nerve was combined with the spinal accessory or inter- chial plexus as donors in 44 patients with upper palsy due to costal nerves. The main reason for these combinations was traction injury. The number of followed up patients was 40, completion of the suture line in cases with recipient nerves of or more precisely 33 with nerve transfers using the medial considerably larger diameter. pectoral nerve, and 29 using the thoracodorsal nerve as do- The medial pectoral nerve, either by itself or in combi- nor. Both nerves were used simultaneoulsy in 22 of the fol- nation with a branch of pectoral ansa, or its two terminal lowed up patients. The
Load more

Recommended publications
  • Study of Brachial Plexus with Regards to Its Formation, Branching Pattern and Variations and Possible Clinical Implications of Those Variations
    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 4 Ver. VII (Apr. 2016), PP 23-28 www.iosrjournals.org Study of Brachial Plexus With Regards To Its Formation, Branching Pattern and Variations and Possible Clinical Implications of Those Variations. Dr. Shambhu Prasad1, Dr. Pankaj K Patel2 1 (Assistant Professor , Department of Anatomy , NMCH , Sasaram , India ) 2 (Assistant Professor , Department of Pathology , NMCH , Sasaram , India ) Abstract: Aim of the study: to search variations in formation and branching pattern of brachial plexus and correlate them with possible clinical and surgical implications. Materials and Methods: 25human bodies were dissected for this study. Dissection was started in posterior triangle of neck and extended to distal part of upper limb passing through axilla . Photographs were taken and data was tabulated and analyzed . Observations: All 50 plexuses had origin from C5 – T1 . Dorsal scapular nerve was absent in 2 plexuses. Long thoracic nerve was made of C5,C6 fibers in one and of C6,C7 fibers in another . Lower trunk was abnormal in 2 plexuses both of same body, their was no contribution from T1 fibers to posterior cord in one of these plexus. One plexus had double lateral pectoral nerve , communication between lateral and medial pectoral nerves , lateral pectoral and medial root of median nerve also between musculocutaneous and lateral root of median nerve . 2 more plexuses had communication between lateral and medial pectoral nerves. One plexus showed 2 branches coming from posterior division of upper trunk itself before formation of posterior cord.
    [Show full text]
  • Bilateral Presence of a Variant Subscapularis Muscle
    CASE REPORT Bilateral presence of a variant subscapularis muscle Krause DA and Youdas JW Krause DA, Youdas JW. Bilateral presence of a variant subscapularis the lateral subscapularis inserting into the proximal humerus with the tendon of muscle. Int J Anat Var. 2017;10(4):79-80. the subscapularis. The axillary and lower subscapular nerves coursed between the observed muscle and the subscapularis. The presence of the muscle has potential ABSTRACT to entrap the axillary nerve and the lower subscapular nerve. We describe the presence of an accessory subscapularis muscle observed bilaterally Key Words: Accessory subscapularis; Axillary nerve; Lower subscapular nerve; in a human anatomy laboratory. The muscle originated from the mid-region of Entrapment INTRODUCTION everal anatomic variations in axillary musculature have been reported (1- S4). One of the more common variations is the axillary arch muscle, also known as Langer’s muscle, the axillopectoral muscle, and the pectordorsal muscle (3,4). This muscle typically arises from the lateral aspect of the latissimus dorsi inserting deep to the pectoralis major on the humerus. Several variations of the axillary arch muscle are described with a reported incidence of 6-9% (4-6). Less frequent and distinctly different than the axillary arch muscle, is a variant muscle associated with the subscapularis. This has been termed the subscapulo-humeral muscle, subscapularis minor, subscapularis-teres-latissimus muscle, and the accessory subcapularis muscle (1,2,7). Reported incidence ranges from 0.45 to 2.6% (2,7). CASE REPORT A variant muscle associated with the subscapularis bilaterally was observed on a Caucasian female embalmed cadaver during routine dissection in a human anatomy class for first year physical therapy students.
    [Show full text]
  • Muscle Attachment Sites in the Upper Limb
    This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. Muscle Attachment Sites in the Upper Limb The Clavicle Pectoralis major Smooth superior surface of the shaft, under the platysma muscle Deltoid tubercle: Right clavicle attachment of the deltoid Deltoid Axillary nerve Acromial facet Trapezius Sternocleidomastoid and Trapezius innervated by the Spinal Accessory nerve Sternocleidomastoid Conoid tubercle, attachment of the conoid ligament which is the medial part of the Sternal facet coracoclavicular ligament Conoid ligament Costoclavicular ligament Acromial facet Impression for the Trapezoid line, attachment of the costoclavicular ligament Subclavian groove: Subclavius trapezoid ligament which binds the clavicle to site of attachment of the Innervated by Nerve to Subclavius which is the lateral part of the the first rib subclavius muscle coracoclavicular ligament Trapezoid ligament This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. The Scapula Trapezius Right scapula: posterior Levator scapulae Supraspinatus Deltoid Deltoid and Teres Minor are innervated by the Axillary nerve Rhomboid minor Levator Scapulae, Rhomboid minor and Rhomboid Major are innervated by the Dorsal Scapular Nerve Supraspinatus and Infraspinatus innervated by the Suprascapular nerve Infraspinatus Long head of triceps Rhomboid major Teres Minor Teres Major Teres Major
    [Show full text]
  • Examination of the Shoulder Bruce S
    Examination of the Shoulder Bruce S. Wolock, MD Towson Orthopaedic Associates 3 Joints, 1 Articulation 1. Sternoclavicular 2. Acromioclavicular 3. Glenohumeral 4. Scapulothoracic AC Separation Bony Landmarks 1. Suprasternal notch 2. Sternoclavicular joint 3. Coracoid 4. Acromioclavicular joint 5. Acromion 6. Greater tuberosity of the humerus 7. Bicipital groove 8. Scapular spine 9. Scapular borders-vertebral and lateral Sternoclavicular Dislocation Soft Tissues 1. Rotator Cuff 2. Subacromial bursa 3. Axilla 4. Muscles: a. Sternocleidomastoid b. Pectoralis major c. Biceps d. Deltoid Congenital Absence of Pectoralis Major Pectoralis Major Rupture Soft Tissues (con’t) e. Trapezius f. Rhomboid major and minor g. Latissimus dorsi h. Serratus anterior Range of Motion: Active and Passive 1. Abduction - 90 degrees 2. Adduction - 45 degrees 3. Extension - 45 degrees 4. Flexion - 180 degrees 5. Internal rotation – 90 degrees 6. External rotation – 45 degrees Muscle Testing 1. Flexion a. Primary - Anterior deltoid (axillary nerve, C5) - Coracobrachialis (musculocutaneous nerve, C5/6 b. Secondary - Pectoralis major - Biceps Biceps Rupture- Longhead Muscle Testing 2. Extension a. Primary - Latissimus dorsi (thoracodorsal nerve, C6/8) - Teres major (lower subscapular nerve, C5/6) - Posterior deltoid (axillary nerve, C5/6) b. Secondary - Teres minor - Triceps Abduction Primary a. Middle deltoid (axillary nerve, C5/6) b. Supraspinatus (suprascapular nerve, C5/6) Secondary a. Anterior and posterior deltoid b. Serratus anterior Deltoid Ruputure Axillary Nerve Palsy Adduction Primary a. Pectoralis major (medial and lateral pectoral nerves, C5-T1 b. Latissimus dorsi (thoracodorsal nerve, C6/8) Secondary a. Teres major b. Anterior deltoid External Rotation Primary a. Infraspinatus (suprascapular nerve, C5/6) b. Teres minor (axillary nerve, C5) Secondary a.
    [Show full text]
  • Brachial Plexus Posterior Cord Variability: a Case Report and Review
    CASE REPORT Brachial plexus posterior cord variability: a case report and review Edward O, Arachchi A, Christopher B Edward O, Arachchi A, Christopher B. Brachial plexus posterior cord anatomical variability. This case report details the anatomical variants discovered variability: a case report and review. Int J Anat Var. 2017;10(3):49-50. in the posterior cord of the brachial plexus in a routine cadaveric dissection at the University of Melbourne, Australia. Similar findings in the literature are reviewed ABSTRACT and the clinical significance of these findings is discussed. The formation and distribution of the brachial plexus is a source of great Key Words: Brachial plexus; Posterior cord; Axillary nerve; Anatomical variation INTRODUCTION he brachial plexus is the neural network that supplies motor and sensory Tinnervation to the upper limb. It is typically composed of anterior rami from C5 to T1 spinal segments, which subsequently unite to form superior, middle and inferior trunks. These trunks divide and reunite to form cords 1 surrounding the axillary artery, which terminate in branches of the plexus. The posterior cord is classically described as a union of the posterior divisions from the superior, middle and inferior trunks of the brachial plexus, with fibres from all five spinal segments. The upper subscapular, thoracodorsal and lower subscapular nerves propagate from the cord prior to the axillary and radial nerves forming terminal branches. Variability in the brachial plexus is frequently reported in the literature. It is C5 nerve root Suprascapular nerve important for clinicians to be aware of possible variations when considering Posterior division of C5-C6 injuries or disease of the upper limb.
    [Show full text]
  • BRACHIAL PLEXUS ANATOMY, INJURIES and MANAGEMENT • Brachial Plexus Is Network of Nerves That Supply Sensation and Motor Function to Upper Extremity
    BRACHIAL PLEXUS ANATOMY, INJURIES AND MANAGEMENT • Brachial plexus is network of nerves that supply sensation and motor function to upper extremity • Formed by ventral primary rami of lowest four cervical and upper most thoracic nerve ( c5-T1) Anatomy • Roots - c5 – t1 • Trunks – Upper ,middle and lower • Division- Anterior and posterior • Cords – Medial, posterior and lateral • Branches commons.wikimedia.org/wiki/File:Brachial_plexus.jpg Branches • Roots - phrenic nerve – C3,4,5 – diaphragm Long thoracic n - c5,6,7 – serratus anterior dorsal scapular n – c5 - rhomboidus , levator scapulae • Trunk - suprascapular n – c5- supraspinatus infraspinatus Branches of cord • Lateral cord lateral pectoral nerve • Medial cord medial cutaneous nerve of arm medial cutaneous nerve of forearm medial pectoral nerve • posterior cord upper and lower subscapular nerve thoraco-dorsal nerve (c6-8) • Lateral cord – musculocutaneous nerve (c5,6,7) and contribute to medial nerve • Posterior cord – axillary(c5-6) and radial nerve (c5-t1) • Medial cord – median nerve contribution and ulnar nerve (c8-T1) Roots Sensory Motor Deficits Reflex C5 Lateral border upper Deltoid Biceps arm to elbow Supraspinatus Infraspinatus Rhomboids C6 Lateral forearm Biceps supinator Thumb, index Brachioradialis Brachialis C7 Middle finger, Triceps triceps Front & back of hand Wrist flexors & Extensors Lat.dorsi,Pec major C8 Little finger Finger flexor & finger Heel of hand to above extensor wrist Flexor Carpi ulnaris T1 In the axilla All small hand none muscles Variations • Pre-fixed ( 28-62%) post-fixed ( 16-73%) http://www.msdlatinamerica.com/ebooks/HandSurgery/sid744608.html Injuries of brachial plexus • Most common cause of injury – RTA (70%) • Obstetrics • Iatrogenic – positioning , surgical trauma . • Miscellaneous - radiation , tumors ,neuritis .
    [Show full text]
  • Electrodiagnosis of Brachial Plexopathies and Proximal Upper Extremity Neuropathies
    Electrodiagnosis of Brachial Plexopathies and Proximal Upper Extremity Neuropathies Zachary Simmons, MD* KEYWORDS Brachial plexus Brachial plexopathy Axillary nerve Musculocutaneous nerve Suprascapular nerve Nerve conduction studies Electromyography KEY POINTS The brachial plexus provides all motor and sensory innervation of the upper extremity. The plexus is usually derived from the C5 through T1 anterior primary rami, which divide in various ways to form the upper, middle, and lower trunks; the lateral, posterior, and medial cords; and multiple terminal branches. Traction is the most common cause of brachial plexopathy, although compression, lacer- ations, ischemia, neoplasms, radiation, thoracic outlet syndrome, and neuralgic amyotro- phy may all produce brachial plexus lesions. Upper extremity mononeuropathies affecting the musculocutaneous, axillary, and supra- scapular motor nerves and the medial and lateral antebrachial cutaneous sensory nerves often occur in the context of more widespread brachial plexus damage, often from trauma or neuralgic amyotrophy but may occur in isolation. Extensive electrodiagnostic testing often is needed to properly localize lesions of the brachial plexus, frequently requiring testing of sensory nerves, which are not commonly used in the assessment of other types of lesions. INTRODUCTION Few anatomic structures are as daunting to medical students, residents, and prac- ticing physicians as the brachial plexus. Yet, detailed understanding of brachial plexus anatomy is central to electrodiagnosis because of the plexus’ role in supplying all motor and sensory innervation of the upper extremity and shoulder girdle. There also are several proximal upper extremity nerves, derived from the brachial plexus, Conflicts of Interest: None. Neuromuscular Program and ALS Center, Penn State Hershey Medical Center, Penn State College of Medicine, PA, USA * Department of Neurology, Penn State Hershey Medical Center, EC 037 30 Hope Drive, PO Box 859, Hershey, PA 17033.
    [Show full text]
  • Tricks and Techniques to Maximize Success with Nerve Transfers
    IC12-L: Tricks and Techniques to Maximize Success with Nerve Transfers Moderator(s): Susan E. Mackinnon, MD Faculty: Christine B. Novak, PT, PhD and J. Megan Patterson, MD Session Handouts Friday, October 02, 2020 75TH VIRTUAL ANNUAL MEETING OF THE ASSH OCTOBER 1-3, 2020 822 West Washington Blvd Chicago, IL 60607 Phone: (312) 880-1900 Web: www.assh.org Email: [email protected] All property rights in the material presented, including common-law copyright, are expressly reserved to the speaker or the ASSH. No statement or presentation made is to be regarded as dedicated to the public domain. IC12 – Tricks and Techniques to Maximize Success with Nerve Transfers American Society for Surgery of the Hand Annual Meeting, October 2, 2020 Susan E. Mackinnon, MD, St. Louis, Missouri J. Megan M. Patterson, Chapel Hill, North Carolina Christine B. Novak, PT, PhD, Toronto, Ontario Andrew Yee, BS, St. Louis, Missouri Overview: Following complex nerve injury, motor and sensory recovery can be less than optimal. For high median, ulnar and radial nerve injuries, nerve transfers can provide a distal source of motor and/or sensory innervation closer to the target end organ allowing for faster recovery and improved outcome. This course will focus on techniques to maximize success with upper extremity motor and sensory nerve transfers. Classification of Nerve Injury: Degree of Injury Tinel’s Sign Recovery Rate of Surgical Procedure Present Recovery I Neurapraxia No Complete Up to 12 weeks None II Axonotmesis Yes Complete 1” per month None III Yes Varies *
    [Show full text]
  • Unilateral Intercordal Neural Communication Coexistent with Variant Branching Pattern of Posterior Cord of Brachial Plexus
    CAse reporT Unilateral intercordal neUral commUnication coexistent with variant branching pattern of posterior cord of brachial plexUs Renu Baliyan, Vandana Mehta, Jyoti Arora, Ashish Kr. Nayyar, R. K. Suri, Gaytri Rath Department of Anatomy, Vardhman Mahavir Medical College, New Delhi, India Summary: 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 uncount- able 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. Key words: Posterior cord; Medial cord; Lateral cord; Neural communication introduction along with an intercordal neural communication between medial and lateral cords of brachial plexus. The hallmark of the axillary region is the brachial plexus, which is a plexiform arrangement of the anterior primary case report rami of the lowest 4 cervical and first thoracic spinal nerves.
    [Show full text]
  • SŁOWNIK ANATOMICZNY (ANGIELSKO–Łacinsłownik Anatomiczny (Angielsko-Łacińsko-Polski)´ SKO–POLSKI)
    ANATOMY WORDS (ENGLISH–LATIN–POLISH) SŁOWNIK ANATOMICZNY (ANGIELSKO–ŁACINSłownik anatomiczny (angielsko-łacińsko-polski)´ SKO–POLSKI) English – Je˛zyk angielski Latin – Łacina Polish – Je˛zyk polski Arteries – Te˛tnice accessory obturator artery arteria obturatoria accessoria tętnica zasłonowa dodatkowa acetabular branch ramus acetabularis gałąź panewkowa anterior basal segmental artery arteria segmentalis basalis anterior pulmonis tętnica segmentowa podstawna przednia (dextri et sinistri) płuca (prawego i lewego) anterior cecal artery arteria caecalis anterior tętnica kątnicza przednia anterior cerebral artery arteria cerebri anterior tętnica przednia mózgu anterior choroidal artery arteria choroidea anterior tętnica naczyniówkowa przednia anterior ciliary arteries arteriae ciliares anteriores tętnice rzęskowe przednie anterior circumflex humeral artery arteria circumflexa humeri anterior tętnica okalająca ramię przednia anterior communicating artery arteria communicans anterior tętnica łącząca przednia anterior conjunctival artery arteria conjunctivalis anterior tętnica spojówkowa przednia anterior ethmoidal artery arteria ethmoidalis anterior tętnica sitowa przednia anterior inferior cerebellar artery arteria anterior inferior cerebelli tętnica dolna przednia móżdżku anterior interosseous artery arteria interossea anterior tętnica międzykostna przednia anterior labial branches of deep external rami labiales anteriores arteriae pudendae gałęzie wargowe przednie tętnicy sromowej pudendal artery externae profundae zewnętrznej głębokiej
    [Show full text]
  • Langer's Axillary Arch (Axillopectoral Muscle): a Variation of Latissimus
    eISSN 1308-4038 International Journal of Anatomical Variations (2010) 3: 91–92 Case Report Langer’s axillary arch (axillopectoral muscle): a variation of latissimus dorsi muscle Published online June 30th, 2010 © http://www.ijav.org Sinan BAKIRCI ABSTRACT Ilker Mustafa KAFA Langer’s axillary arch (axillopectoral muscle) is a variant muscular structure of the axilla which was described Murat UYSAL under various names as Langer’s muscle, axillary arch or muscular axillary arch by different authors. During Erdogan SENDEMIR routine dissections, we found a muscular slip on the right axillary fossa that originated from latissimus dorsi muscle and attached to the deep surface of the tendon of pectoralis major muscle, and described it as Langer’s axillary arch. Arterial, venous and nervous structures passed under this muscular slip which constitutes an arch in the axillary fossa. Although axillary arch is not very rare, it is generally neglected and not explored or described well. It has immense clinical and morphologic importance for surgical operations performed on axillary region; thus, surgeons should well be aware of its possible existence. © IJAV. 2010; 3: 91–92. Department of Anatomy, Faculty of Medicine, Uludag University, Bursa, TURKEY. Ilker Mustafa Kafa, MD Department of Anatomy Uludag University Faculty of Medicine Gorukle, 16059, Bursa, TURKEY. +90 (224) 295 23 16 [email protected] Received November 20th, 2009; accepted June 21st, 2010 Key words [axillary arch] [Langer’s muscle] [latissimus dorsi muscle] [axillopectoral muscle] [axillary fossa] Introduction os ilium. The axillary arch is a variant muscular slip of Best-known variant structure of the axillary components this muscle and is about 7 to 10 cm in length, splits from of men is a muscular or fibro-muscular slip extending the upper edge of the latissimus dorsi and crosses the from the latissimus dorsi muscle to the tendons, muscles or axilla in front of the axillary vessels and nerves [4].
    [Show full text]
  • Winged Scapula
    r e v b r a s o r t o p . 2 0 1 5;5 0(5):573–577 www.rbo.org.br Artigo Original Síndrome do aprisionamento fascial do nervo ଝ torácico longo: escápula alada a,b c,∗ b,d Jefferson Braga Silva , Samanta Gerhardt e Ivan Pacheco a Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil b Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brasil c Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS, Brasil d Instituto de Medicina do Esporte, Hospital Mãe de Deus, Porto Alegre, RS, Brasil informações sobre o artigo r e s u m o Histórico do artigo: Objetivo: Analisar os resultados de cirurgia de intervenc¸ão precoce em pacientes com sín- Recebido em 1 de julho de 2014 drome do aprisionamento fascial do nervo torácico longo e consequente escápula alada. Aceito em 16 de setembro de 2014 Métodos: Acompanhamos seis pacientes com uma síndrome de aprisionamento sem On-line em 24 de dezembro de 2014 restric¸ões específicas de estiramento ao nervo. Resultados: Pacientes tiveram melhoria em seus sintomas seis a 20 meses após o proce- Palavras-chave: dimento. Sintomas motores melhoraram completamente sem qualquer dor persistente. A Escápula deformidade medial da escápula alada melhorou em todos os casos sem distúrbios estéticos Tórax residuais. Síndromes de compressão nervosa Conclusão: A abordagem de liberac¸ão cirúrgica precoce parece ser um melhor preditor na recuperac¸ão de paralisia não traumática do músculo serrátil anterior.
    [Show full text]