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Long Brachioradialis Muscle: a Case Report Anatomy SD Shetty1, SB Nayak1*, V Madhav1, a Padavinangady1, CS Braganza2

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Long Brachioradialis Muscle: a Case Report Anatomy SD Shetty1, SB Nayak1*, V Madhav1, a Padavinangady1, CS Braganza2 Page 1 of 3 Case report Long brachioradialis muscle: A case report Anatomy SD Shetty1, SB Nayak1*, V Madhav1, A Padavinangady1, CS Braganza2 Abstract The muscle fibres end above the mid noted a very long brachioradialis Introduction forearm level in a flat tendon which muscle in the left upper limb of an adult The brachioradialis muscle originates inserts on the lateral side of the distal male cadaver. from the upper part of the lateral end of the radius, just proximal to the 1 supracondylar ridge of the humerus. styloid process . Sometimes, an The brachioradialis muscle took its Variations in its origin are very rare. additional head of brachioradialis origin from the entire length of the The aim of this case report is to arises from the lower part of the lateral supracondylar line and merged 2 inform anatomists and clinicians brachialis muscle . with the insertion of the deltoid muscle. about the presence of an unusually Some of the deltoid fibres continued The brachioradialis muscle is often into the brachioradialis muscle (Figure long brachioradialis muscle and about its clinical implication. fused proximally with brachialis. Its 1 and Figure 2). Case report tendon may divide into two or three We observed the presence of a very separately attached slips. In rare Anteriorly some fleshy fibres of the long brachioradialis muscle in the left instances it is double or absent. Its brachialis muscle directly continued upper limb of an adult male cadaver. radial attachment may be much more with the brachioradialis muscle. The brachioradialis muscle took its proximal than the base of the styloid Distally, the muscle formed the lateral 1 origin from the entire length of the process . Presence of brachioradialis boundary of the cubital fossa and its lateral supracondylar line and merged accessorius is one of the very rare tendon was inserted to the base of the with the insertion of the deltoid muscular variations of the styloid process of the radius. It was 3 muscle. Posteriorly some of the brachioradialis muscle . supplied by a branch of the radial deltoid fibres continued into the nerve. There were no other notable brachioradialis muscle and anteriorly The aim of this report is to bring variations in the limb. fleshy fibres of the brachialis muscle awareness among the surgeons about directly continued with possibility of such an additional Discussion brachioradialis muscle. muscle which can be used in muscle Proper knowledge of muscular Conclusion grafts. variations is essential not only for The knowledge of such a type of anatomists but also for surgeons. Such variation is important for anatomists, Case report muscular variations may lead to error preparation, read approvedand the final manuscript. During routine dissection classes for in both diagnosis and treatment. In the surgeons and orthopaedicians. t undergraduate medical students, we present case the brachioradialis muscle Introduction Brachioradialis is one of the muscles of the forearm that flexes the arm at the elbow and helps in supination and pronation. It is the most superficial muscle along the radial side of the forearm. It forms the lateral border of Conflict of interests: None declared. the cubital fossa. It arises from proximal 2/3 of the lateral supracondylar crest of the humerus and from the anterior surface of the lateral intermuscular septum. *Corresponding author Email: [email protected] 1 Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, Karnataka State, INDIA 2 Research Institute, Nationwide Children's Figure 1: Dissection of the left upper limb (anterolateral view) showing the long All authors contributedAll to conception design,and manuscrip All authors abide by the Association Medical for Ethics (AME) ethical of rules disclosure. Hospital Center for Gene Therapy, brachioradialis (BR) muscle. Note its high origin and fusion with the deltoid (D). Competing interests: None declared. Neuromuscular Division Columbus, OHIO Biceps brachii (B), brachial artery (BA) and common extensor tendon (CET ) can also be seen. Licensee OAPL (UK) 2014. Creative Commons Attribution License (CC-BY) FOR CITATION PURPOSES: Shetty SD, Nayak SB, Madhav V, Abhinitha P, Braganza CS. Long brachioradialis muscle: A case report. OA Case Reports 2014 Apr 19;3(4):40. Page 2 of 3 Case report took its origin from the entire length of the lateral supracondylar line and merged with the insertion of the deltoid muscle. Some of the deltoid fibres continued into the brachioradialis muscle. Anteriorly some fleshy fibres of the brachialis muscle directly continued with the brachioradialis muscle. Brachioradialis and inferolateral part of the brachialis have a common origin. Some authors consider the inferolateral part of the brachialis as a detached portion of brachioradialis. In the current case separation between Figure 2: Dissection of the left upper limb (closer view) showing the long the two muscles has not occurred brachioradialis (BR) muscle. Note its high origin and fusion with the deltoid (D). which is seen as a fibromuscular band Biceps brachii (B), brachial artery (BA), triceps brachii (T) and common extensor between the two. Fating and Salv4 tendon (CET) can also be seen. reported a case of a third head of the biceps brachii and coexisting fused humerus, close to the insertion of the The anatomical variations of the higher origin of brachioradialis. deltoid. Some of its fibres continued muscles of the upper limb have become further up to the acromion process of important because of new imaging Brachioradialis is chiefly a shunt the scapula. These fibres passed techniques, such as magnetic resonance muscle, it acts mainly along the long downwards along with the deltoid and imaging and computed tomography12. axis of the forearm to provide joined the fibres from the humerus centripetal or shunt force at the elbow before getting merged with the Conclusion joint5. Shunt muscles are considered brachioradialis distally. The knowledge of the variations as good stabilising muscles, because reported here may be of great their proximal attachment lies near These additional muscle fibres were importance to radiologists and the joint they act over and their distal compared with the brachioradialis orthopaedic surgeons. The high origin attachment lies at a greater distance accessories. Brachioradialis muscle is of the brachioradialis in the current away from the joint. often fused proximally with brachialis; case may give added advantage to the its tendon may divide into two or muscle to act on the elbow joint in George and Nayak6 have reported a three separately attached slips8. addition its actions on radioulnar joints. preparation, read andapproved the final manuscript. case where a few fleshy fibres from t brachialis merged with Mongotra et al. found a variation in References brachioradialis and other superficial the insertion pattern of the Brachialis 1. Standring S, ed. Gray’s Anatomy. The flexor of the forearm after an oblique muscle on the left side which beside Anatomical Basis of Clinical course. Some of the fibres were its usual insertion was inserted as a Practice.40th Ed., Edinburg, Churchill & inserted on the medial aspects of the thick muscular slip to the origin of Livingstone. 2008; 1231, 1233. olecranon process of the ulna. The Brachioradialis. So, a fibromuscular 2. Prakash Rai R, Ranade AV. Multiple additional slip of brachialis may tunnel was formed between the variations of extensor muscles of mechanically stabilize the insertion of the Brachialis and origin Conflict of interests: None declared. forearm in relation to the radial nerve: ulnohumeral joint. It can cause of Brachioradialis9. a case report and review. Int J Morphol. compression neuropathy of the 2008; 26(2):447- 449. median nerve and vascular The brachioradialis muscle is utilized 3. Dawson M. Sketch of two small compression symptoms due to in tendon-transfer operations to supernumerary muscles of the arm. entrapment of the brachial artery. restore impotent hand functions, such Edinburgh Medical and Surgical Nair et al. found additional muscle as the ability to grasp and pinch, one Journal. 1822; 18:82-83. fibres of brachioradialis with which lost in the cervical part of the 4. Fating AS, Salve VM. A third head of anomalous high origin and spinal cord, brachial plexus or the biceps brachi and co-existing fused entrapment of the radial nerve in an peripheral nerve injuries10. higher origin of brachio-radialis - a case osseomuscular canal7. report. IJAV. 2011; 4: 31-33. Transfer of the brachioradialis tendon 5. Macconaill MA. The movements of The anomalous fleshy fibres in their is also performed for correction of bones and joints; function of the All authors contributed to conception and design, manuscrip All authors abide by the Association Medical for Ethics (AME) ethical of rules disclosure. case were attached proximally to the various deformities in spastic cerebral Competing interests: None declared. middle part of the shaft of the palsy11. Licensee OAPL (UK) 2014. Creative Commons Attribution License (CC-BY) FOR CITATION PURPOSES: Shetty SD, Nayak SB, Madhav V, Abhinitha P, Braganza CS. Long brachioradialis muscle: A case report. OA Case Reports 2014 Apr 19;3(4):40. Page 3 of 3 Case report musculature. J Bone Joint Surg Br. 1949; 31(1):100-4. 6. George BM, Nayak SB. Median nerve and brachial artery entrapment in the abnormal brachialis muscle-a case report. Neuroanatomy. 2008; 7:41-42. 7. Nair V, Nair RV, Mookambika RV, Mohandas Rao KG, Krishnaraja Somayaji S. Additional muscle fibers of Brachioradialis with Anomalous high origin and Entrapment of Radial nerve in an Osseomuscular canal. Bratisl Lek Listy. 2012; 113(10): 622-623. 8. Rajanigandha Vadgaonkar, Rajalakshmi Rai, Anu V. Ranade, S. R. Nayak, Mangala M. Pai, R. Lakshmi. A case report on accessory brachialis muscle. Rom J Morphol Embryol. 2008; 49(4): 581–583. 9. Mangotra R, Raina S, Sharma M. “Fibromuscular tunnel between brachialis and brachioradialis muscle with neurovascular abnormalities”. Journal of Evolution of Medical and Dental Sciences. 2013; l2 (29):5466- 5471.
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