VARIATIONS in the BRANCHING PATTERN of the CORDS of the BRACHIAL PLEXUS Prashant Moolya *
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Anatomical Variations of Brachial Plexus in Fetal Cadavers
DOI: 10.5137/1019-5149.JTN.21339-17.2 Received: 27.07.2017 / Accepted: 18.10.2017 Published Online: 13.11.2017 Original Investigation Anatomical Variations of Brachial Plexus in Fetal Cadavers Alparslan KIRIK1, Senem Ertugrul MUT2, Mehmet Kadri DANEYEMEZ3, Halil Ibrahim SECER4 1Etimesgut Sehit Sait Erturk State Hospital, Neurosurgery Clinic, Ankara, Turkey 2University of Kyrenia, Faculty of Medicine, Visiting Professor, Near East University, Faculty of Medicine, Department of Neurology, Girne, Turkish Republic of Northern Cyprus 3University of Health Sciences, Gulhane Training and Research Hospital, Department of Neurosurgery, Ankara, Turkey 4University of Kyrenia, Faculty of Medicine, Visiting Professor, Near East University, Faculty of Medicine, Department of Neurosurgery, Girne, Turkish Republic of Northern Cyprus This study has been presented as an oral presentation at the 25th Scientific Congress of the Turkish Neurosurgical Society between 22 and 26 April 2011 at Antalya, Turkey. ABSTRACT AIM: The plexus brachialis is a complex structure with anatomical variations and connections with neighboring tissues. These variations may cause disparity in the motor and sensorial innervations of the upper extremity. The knowledge of anatomy and possible variations are important for performing surgical procedures in the neck, shoulder and axilla. This study was planned to demonstrate the anatomical variations of the infantile brachial plexus. MaterIAL and METHODS: A total of 20 plexus brachialis from 11 fetal cadavers were dissected and examined microscopically. The branching patterns and variations were evaluated. The width of the nerves was assessed at the level of the nerve root, trunk and cord on the basis of all brachial plexuses and they were arranged in terms of thickness. -
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). -
Accessory Subscapularis Muscle – a Forgotten Variation?
+Model MORPHO-307; No. of Pages 4 ARTICLE IN PRESS Morphologie (2017) xxx, xxx—xxx Disponible en ligne sur ScienceDirect www.sciencedirect.com CASE REPORT Accessory subscapularis muscle — A forgotten variation? Muscle subscapulaire accessoire — Une variation oubliée ? a a a b L.A.S. Pires , C.F.C. Souza , A.R. Teixeira , T.F.O. Leite , a a,∗ M.A. Babinski , C.A.A. Chagas a Department of morphology, biomedical institute, Fluminense Federal university, Niterói, Rio de Janeiro, Brazil b Interventional radiology unit, radiology institute, medical school, university of São Paulo, São Paulo, Brazil KEYWORDS Summary The quadrangular space is a space in the axilla bounded by the inferior margin of Anatomic variations; the teres minor muscle, the superior margin of the teres major muscle, the lateral margin of Accessory the long head of the triceps brachii muscle and the surgical neck of the humerus, medially. subscapularis muscle; The axillary nerve (C5-C6) and the posterior circumflex humeral artery and veins pass through Axillary nerve; this space in order to supply their territories. The subscapularis muscle is situated into the Subscapularis muscle scapular fossa and inserts itself into the lesser tubercle of the humerus, thus helping stabilize the shoulder joint. A supernumerary muscle known as accessory subscapularis muscle originates from the anterior surface of the muscle and usually inserts itself into the shoulder joint. It is a rare variation with few reports of its existence and incidence. We present a case of the accessory subscapularis muscle in a male cadaver fixated with a 10% formalin solution. The muscle passed anteriorly to the axillary nerve, thus, predisposing an individual to quadrangular space compression syndrome. -
Anatomical Variations of the Brachial Plexus Terminal Branches in Ethiopian Cadavers
ORIGINAL COMMUNICATION Anatomy Journal of Africa. 2017. Vol 6 (1): 896 – 905. ANATOMICAL VARIATIONS OF THE BRACHIAL PLEXUS TERMINAL BRANCHES IN ETHIOPIAN CADAVERS Edengenet Guday Demis*, Asegedeche Bekele* Corresponding Author: Edengenet Guday Demis, 196, University of Gondar, Gondar, Ethiopia. Email: [email protected] ABSTRACT Anatomical variations are clinically significant, but many are inadequately described or quantified. Variations in anatomy of the brachial plexus are important to surgeons and anesthesiologists performing surgical procedures in the neck, axilla and upper limb regions. It is also important for radiologists who interpret plain and computerized imaging and anatomists to teach anatomy. This study aimed to describe the anatomical variations of the terminal branches of brachial plexus on 20 Ethiopian cadavers. The cadavers were examined bilaterally for the terminal branches of brachial plexus. From the 40 sides studied for the terminal branches of the brachial plexus; 28 sides were found without variation, 10 sides were found with median nerve variation, 2 sides were found with musculocutaneous nerve variation and 2 sides were found with axillary nerve variation. We conclude that variation in the median nerve was more common than variations in other terminal branches. Key words: INTRODUCTION The brachial plexus is usually formed by the may occur (Moore and Dalley, 1992, Standring fusion of the anterior primary rami of the C5-8 et al., 2005). and T1 spinal nerves. It supplies the muscles of the back and the upper limb. The C5 and C6 fuse Most nerves in the upper limb arise from the to form the upper trunk, the C7 continues as the brachial plexus; it begins in the neck and extends middle trunk and the C8 and T1 join to form the into the axilla. -
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. -
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. -
Thoracic Outlet and Pectoralis Minor Syndromes
S EMINARS IN V ASCULAR S URGERY 27 (2014) 86– 117 Available online at www.sciencedirect.com www.elsevier.com/locate/semvascsurg Thoracic outlet and pectoralis minor syndromes n Richard J. Sanders, MD , and Stephen J. Annest, MD Presbyterian/St. Luke's Medical Center, 1719 Gilpin, Denver, CO 80218 article info abstract Compression of the neurovascular bundle to the upper extremity can occur above or below the clavicle; thoracic outlet syndrome (TOS) is above the clavicle and pectoralis minor syndrome is below. More than 90% of cases involve the brachial plexus, 5% involve venous obstruction, and 1% are associate with arterial obstruction. The clinical presentation, including symptoms, physical examination, pathology, etiology, and treatment differences among neurogenic, venous, and arterial TOS syndromes. This review details the diagnostic testing required to differentiate among the associated conditions and recommends appropriate medical or surgical treatment for each compression syndrome. The long- term outcomes of patients with TOS and pectoralis minor syndrome also vary and depend on duration of symptoms before initiation of physical therapy and surgical intervention. Overall, it can be expected that 480% of patients with these compression syndromes can experience functional improvement of their upper extremity; higher for arterial and venous TOS than for neurogenic compression. & 2015 Published by Elsevier Inc. 1. Introduction compression giving rise to neurogenic TOS (NTOS) and/or neurogenic PMS (NPMS). Much less common is subclavian Compression of the neurovascular bundle of the upper and axillary vein obstruction giving rise to venous TOS (VTOS) extremity can occur above or below the clavicle. Above the or venous PMS (VPMS). -
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. -
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. -
Download PDF File
Folia Morphol. Vol. 79, No. 1, pp. 1–14 DOI: 10.5603/FM.a2019.0047 R E V I E W A R T I C L E Copyright © 2020 Via Medica ISSN 0015–5659 journals.viamedica.pl Should Terminologia Anatomica be revised and extended? A critical literature review P.P. Chmielewski1, B. Strzelec2, 3 1Division of Anatomy, Department of Human Morphology and Embryology, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland 2Department and Clinic of Vascular, General and Transplantation Surgery, Jan Mikulicz-Radecki Medical University Hospital, Wroclaw Medical University, Wroclaw, Poland 3Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland [Received: 14 November 2018; Accepted: 31 December 2018] The first edition of the Terminologia Anatomica was published in 1998 by the Federative Committee for Anatomical Terminology, whereas the second edition was issued in 2011 by the Federative International Programme for Anatomical Terminologies. Since then many attempts have been made to revise and extend the official terminology as several inconsistencies have been noted. Moreover, numerous crucial terms were either omitted or deliberately excluded from the official terminology, like sulcus popliteus and diaphragma urogenitale, respec- tively. Furthermore, several synonyms are to be discarded. Notwithstanding the criticism, the use of the current version of terminology is strongly recommended. Although the Terminologia Anatomica is open to future expansion and revision, every change should be made after a thorough discussion of the historical context and scientific legitimacy of a given term. The anatomical nomenclature must be as simple as possible but also precise and coherent. It is generally accepted that hasty innovation ought not to be endorsed. -
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.