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Toruńska E, Owczarek-Konopka M, Konopka M, Gielecki JS, Klepacki Ł. Brachial plexopathy as a result of anatomical prone position in COVID-19 patients-Systematic review. Clin Anat 2024; 37:92-101. [PMID: 37646090 DOI: 10.1002/ca.24112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/08/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Abstract
In patients with COVID-19 different methods improving therapy have been used, including one of the anatomical position-prone position, to support ventilation. The aim of this review was to summarize the cases of brachial plexopathy as a consequence of the prone position in COVID-19 patients, and thus bring closer the issue of the brachial plexus in the face of clinical aspects of its function, palsy, and consequences. The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed, inclusion criteria were created according to Patients, Interventions, Comparisons, Outcomes (PICO). PubMed and Scopus were searched until April 1, 2023 by entering the key term with Boolean terms. The risk of bias was assessed using JBI's critical appraisal tools. Fifteen papers with 30 patients were included in the review. This study showed that brachial plexopathy after the prone position occurs more often among males, who are at least 50 years old with comorbidities like hypertension, overweight, and diabetes mellitus. The most common symptoms were weakness, pain, and motion deficits. Duration of the prone position session and the number of episodes were different as well as the modification of positioning. Brachial plexopathy is a significant problem during prone position, especially when hospitalization is prolonged, patients are males, have comorbidities, and changes in body weight. Attention should be drawn to understand the anatomy of the brachial plexus, correct positioning, avoiding factors worsening the prognosis, and proper nutrition of the patients.
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Affiliation(s)
- Ewa Toruńska
- Department of Anatomy, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Mikołaj Konopka
- Department of Anatomy, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Łukasz Klepacki
- Department of Anatomy, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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Koutserimpas C, Tsakotos G, Piagkou M, Triantafyllou G, Totlis T, Mariorakis C, Karampelias V, Natsis K. The Coexistence of the Superficial Brachial Artery With the Common Origin of the Posterior Circumflex Humeral Artery and the Deep Brachial Artery. Cureus 2023; 15:e45903. [PMID: 37885498 PMCID: PMC10599095 DOI: 10.7759/cureus.45903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
The brachial artery (ΒΑ) represents the axillary artery's extension as it distally progresses to the teres major muscle or beneath the tendon of the latissimus dorsi muscle. Throughout its course, the BA maintains continuous proximity to the median nerve. Occasionally, an artery located in front of the arm muscles may exhibit a slightly more lateral position than the BA, following a convoluted path, referred to as the superficial brachial artery (SBA). SBA variants are not uncommon and can impact neural structures as well. In the course of routine dissection on a formalin-embalmed donated cadaver through the Body Donation Program, the following notable findings were identified: a) a BA bilateral trifurcation, below the tendon of the latissimus dorsi muscle; b) a posterior circumflex humeral artery of low origin (brachial artery); c) the coexistence of an SBA with the main BA; d) a subscapular artery of high origin (second part of the axillary artery); e) an anterior circumflex humeral artery duplication. These BA variants, particularly those related to the SBA, hold significance in upper limb surgery and everyday clinical practice. In such cases, meticulous surgical dissection is crucial to prevent arterial injury, and in complex situations, preoperative imaging might be advisable. Additionally, it's important to note that concurrent neural variants may also be present, potentially complicating the surgical approach.
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Affiliation(s)
- Christos Koutserimpas
- Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Greece, Athens, GRC
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - George Tsakotos
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | - Maria Piagkou
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | | | - Trifon Totlis
- Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | | | | | - Konstantinos Natsis
- Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Piagkou M, Tsakotos G, Triantafyllou G, Koutserimpas C, Chytas D, Karampelias V, Pantekidis I, Triantafyllou A, Natsis K. Coracobrachialis muscle morphology and coexisted neural variants: a cadaveric case series. Surg Radiol Anat 2023; 45:1117-1124. [PMID: 37464221 PMCID: PMC10514118 DOI: 10.1007/s00276-023-03207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE The current cadaveric case series evaluates the coracobrachialis muscle morphology, the related musculocutaneous nerve origin, course, and branching pattern, as well as associated adjacent neuromuscular variants. MATERIALS AND METHODS Twenty-seven (24 paired and 3 unpaired) cadaveric arms were dissected to identify the coracobrachialis possible variants with emphasis on the musculocutaneous nerve course and coexisted neural variants. RESULTS Four morphological types of the coracobrachialis were identified: a two-headed muscle in 62.96% (17/27 arms), a three-headed in 22.2% (6/27), a one-headed in 11.1% (3/27), and a four-headed in 3.7% (1 arm). A coracobrachialis variant morphology was identified in 37.04% (10/27). A three-headed biceps brachii muscle coexisted in 23.53% (4/17). Two different courses of the musculocutaneous nerve were recorded: 1. a course between coracobrachialis superficial and deep heads (in cases of two or more heads) (100%, 24/24), and 2. a medial course in case of one-headed coracobrachialis (100%, 3/3). Three neural interconnections were found: 1. the lateral cord of the brachial plexus with the medial root of the median nerve in 18.52%, 2. the musculocutaneous with the median nerve in 7.41% and 3. the radial with the ulnar nerve in 3.71%. Duplication of the lateral root of the median nerve was identified in 11.1%. CONCLUSIONS The knowledge of the morphology of the muscles of the anterior arm compartment, especially the coracobrachialis variant morphology and the related musculocutaneous nerve variable course, is of paramount importance for surgeons. Careful dissection and knowledge of relatively common variants play a significant role in reducing iatrogenic injury.
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Affiliation(s)
- Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health, and Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece.
| | - George Tsakotos
- Department of Anatomy, School of Medicine, Faculty of Health, and Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece
| | - George Triantafyllou
- Department of Anatomy, School of Medicine, Faculty of Health, and Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Athens, Greece
| | - Dimitrios Chytas
- Basic Sciences Laboratory, Department of Physiotherapy, University of Peloponnese, Sparta, Greece
- European University Cyprus, Engomi, Nicosia, Cyprus
| | - Vasilios Karampelias
- Department of Anatomy, School of Medicine, Faculty of Health, and Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece
| | - Ioannis Pantekidis
- Department of Anatomy, School of Medicine, Faculty of Health, and Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece
| | - Anastasia Triantafyllou
- Department of Anatomy, School of Medicine, Faculty of Health, and Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health and Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Oza PP, Yung HC, Vaz Grace K. Variations in the Branching Pattern and Course of the Left Axillary Artery: A Cadaveric Case Report. Cureus 2023; 15:e40852. [PMID: 37489202 PMCID: PMC10363335 DOI: 10.7759/cureus.40852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
The axillary artery is the primary arterial supply of the upper limb and functions as a key landmark in the region of the axilla. Anatomical variations in the axillary artery may arise from abnormal angiogenesis in the upper limb bud during embryological development. The routine dissection of the upper limb of an 88-year-old male cadaver revealed unilateral variations in the left axillary artery, including an abnormal anteromedial course with respect to the divisions and cords of the brachial plexus, while no variations were observed in the right axillary artery. Variations in branching were observed in each part of the artery. In the first part of the artery, variations included an accessory branch coursing towards the clavicle and another to the subscapularis muscle. A total of four branches arose from the second part of the artery: a thoracoacromial artery, an accessory pectoral branch, and two common trunks. The first common trunk gave off the alar thoracic artery, an accessory lateral thoracic artery, and the subscapular artery, which further gave off the thoracodorsal and lateral thoracic arteries, prior to continuing as the circumflex scapular artery. The second common trunk yielded the anterior and posterior circumflex humeral arteries prior to continuing as the profunda brachii artery. No branches arose from the third part of the artery. Awareness of variations in the course and branching patterns of the axillary artery as observed in this cadaveric donor is essential for anesthetic, radiographic, surgical, and other interventional procedures of the upper limb.
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Affiliation(s)
- Palak P Oza
- Department of Molecular, Cellular and Biomedical Sciences, City University of New York (CUNY) School of Medicine, New York, USA
| | - Halley C Yung
- Department of Molecular, Cellular and Biomedical Sciences, City University of New York (CUNY) School of Medicine, New York, USA
| | - Kiran Vaz Grace
- Department of Molecular, Cellular and Biomedical Sciences, City University of New York (CUNY) School of Medicine, New York, USA
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Patil S, Rathinam B, Kumar B, Chaware P, Wakode N, Wakode S, Gandhi K. A Cadaveric Study to Define the Variant Patterns of Median Nerve Formation. Cureus 2023; 15:e39806. [PMID: 37398784 PMCID: PMC10313528 DOI: 10.7759/cureus.39806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
The median nerve is one of the important nerves of the upper limb which supplies the muscles of the front of the forearm, muscles of the hand, and skin of the hand. Many works of literature mentioned its formation by the fusion of two roots, the medial root from the medial cord and the lateral root from the lateral cord. But multiple variations in the median nerve formation have clinical importance from surgical and anesthetic points of view. For the study purpose, we dissected 68 axillae of 34 formalin-fixed cadavers. Out of 68 axillae, two (2.9%) showed median nerve formation by a single root, 19 (27.9%) showed median nerve formation by three roots, and three (4.4%) showed median nerve formation by four roots. A normal pattern of median nerve formation by fusion of two roots was seen in 44 (64.7%) axilla. The knowledge of variant patterns of median nerve formation will be helpful to surgeons and anesthetists while performing surgical or anesthetic procedures in the axilla to avoid any injury to the median nerve.
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Affiliation(s)
- Sumit Patil
- Anatomy, All India Institute of Medical Sciences, Bhopal, IND
| | - Bertha Rathinam
- Anatomy, All India Institute of Medical Sciences, Bhopal, IND
| | - Brijesh Kumar
- Anatomy, All India Institute of Medical Sciences, Bhopal, IND
| | | | - Naina Wakode
- Anatomy, Atal Bihari Vajpayee Government Medical College, Vidisha, IND
| | - Santosh Wakode
- Physiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Kusum Gandhi
- Anatomy, All India Institute of Medical Sciences, Bhopal, IND
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Vanhoof MJM, Wagemans C, van Leeuwen T, Vereecke EE. Branching patters of the vascularization and innervation of the primate forelimb. J Morphol 2022; 283:1273-1284. [PMID: 35915895 DOI: 10.1002/jmor.21501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/07/2022] [Accepted: 07/01/2022] [Indexed: 11/07/2022]
Abstract
In this study, we investigate the branching patterns of the vascularization and innervation of the primate forelimb by performing detailed dissections of five unembalmed nonhuman primate specimens belonging to five different species, i.e., rhesus macaque (Macaca mulatta), white-handed gibbon (Hylobates lar), Western gorilla (Gorilla gorilla), chimpanzee (Pan troglodytes), and bonobo (Pan paniscus). Results are compared with five embalmed human specimens (Homo sapiens), and anatomical data of previous studies on nonhuman primates are also included to provide a broader comparative framework. The results show that the overall configuration of the forelimb blood vessels and nerves of the different primate species is similar, although some apparent interspecific differences are found. In all nonhuman primates, in contrast to humans, the superficial vena basilica is absent. Moreover, in gorilla, chimpanzee, and bonobo the superficial v. cephalica is confined to the forearm. In humans, both an arteria interossea anterior and posterior are present, while in the nonhuman primates only an a. interossea anterior is present, which migrates to the posterior side at the level of the musculus pronator quadratus. For the innervation, the nervus medianus and n. ulnaris connect in the forearm of the gorilla and macaque. In the gibbon, the brachial plexus shows some differences in the branching pattern at the fasciculus level compared to the other primates. We conclude that the forelimb innervation branching pattern shows some minor differences between the nonhuman primate species, compared to a higher plasticity in the vascularization. However, the exact functional implications of these differences still remain unclear. Therefore, more research in a broader range of primate species and sampling more specimens for each taxon is needed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marie J M Vanhoof
- Muscles & Movement, Biomedical Sciences Group, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Colette Wagemans
- Muscles & Movement, Biomedical Sciences Group, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Timo van Leeuwen
- Muscles & Movement, Biomedical Sciences Group, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Evie E Vereecke
- Muscles & Movement, Biomedical Sciences Group, KU Leuven Campus Kulak, Kortrijk, Belgium
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Ghosh B, Dilkash MNA, Prasad S, Sinha SK. Anatomical variation of median nerve: cadaveric study in brachial plexus. Anat Cell Biol 2022; 55:130-134. [PMID: 35718802 PMCID: PMC9256496 DOI: 10.5115/acb.22.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/17/2022] [Indexed: 11/27/2022] Open
Abstract
Median nerve is formed by lateral root from lateral cord and medial root from medial cord of brachial plexus. Formation of median nerve occur in front or lateral to axillary artery in axilla. In the present study we observed anatomical variations of median nerve formation in the brachial plexus. We examined formalin fixed 60 upper limbs from 30 adult cadavers (15 males and 15 females) which were above the age 40 years from the department of Anatomy. All the cadavers were dissected on both sides according to Cunningham's Manual of Practical Anatomy. Normal formation of median nerve by two roots noted in 42 (70.0%) of upper limb specimen. Variation of median nerve formation noted in 18 (30.0%) upper limb specimen. Three roots taking part in the formation of median nerve in 13 (21.7%) upper limb specimen where additional root coming from lateral cord of brachial plexus. Four roots taking part in formation of median nerve in 3 (5.0%) upper limb specimen, where additional roots coming from lateral cord and posterior cord of brachial plexus. Lateral root crossed the axillary artery anteriorly to join with medial root lying medial to axillary artery. The median nerve formed medial to third part of axillary artery. Additional communication with musculocutaneous nerve with median nerve seen in 2 (3.3%) upper limb specimen. Knowledge of such anatomical variations is of interest to the anatomist and clinician alike. Surgeons who perform procedures involving neoplasm or repairing trauma need to be aware of these variations. Median nerve variation may lead to confusions in surgical procedures and axillary brachial plexus nerve block anesthesia.
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Affiliation(s)
- Buddhadeb Ghosh
- Department of Anatomy, Katihar Medical College, Katihar, India
| | | | - Sunanda Prasad
- Department of Anatomy, Katihar Medical College, Katihar, India
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Passey J, Rabbani P, Razdan SK, Kumar S, Kumar A. Variations of Median Nerve Formation in North Indian Population. Cureus 2022; 14:e20890. [PMID: 35145795 PMCID: PMC8809111 DOI: 10.7759/cureus.20890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: The median nerve is usually formed by two roots contributed from the medial and lateral cords of the brachial plexus. Morphological variations of the median nerve can have clinical implications from the anesthetic and surgical points of view. In this cadaveric observation study, we report the variations of median nerve formation in the North Indian population. Methods: We observed the formation of the median nerve in 40 human cadaveric upper limb specimens. The specimens belonged to 20 right and 20 left upper limbs. Variations in the formation of the median nerve were noted. Results: Of the 40 dissected specimens, six (15%) had triple roots including a supernumerary root contributing to the medial nerve formation. The supernumerary root was a branch of the lateral cord in five cases, and it had an additional contribution from the medial cord in one case. The median nerve formation and continuation were located anterior or laterally in 39 specimens (97.5%) and medial in one (2.5%) in relation to the axillary artery. Conclusion: We observed supernumerary roots of varying morphology contributing to the median nerve formation. These variations should be considered during the administration of regional anesthesia and during the management of brachial plexus injuries. Further large multi-region studies will help in a better understanding of these variations.
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Lalloo J, Gupta P. Relationship Between Gender, Age, BMI and Side of Body on the Size and Position of Nerves of the Brachial Plexus in Axilla: Pilot Study. Local Reg Anesth 2021; 14:161-166. [PMID: 34849020 PMCID: PMC8612660 DOI: 10.2147/lra.s334618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives Studies demonstrate variations in the size and position of the nerves in the brachial plexus. The objective of this pilot study was to determine the effect of age, gender, BMI and side of body on the size and position of these nerves and to determine the feasibility of a further study. Methods Twenty healthy volunteers were recruited. The ultrasound position of the nerves was confirmed by a dynamic scan. The size of the nerves was calculated using the freehand calliper tool. A graph was designed to study the position of the nerves. ImageJ was used to analyse the position of the nerves. Student's t-tests were carried out to compare the gender and side of arm with the size of the nerve. Pearson's correlation coefficients were calculated to determine the correlation between BMI and age with the size of the nerves. The position of the nerves was compared between male and female, and left and right sides of the body. Results The mean size of the median nerve, musculocutaneous nerve, radial nerve and ulnar nerve was 0.099, 0.032, 0.179 and 0.076 cm2 (males) and 0.091, 0.022, 0.128 and 0.026 cm2 (females), respectively. There were significant differences between the size of nerves and gender in the musculocutaneous, radial and ulnar nerves (P <0.05). The correlations between the sizes of the nerves with BMI and age were not significant. The position of the radial nerves was found to be variable within the same genders and between males and females. The position of the nerves was variable between the left and right hand side. Conclusion The position and size of brachial plexus branches in axilla is very variable. This pilot study highlights the need for further research with larger sample sizes to fully understand the extent and implication of this variability.
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Affiliation(s)
- James Lalloo
- Department of Anaesthesia, Airedale NHS Foundation Trust, Steeton, West Yorkshire, UK
| | - Pawan Gupta
- Department of Anaesthesia, Leeds Teaching Hospitals Trust, Leeds, West Yorkshire, UK
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Benes M, Kachlik D, Belbl M, Kunc V, Havlikova S, Whitley A, Kunc V. A meta-analysis on the anatomical variability of the brachial plexus: Part I - Roots, trunks, divisions and cords. Ann Anat 2021; 238:151751. [PMID: 33940116 DOI: 10.1016/j.aanat.2021.151751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The brachial plexus is a complex anatomical structure that gives rise to all the nerves of the upper limb. Its variability is frequently observed and represents a challenge for interventions in the lower neck and axilla. The aim of this study was to present a comprehensive and evidence-based review with meta-analytic techniques on the variability of roots, trunks, divisions and cords of the brachial plexus. MATERIALS AND METHODS Major medical databases were searched to identify all anatomical studies investigating the variability in the formation of the brachial plexus. Data extracted consisted of demographic information, morphometric parameters, the arrangement of the brachial plexus at the level of the roots, trunks, divisions and cords and the relationship of the brachial plexus to the axillary artery and scalene muscles. The different configurations of the brachial plexus were put into a new classification, and the pooled prevalence of each case was calculated using a random effects model. A sub-analysis on age and geographical location was also performed. RESULTS A total of 40 studies (3055 upper limbs) were included in the meta-analysis. The regular arrangement of roots forming trunks was identified in 84% (95% CI 79-89%) of cases. The overall prevalence of the prefixed and postfixed brachial plexus was 11% (95% CI 6-17%) and 1% (95% CI 0-1%), respectively and in less than 0.1% of cases the brachial plexus received a branch from both C4 and T2. For divisions forming cords, the regular arrangement was observed in 96% (95% CI 93-98%) of cases. Additional communicating branches between the components of the brachial plexus appeared in 5% (95% CI 3-7%) of cases. The relationship of the brachial plexus to the axillary artery and scalene muscles was considered regular in 96% (95% CI 89-100%) and 86% (95% CI 66-98%) of cases, respectively. Analysis of the morphometric parameters revealed the proportional consistency between the components forming the plexus during aging. CONCLUSIONS Knowledge of anatomical variations of the brachial plexus is important for examinations and interventions in the lower neck and axilla. The variability was observed especially in the roots forming trunks, while divisions forming cords showed quite stable appearance. The results of this evidence-based review and meta-analysis can be applied in many different medical disciplines.
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Affiliation(s)
- Michal Benes
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06 Prague 5, Czech Republic; Department of Health Care Studies, College of Polytechnics, Tolsteho 16, 586 01 Jihlava, Czech Republic.
| | - Miroslav Belbl
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Vladimir Kunc
- Department of Computer Science, Czech Technical University, Karlovo namesti 13, 121 35 Prague 2, Czech Republic
| | - Sarlota Havlikova
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Adam Whitley
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06 Prague 5, Czech Republic; Department of Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Srobarova 50, 100 34 Prague 10, Czech Republic
| | - Vojtech Kunc
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 06 Prague 5, Czech Republic; Clinic of Trauma Surgery, Masaryk Hospital, Socialni pece 3316/12A, 400 11 Usti nad Labem, Czech Republic
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Acer N, Turgut M. Evaluation of Brachial Plexus Using Combined Stereological Techniques of Diffusion Tensor Imaging and Fiber Tracking. J Brachial Plex Peripher Nerve Inj 2019; 14:e16-e23. [PMID: 31198435 PMCID: PMC6561765 DOI: 10.1055/s-0039-1687913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/18/2019] [Indexed: 02/03/2023] Open
Abstract
Background Brachial plexus (BP) is composed of intercommunications among the ventral roots of the nerves C5, C6, C7, C8, and T1 in the neck. The in vivo and in vitro evaluation of axons of the peripheral nervous system is performed using different techniques. Recently, many studies describing the application of fiber tractography and stereological axon number estimation to peripheral nerves have been published. Methods Various quantitative parameters of nerve fibers, including axon number, density, axonal area, and myelin thickness, can be estimated using stereological techniques. In vivo three-dimensional reconstruction of axons of BP can be visualized using a combined technique of diffusion tensor imaging (DTI) and fiber tracking with the potential to evaluate nerve fiber content. Conclusion It is concluded that terminal branches of BP can be successfully visualized using DTI, which is a highly reproducible method for the evaluation of BP as it shows anatomical and functional features of neural structures. We believe that quantitative morphological findings obtained from BP will be useful for new experimental, developmental, and pathological studies in the future.
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Affiliation(s)
- Niyazi Acer
- Department of Anatomy, Erciyes University School of Medicine, Kayseri, Turkey
| | - Mehmet Turgut
- Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydın, Turkey
- Department of Histology and Embryology, Adnan Menderes University Health Sciences Institute, Aydın, Turkey
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Michelin P, Legrand J, Lee KS, Leleup G, Etancelin M, Banse C, Dacher JN, Duparc F. Axillary Sonography of the Shoulder: An Adjunctive Approach. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2707-2715. [PMID: 29575005 DOI: 10.1002/jum.14601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/03/2018] [Accepted: 01/06/2018] [Indexed: 06/08/2023]
Abstract
Sonography of the shoulder is widely used to assess various disorders, including tendinous diseases of the rotator cuff and the long head of the biceps brachii muscle. The shoulder is commonly explored through anterior, superior, and posterior approaches, but the inferior axillary approach is rarely considered in the literature. However, this technique allows the direct visualization of relevant anatomic structures. The aim of this pictorial essay is, first, to technically describe this approach and the normal musculoskeletal sonographic anatomy of the region and, second, to present the sonographic findings of shoulder disorders that may be helpfully explored this technique.
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Affiliation(s)
- Paul Michelin
- Department of Radiology, Rouen University Hospital, Rouen, France
- Laboratory of Anatomy, Faculty of Medicine and Pharmacy of Rouen, University of Normandie, Rouen, France
- CETAPS Laboratory, Faculty of Sports Science of Rouen, University of Normandie, Rouen, France
| | - Julie Legrand
- Department of Radiology, Rouen University Hospital, Rouen, France
| | - Kenneth S Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Grégoire Leleup
- Department of Radiology, Rouen University Hospital, Rouen, France
| | | | - Christopher Banse
- Department of Rheumatology, Rouen University Hospital, Rouen, France
| | | | - Fabrice Duparc
- Department of Orthopedic Surgery and Traumatology, Rouen University Hospital, Rouen, France
- Laboratory of Anatomy, Faculty of Medicine and Pharmacy of Rouen, University of Normandie, Rouen, France
- CETAPS Laboratory, Faculty of Sports Science of Rouen, University of Normandie, Rouen, France
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Alrawashdeh O. Prevalence of Asymptomatic Neurophysiological Carpal Tunnel Syndrome in 130 Healthy Individuals. Neurol Int 2016; 8:6553. [PMID: 27994828 PMCID: PMC5136750 DOI: 10.4081/ni.2016.6553] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/05/2016] [Accepted: 06/05/2016] [Indexed: 11/23/2022] Open
Abstract
Diagnosis of carpal tunnel syndrome (CTS) is frequently confirmed by performing nerve conduction studies. Previous studies demonstrated that abnormal nerve conduction study (NCS) is suggestive of CTS among asymptomatic individuals. However, previous studies included individuals with risk factors for the syndrome. A NCS was performed on the median and ulnar nerves in 130 healthy individuals. About 15% of individuals in this study demonstrated electrodiagnostic evidence of carpal tunnels syndrome. Four cases have shown signs of isolated median neuropathy with normal median sensory component. Results indicated that the most widely used method for confirming diagnosis of CTS may have up to 15% of false positives. However, most of those showed changes of minimal CTS. Isolated prolongation of the median motor latency should be investigated further as they are usually classified as moderate to severe CTS and may undergo unnecessary surgeries.
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Affiliation(s)
- Omar Alrawashdeh
- Clinical Neurology, Faculty of Medicine, Mutah University , Mutah, Jordan
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14
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Variations in brachial plexus with respect to concomitant accompanying aberrant arm arteries. Ann Anat 2016; 208:40-48. [PMID: 27507152 DOI: 10.1016/j.aanat.2016.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/11/2016] [Accepted: 07/26/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Variations in the brachial plexus are the rule rather than the exception. This fact is of special interest for the anesthetist when planning axillary block of brachial plexus. MATERIAL AND METHODS 167 cadaver arms were evaluated for variations in brachial plexus, with focus on the cords of the plexus, the loop of the median nerve, and the course of the median, musculocutaneous, ulnar, axillary and radial nerves. In addition, concomitant arterial variations were recorded. RESULTS In 167 arms, variations were detected in 60 cases (36%). With 46 arms (28%) most variations concern the median nerve, followed by 13 cases (8%) which involved the musculocutaneous nerve. Ulnar, axillary and radial nerve variations were rare, amounting to 1.2% for each nerve. In median nerve conditions with a shifted loop of median nerve (12%), a hidden position of the loop or a hidden course of the beginning median nerve (8%) and a doubled loop of median nerve (17%) were observed. In musculocutaneous nerve conditions with a non-perforated coracobrachialis (1.8%), a doubled origin of the nerve (1.2%) and a giving back of branches to the median nerve (1.8%) were noted. Variations in ulnar, axillary and radial nerves concerned lower than normal diameters. CONCLUSIONS It must be stressed that cases which showed a hidden position or a doubled expression of the loop of the median nerve, a hidden course of its beginning and variable interconnections between musculocutaneous and median nerves are of special interest for anesthetists and surgeons. Hence, it is important to note that variations of arm arteries can be associated with brachial plexus variations. For example, a common trunk of axillary artery followed by a hidden loop and course of the median nerve may result in incomplete axillary block of brachial plexus.
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15
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Bilateral variant branching pattern of posterior cord of brachial plexus. J ANAT SOC INDIA 2016. [DOI: 10.1016/j.jasi.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Natsis K, Paraskevas G, Tzika M. Five Roots Pattern of Median Nerve Formation. ACTA MEDICA (HRADEC KRÁLOVÉ) 2016; 59:26-8. [PMID: 27131354 DOI: 10.14712/18059694.2016.52] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
An unusual combination of median nerve's variations has been encountered in a male cadaver during routine educational dissection. In particular, the median nerve was formed by five roots; three roots originated from the lateral cord of the brachial plexus joined individually the median nerve's medial root. The latter (fourth) root was united with the lateral (fifth) root of the median nerve forming the median nerve distally in the upper arm and not the axilla as usually. In addition, the median nerve was situated medial to the brachial artery. We review comprehensively the relevant variants, their embryologic development and their potential clinical applications.
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Affiliation(s)
- Konstantinos Natsis
- Department of Anatomy, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Paraskevas
- Department of Anatomy, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Maria Tzika
- Department of Anatomy, Faculty of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Leung S, Zlotolow DA, Kozin SH, Abzug JM. Surgical Anatomy of the Supraclavicular Brachial Plexus. J Bone Joint Surg Am 2015; 97:1067-73. [PMID: 26135073 DOI: 10.2106/jbjs.n.00706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Brachial plexus exploration is performed in infants when addressing birth palsies and in children and adults following trauma. The upper trunk is most often injured. Traditional drawings of the brachial plexus depict the suprascapular nerve as a branch of the midportion of the upper trunk, with the more lateral branch of the upper trunk as the anterior division. We have not found this orientation to be accurate in clinical practice. The purpose of this study was to determine the branching patterns of the upper trunk and to delineate nerve orientations at the level of the divisions. METHODS Bilateral brachial plexus dissections were performed on eight adult cadavers. The length of the upper trunk and distance of the takeoff of the suprascapular nerve from the anterior and posterior divisions was measured. The native positions of the divisions and of the suprascapular nerve from lateral to medial were recorded across all trunks. RESULTS In six (38%) of the sixteen specimens, a trifurcation was found at the level of the upper trunk. The suprascapular nerve was the most lateral structure at the clavicular level in all specimens, followed by the posterior division and then the anterior division. The mean distance of the takeoff of the suprascapular nerve was 4 mm proximal to the branch point of the divisions; however, in two specimens, the nerve was found to take off from the posterior division proper. CONCLUSIONS These findings differ from the standard illustrations and descriptions of the brachial plexus. A thorough understanding of the course of the upper trunk and its branches, such as the suprascapular nerve, is vital to performing nerve transfer surgery or neuroma excision and grafting.
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Affiliation(s)
- Sophia Leung
- Department of Orthopaedics, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 300, Baltimore, MD 21201. E-mail address:
| | - Dan A Zlotolow
- Shriners Hospitals for Children, 3551 North Broad Street, Philadelphia, PA 19140. E-mail address for D.A. Zlotolow: . E-mail address for S.H. Kozin:
| | - Scott H Kozin
- Shriners Hospitals for Children, 3551 North Broad Street, Philadelphia, PA 19140. E-mail address for D.A. Zlotolow: . E-mail address for S.H. Kozin:
| | - Joshua M Abzug
- Department of Orthopaedics, University of Maryland School of Medicine, 1 Texas Station Court, Suite 300, Timonium, MD 21093. E-mail address:
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Backus TC, Solounias N, Mihlbachler MC. The Brachial Plexus of the Sumatran Rhino (Dicerorhinus sumatrensis) and Application of Brachial Plexus Anatomy Toward Mammal Phylogeny. J MAMM EVOL 2015. [DOI: 10.1007/s10914-015-9297-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Closure of the Axillary Artery Puncture Site with StarClose System after Endovascular Interventions. J Vasc Interv Radiol 2014; 25:640-5. [DOI: 10.1016/j.jvir.2014.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 01/01/2014] [Accepted: 01/03/2014] [Indexed: 11/21/2022] Open
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20
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Viswanathan U, Madhivadhany V, Shankar N. Bilateral single cord of the brachial plexus in an adult female cadaver of South Indian origin. Anat Cell Biol 2013; 46:223-7. [PMID: 24179700 PMCID: PMC3811857 DOI: 10.5115/acb.2013.46.3.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 08/16/2013] [Accepted: 08/21/2013] [Indexed: 11/27/2022] Open
Abstract
The occurrence of a brachial plexus united into a single cord is very rare. During routine dissection of an elderly female cadaver, the brachial plexus united into a single cord was observed bilaterally. On the left side, C4, C5, and C6 roots combined to form the upper trunk, the C7 root continued as the middle trunk, and C8 and T1 united to form the lower trunk. All three trunks almost immediately fused to form a single cord. On the right side, C5 and C6 roots joined to form the upper trunk, which divided into anterior and posterior divisions. C7, C8, and T1 roots combined to form the lower trunk. The anterior and posterior divisions united with the lower trunk to form a single cord. On both sides, the subclavian artery was superior to the single cord. Supraclavicular brachial plexus injuries in such individuals may have serious clinical manifestations.
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Affiliation(s)
- Uma Viswanathan
- Department of Anatomy, St. John's Medical College, Bangalore, India
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21
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Song ZF, Sun MM, Wu ZY, Lv HZ, Xia CL. Anatomical study of the communicating branches of cords of the brachial plexus and their clinical implications. Clin Anat 2013; 27:631-6. [PMID: 23526687 DOI: 10.1002/ca.22126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Revised: 11/18/2011] [Accepted: 05/26/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Zhan-Feng Song
- Boxi Institute of Clinical Anatomy & Lab of Aging and Nervous Diseases; Medical College of Soochow University; Suzhou 215123 China
- The General Hospital of Xingtai Mining Industry Bloc; Xingtai 054000 China
| | - Mao-Min Sun
- Boxi Institute of Clinical Anatomy & Lab of Aging and Nervous Diseases; Medical College of Soochow University; Suzhou 215123 China
| | - Zhan-Yong Wu
- The General Hospital of Xingtai Mining Industry Bloc; Xingtai 054000 China
| | - Hang-Zhou Lv
- The General Hospital of Xingtai Mining Industry Bloc; Xingtai 054000 China
| | - Chun-Lin Xia
- Boxi Institute of Clinical Anatomy & Lab of Aging and Nervous Diseases; Medical College of Soochow University; Suzhou 215123 China
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Jeon CH, Kee KH, Kim JY, Yoon SP. Bilateral variations of musculocutaneous nerves with rare pattern in a Korean female cadaver. Anat Sci Int 2013; 88:167-70. [DOI: 10.1007/s12565-013-0170-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 01/08/2013] [Indexed: 11/30/2022]
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23
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Woźniak J, Kędzia A, Dudek K. Brachial plexus variations during the fetal period. Anat Sci Int 2012; 87:223-33. [DOI: 10.1007/s12565-012-0150-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 08/07/2012] [Indexed: 10/27/2022]
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24
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Study of sensory and motor fascicles in brachial plexus and establishment of a digital three-dimensional graphic model. Ann Plast Surg 2012; 67:615-9. [PMID: 22123540 DOI: 10.1097/sap.0b013e31822f677e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To investigate a 3-dimensional (3D) model of human brachial plexus including its topography of sensory and motor fascicles with the assistance of the computer technology, 2 brachial plexus were serially horizontally sliced. Each slice was stained by Karnovsky-Roots acetylcholinesterase histochemical method. The stained sections were scanned, and the image was put into the computer serially. At last, the 3D diagram of brachial plexus was made. The internal structure of the brachial plexus was found to be very complicated. The fascicles bifurcated and recombined with one another with no fixed rules. All fascicles were mixed sensory and motor fibers. Acetylcholinesterase histochemical staining from a serial tissue section is a useful technique to distinguish sensory fibers from motor ones. The 3D visualization of the brachial plexus may help to develop a computerized database of the fascicle topography to provide an anatomical reference in fascicular repair of brachial plexus.
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25
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A possible relationship between reliability of thoracic outlet syndrome diagnostic testing and the position of the axillary artery. Surg Radiol Anat 2012; 34:499-507. [DOI: 10.1007/s00276-012-0948-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 02/16/2012] [Indexed: 10/28/2022]
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26
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Uzel AP, Bulla A, Steinmann G, LaurentJoye M, Caix P. [Absence of the musculocutaneous nerve and its distribution from median nerve: About two cases and literature review]. Morphologie 2011; 95:146-150. [PMID: 22079600 DOI: 10.1016/j.morpho.2011.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Musculocutaneous nerve arises mostly from the lateral cord of brachial plexus. Nevertheless, variations have been reported and, among them: the total absence of musculocutaneous nerve (from 1.4 to 15%), the absence of its passage through the coracobrachial muscle, its variable level of penetration as measured from the tip of the coracoid process, and its communicating branches with the median nerve. We report two cases of unilateral musculocutaneous nerve absence in a 66-year-old male and a 95-year-old female cadavers, on the right and the left side, respectively. The nerve fibers normally coming from musculocutaneous nerve emerged from the median nerve. The knowledge of this anatomical variation is important specially when performing plexus bloc or Latarjet's procedure.
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Affiliation(s)
- A-P Uzel
- Service d'orthopédie et traumatologie, CHRU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre cedex, Guadeloupe. , maxuzel
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27
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Kendir S, Sen T, Firat T, Leblebicioğlu AG, Türker T, Tekdemir I, Elhan A. Motor nerve lengths of twenty-seven muscles in upper extremity. Clin Anat 2011; 25:373-8. [PMID: 21898604 DOI: 10.1002/ca.21247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 06/14/2011] [Accepted: 06/21/2011] [Indexed: 11/09/2022]
Abstract
The purpose of this study is to determine the lengths of motor nerves in the upper extremity. Motor nerves of 27 muscles in 10 cadavers (16 extremities) were dissected from their roots at the level of intervertebral foramen to the entry point of the nerves to the corresponding muscles. Distance between acromion and the lateral epicondyle of the humerus was also measured in all cadavers. Nerve length of the coracobrachialis muscle was the shortest (18.26 ± 1.64 cm), while the longest was the nerve of the extensor indicis (59.51 ± 4.80 cm). The biceps brachii, the extensor digitorum communis, and the brachialis muscles showed highest coefficient of variation that makes these nerve lengths of muscles inconsistent about their lengths. This study also offers quotients using division of the lengths of each nerve to acromion-the lateral epicondyle distance. Knowledge of the nerve lengths in the upper extremity may provide a better understanding the reinnervation sequence and the recovery time in the multilevel injuries such as brachial plexus lesions. Quotients may be used to estimate average lengths of nerves of upper extremity in infants and children. Moreover, reliability of the biceps brachii as a determinant factor for surgery in obstetrical brachial plexus lesions should be reconsidered due to its highest variation coefficient.
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Affiliation(s)
- Simel Kendir
- Department of Anatomy, Ankara University Faculty of Medicine, Sıhhiye, Ankara, Turkey
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28
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Chakraborty PB, Bhattacharya S, Dutta S. Multiple Neurovascular Abnormalites of a Single Cadaver-A Case Report. J ANAT SOC INDIA 2011. [DOI: 10.1016/s0003-2778(11)80013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Pontell M, Scali F, Marshall E. A unique variation in the course of the musculocutaneous nerve. Clin Anat 2011; 24:968-70. [DOI: 10.1002/ca.21173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 02/19/2011] [Accepted: 02/22/2011] [Indexed: 11/08/2022]
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30
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Wang P, Hsien YL, Ho WY, Liu CC, Hsiao TH. A rare case of multiple neuromuscular variations in the axilla and arm. Kaohsiung J Med Sci 2011; 27:121-4. [PMID: 21421202 DOI: 10.1016/j.kjms.2010.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 06/18/2010] [Indexed: 11/15/2022] Open
Abstract
During the dissection of a 73-year-old embalmed male cadaver, we noted unusual variations in the flexor compartment of the upper limb-bilateral axillary arch muscles, a three-headed biceps brachii muscle with two supernumerary bellies-and variations in the origin of the musculocutaneous and median nerves from the brachial plexus. The morphological and clinical significance of this unique coexistence of multiple neuromuscular variations are discussed.
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Affiliation(s)
- Pei Wang
- School of Medicine, College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
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31
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Clinical sonopathology for the regional anesthesiologist: part 1: vascular and neural. Reg Anesth Pain Med 2011; 35:272-80. [PMID: 20921839 DOI: 10.1097/aap.0b013e3181ddd1f8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The use of ultrasound to facilitate regional anesthesia is an evolving area of clinical, education, and research interests. As our community's experience grows, it has become evident that anesthesiologists performing "routine" ultrasound-guided blocks may very well be confronted with atypical or even pathologic anatomy. As an educational resource for anesthesiologists, the following articles present examples of common sonopathology that may be encountered during ultrasound-guided regional anesthesia. This present article describes sonopathology related to blood vessels and nerves.
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Absence of the musculocutaneous nerve associated with a supernumerary head of biceps brachii: a case report. Surg Radiol Anat 2011; 33:551-4. [DOI: 10.1007/s00276-010-0771-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
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Baliyan R, Mehta V, Arora J, Nayyar AK, Suri RK, Rath G. Unilateral intercordal neural communication coexistent with variant branching pattern of posterior cord of brachial plexus. ACTA MEDICA (HRADEC KRALOVE) 2011; 54:131-134. [PMID: 22250485 DOI: 10.14712/18059694.2016.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
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 ofbrachial plexus, descriptions regarding anomalous branching patterns hold enormous clinical significance for the radiologists, anesthetists and surgeons, besides being of academic interest for the anatomists.
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Affiliation(s)
- Renu Baliyan
- Department of Anatomy, Vardhman Mahavir Medical College, New Delhi, India
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Olinger A, Benninger B. Branching patterns of the lateral thoracic, subscapular, and posterior circumflex humeral arteries and their relationship to the posterior cord of the brachial plexus. Clin Anat 2010; 23:407-12. [PMID: 20235185 DOI: 10.1002/ca.20958] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Anatomical variations in the branching pattern of the axillary artery are common and typically include the lateral thoracic, subscapular, and the posterior circumflex humeral (PCHA) arteries. Previous investigations of single specimen dissections demonstrate numerous variations to axillary artery branching, but the frequency of these occurrences is unclear. This study quantifies the frequency of variant branching of the lateral thoracic, subscapular, and posterior circumflex humeral arteries, how it they relate to the posterior cord of the brachial plexus. Axillae of 83 cadavers were dissected to allow examination of the axillary artery and its branches. Data were collected observing the branching pattern of the lateral thoracic, subscapular, and posterior circumflex humeral arteries, as well as those branches spatial relationship to the two terminal branches of the posterior cord of the brachial plexus. Some of the more common variations included the thoracodorsal artery arising from the lateral thoracic artery (LTA) (7.2%) and the subscapular artery (SSA) arising from the LTA (5.4%). The SSA also produced the LTA (4.2%) and the PCHA (12%). The PCHA also originated from the deep brachial artery (8.4%) and traversed the triangular interval to supply the deltoid muscle. These findings are relevant to both the anatomical and clinical fields as provide evidence as to the frequency of variant axillary artery branching and the potential for neurovascular elements to exist in a location other than their classical anatomical description.
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Affiliation(s)
- Anthony Olinger
- Division of Basic Sciences, Western States Chiropractic College, Portland, Oregon, USA
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Aggarwal A, Puri N, Aggarwal AK, Harjeet K, Sahni D. Anatomical variation in formation of brachial plexus and its branching. Surg Radiol Anat 2010; 32:891-4. [PMID: 20521147 DOI: 10.1007/s00276-010-0683-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Accepted: 05/17/2010] [Indexed: 11/26/2022]
Abstract
Variant brachial plexus formation with two trunks and two cords is uncommon and has clinical implications as it may result in failure of regional brachial or axillary block. During routine anatomical dissection, unilateral variation in the formation of brachial plexus accompanied by unusual positional relationship with axillary artery was discovered in the left upper extremity of a 52-year-old Indian male cadaver. Brachial plexus showed two trunks formed by ventral rami of C5, C6 and C7, C8, T1 spinal nerves, respectively, which first split and then reunited in an unusual manner to form two cords: posterior and lateral instead of three. Medial cord was absent. The branching pattern of the brachial plexus also showed important variations. Second part of axillary artery was found lying inferomedial to brachial plexus instead of passing between medial and lateral cords. Transverse cervical artery was found to be coursing between two trunks instead of passing superficial to brachial plexus. Median nerve was observed to be formed from a single root, instead of usual two roots. Embryologically, this rare variation may be due to the development of axillary artery from ninth segmental artery instead of usual seventh cervical intersegmental artery. Such rare variation is clinically important as this knowledge may help the anesthesiologists and the surgeons to avoid any inadvertent damage to nerves and axillary artery during blocks and surgical interventions.
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Affiliation(s)
- Anjali Aggarwal
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
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Affiliation(s)
- Jeong Uk Han
- Department of Anesthesiology and Pain Medicine, Inha University Hospital, Incheon, Korea
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Bhat KMR, Gowda S, Potu BK. Nerve loop around the axillary vessels by the roots of the median nerve a rare variation in a south Indian male cadaver: a case report. CASES JOURNAL 2009; 2:179. [PMID: 19946489 PMCID: PMC2783134 DOI: 10.1186/1757-1626-2-179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 10/31/2009] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Median nerve is normally formed by the union of medial and lateral root arising from the medial and the lateral cords of the brachial plexus respectively. However, variations in the formation and its relation with the axillary vessels are not uncommon. Therefore, knowledge of the variations in the nerve formation and course is useful for the clinicians during surgery and for differential diagnosis of uncommon clinical conditions. CASE PRESENTATION During the routine dissection in the department of anatomy, Kasturba Medical Collage, Manipal, India, we found unique anatomical variations in the formation and the course of the roots of the median nerve forming the neural loops around the axillary artery and vein. CONCLUSION Here we report the detailed description of these variations along with its clinical, embryological relevance and review of literature.
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Affiliation(s)
- Kumar MR Bhat
- Department of Anatomy, Kasturba Medical Collage, Manipal University, Manipal-576104, India
| | - Siddaraju Gowda
- Department of Anatomy, Kasturba Medical Collage, Manipal University, Manipal-576104, India
| | - Bhagath Kumar Potu
- Department of Anatomy, Kasturba Medical Collage, Manipal University, Manipal-576104, India
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Yang HJ, Gil YC, Lee HY. Intersegmental origin of the axillary artery and accompanying variation in the brachial plexus. Clin Anat 2009; 22:586-94. [PMID: 19484799 DOI: 10.1002/ca.20811] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The wide anatomical variation of the brachial plexus and the axillary artery has been thoroughly explored in previous studies. However, there has been little information reported on the variation in the relationship between the brachial plexus and the axillary artery. The principal feature of this relationship is the passage of the axillary artery through the loop of the median nerve, which occurs in normal arteries derived from the seventh intersegmental artery. In this study, we analyzed the abnormal position and course of the axillary artery related to the brachial plexus in 607 axillae of 306 cadavers. We found 12 unusual axillary arteries that did not pass through the median loop. Eleven arteries were determined to be ninth intersegmental arteries and one as the sixth intersegmental artery. All ninth intersegmental arteries ran caudally to the brachial plexus. In six cases of this type, abnormal connections interfering with the normal arterial position were observed in the brachial plexus. In another five cases of this type, the lateral and medial cords merged and the axillary artery passed anteromedial to the plexus. The sixth intersegmental axillary artery pierced the musculocutaneous nerve which is from the unified lateral and medial cords. This study discussed the how the anomalous structure of the brachial plexus could involve the deterioration of the course of the axillary artery.
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Affiliation(s)
- Hee-Jun Yang
- National Biochip Research Center, Yonsei University College of Medicine, Seoul, Korea
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Soeding P, Eizenberg N. Review article: anatomical considerations for ultrasound guidance for regional anesthesia of the neck and upper limb. Can J Anaesth 2009; 56:518-33. [DOI: 10.1007/s12630-009-9109-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 03/24/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022] Open
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Fregnani JHTG, Macéa MIM, Pereira CSB, Barros MD, Macéa JR. Absence of the musculocutaneous nerve: a rare anatomical variation with possible clinical-surgical implications. SAO PAULO MED J 2008; 126:288-90. [PMID: 19099164 DOI: 10.1590/s1516-31802008000500009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 02/07/2008] [Indexed: 11/21/2022] Open
Abstract
CONTEXT The musculocutaneous nerve is one of the terminal branches of the lateral fasciculus of the brachial plexus, and is responsible for innervation of the flexor musculature of the elbow and for skin sensitivity on the lateral surface of the forearm. Its absence has been described previously, but its real prevalence is unknown. CASE REPORT A case of absence of the musculocutaneous nerve that was observed during the dissection of the right arm of a male cadaver is described. The area of innervation was supplied by the median nerve. From this, three branches emerged: one to the coracobrachialis muscle, another to the biceps brachii muscle and the third to the brachialis muscle. This last branch continued as a lateral antebrachial cutaneous nerve. This is an anatomical variation that has clinical-surgical implications, considering that injury to the median nerve in this case would have caused unexpected paralysis of the flexor musculature of the elbow and hypoesthesia of the lateral surface of the forearm.
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Van Hoof T, Gomes GT, Audenaert E, Verstraete K, Kerckaert I, D'herde K. 3D Computerized Model for Measuring Strain and Displacement of the Brachial Plexus Following Placement of Reverse Shoulder Prosthesis. Anat Rec (Hoboken) 2008; 291:1173-85. [DOI: 10.1002/ar.20735] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Singhal S, Rao VV, Ravindranath R. Variations in brachial plexus and the relationship of median nerve with the axillary artery: a case report. J Brachial Plex Peripher Nerve Inj 2007; 2:21. [PMID: 17915015 PMCID: PMC2082021 DOI: 10.1186/1749-7221-2-21] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Accepted: 10/03/2007] [Indexed: 11/23/2022] Open
Abstract
Background Brachial Plexus innervates the upper limb. As it is the point of formation of many nerves, variations are common. Knowledge of these is important to anatomists, radiologists, anesthesiologists and surgeons. The presence of anatomical variations of the peripheral nervous system is often used to explain unexpected clinical signs and symptoms. Case Presentation On routine dissection of an embalmed 57 year old male cadaver, variations were found in the formation of divisions and cords of the Brachial Plexus of the right side. Some previously unreported findings observed were; direct branches to the muscles Pectoralis Minor and Latissimus dorsi from C6, innervation of deltoid by C6 and C7 roots and the origin of lateral pectoral nerve from the posterior division of upper trunk. The median nerve was present lateral to axillary artery. The left side brachial plexus was also inspected and found to have normal anatomy. Conclusion The probable cause for such variations and their embryological basis is discussed in the paper. It is also concluded that although these variations may not have affected the functioning of upper limb in this individual, knowledge of such variations is essential in evaluation of unexplained sensory and motor loss after trauma and surgical interventions to the upper limb.
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Affiliation(s)
- Suruchi Singhal
- Department of Anatomy, St John's Medical College, Bangalore – 560034, India
| | - Vani Vijay Rao
- Department of Anatomy, St John's Medical College, Bangalore – 560034, India
| | - Roopa Ravindranath
- Department of Anatomy, St John's Medical College, Bangalore – 560034, India
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Pandey S. Reply to “Anatomical variations of the cords of brachial plexus and the median nerve”. Clin Anat 2007. [DOI: 10.1002/ca.20502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kocabiyik N, Yalçin B, Yalcin B, Candir N, Ozan H. Letter to the editor. Clin Anat 2007; 20:709; author reply 710. [PMID: 17583583 DOI: 10.1002/ca.20510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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