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Natsis K, Tsakotos G, Triantafyllou G, Olewnik Ł, Zielinska N, Koutserimpas C, Totlis T, Piagkou M. Muscle interconnections in the anterior and posterior arm compartment: a cadaveric case series with possible clinical implications. Surg Radiol Anat 2023; 45:1111-1116. [PMID: 37468724 PMCID: PMC10514112 DOI: 10.1007/s00276-023-03209-5] [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: 05/20/2023] [Accepted: 07/08/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE The report describes four cases of accessory bundles (ABs) or fibers connecting the muscles of the anterior with the posterior arm compartment. The ABs morphology (pure muscular or musculofascial or musculoaponeurotic) is described emphasizing their attachment points, characterized as muscles' interconnections. MATERIALS AND METHODS Four formalin-embalmed donated male cadavers were dissected. RESULTS The muscles' interconnections were unilaterally identified. In the first case, the two ABs originated from the coracobrachialis muscle (CB), received fibers from the biceps brachii (BB), and were inserted into the triceps brachii (TB) medial head. The ABs created an arch over the brachial vessels and the median nerve (MN). In the second case, an accessory musculoaponeurotic structure was identified between CB and TB medial head and extended over the brachial vessels. In the third case, the myofascial ABs between the BB short head and the upper arm fascia, coursed anterior to the MN, the brachial artery, and the ulnar nerve, with direction to the TB medial head. In the fourth case, the three muscular ABs originating from the CB superficial and deep heads, in common with the BB short head, joined the upper arm fascia and the TB medial head and possibly entrapped the musculocutaneous nerve, the MN, and the brachial artery. CONCLUSION ABs or musculoaponeurotic extensions may predispose to complications due to their potential compression on nerves and vessels. Clinicians should consider the possible existence of such bridging variants between muscles, in the differential diagnosis of a patient presenting with ischemia, edema, or MN palsy symptoms.
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Affiliation(s)
- Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Tsakotos
- Department of Anatomy, School of Medicine, Faculty of Health 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 Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland
| | - Christos Koutserimpas
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Athens, Greece
| | - Trifon Totlis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527, Athens, Greece.
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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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Ilayperuma I, Nanayakkara BG, Hasan R, Uluwitiya SM, Palahepitiya KN. Coracobrachialis muscle: morphology, morphometry and gender differences. Surg Radiol Anat 2015; 38:335-40. [PMID: 26464302 DOI: 10.1007/s00276-015-1564-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Coracobrachialis (CBM) is a complex muscle with a wide range of variations in its morphology and innervation. The goal of this study was to elucidate the morphology, morphometry, gender differences of CBM and precise anatomical position of the musculocutaneous nerve (MCN) with reference to surrounding anatomical landmarks in an adult Sri Lankan population. METHOD Cadaveric upper limbs (n = 312) were examined for the proximal and distal attachments, length, width, thickness of CBM and its relationship with the MCN. RESULTS The CBM originated from the tip of the coracoid process of the scapula and lateral, posterior and medial aspects of the tendon of short head of biceps brachii. Gender differences were observed in all morphometrical parameters of CBM. In 83.33 %, MCN perforated the CBM. In 50 % the MCN pierced the middle one-third of CBM while none pierced the lower one-third. The distance from the coracoid process to the point of entry of MCN into CBM (distance P) was 50.62 mm. A positive correlation was observed between the arm length and distance P indicating that arm length provides an accurate and reliable means of gauging the distance P of an individual. CONCLUSION The present study provides new evidence pertaining to the origin of CBM. Further, it was revealed that the predicted distance P of any upper extremity can be calculated by dividing the arm length by 5. Precise anatomical location of MCN in relation to CBM using unequivocal and well-defined anatomical landmarks will be imperative in modern surgical procedures.
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Affiliation(s)
- Isurani Ilayperuma
- Department of Anatomy, Faculty of Medicine, University of Ruhuna, P.O. Box 70, Galle, Sri Lanka.
| | - B G Nanayakkara
- Department of Anatomy, Faculty of Medicine, University of Ruhuna, P.O. Box 70, Galle, Sri Lanka
| | - R Hasan
- Department of Anatomy, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - S M Uluwitiya
- Department of Anatomy, Faculty of Medicine, University of Ruhuna, P.O. Box 70, Galle, Sri Lanka
| | - K N Palahepitiya
- Department of Anatomy, Faculty of Medicine, University of Ruhuna, P.O. Box 70, Galle, Sri Lanka
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The accessory coracobrachialis muscle: ultrasound and MR features. Skeletal Radiol 2015; 44:1273-8. [PMID: 25924580 DOI: 10.1007/s00256-015-2153-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/31/2015] [Accepted: 04/09/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To present the prevalence, clinical relevance, and ultrasound (US) and magnetic resonance imaging (MRI) appearances of the accessory coracobrachialis (ACB) muscle. MATERIALS AND METHODS We present an US prospective study of the ACB muscle over a 2-year period. Five of the eight patients with suspected ACB on US were subsequently examined by MRI. RESULTS An ACB muscle was demonstrated by US in eight patients (eight shoulders), including seven females, one male, with mean age 39 years, over 770 (664 patients) consecutive shoulder US examinations referred to our institution yielding a prevalence of 1.04%. In dynamic US assessment, one case of subcoracoid impingement secondary to a bulky ACB was diagnosed. No thoracic outlet syndrome was encountered in the remaining cases. MRI confirmed the presence of the accessory muscle in five cases. CONCLUSIONS ACB muscle is a rarely reported yet not uncommon anatomic variation of the shoulder musculature encountered only in eight of 664 patients referred for shoulder US study. Its US and MRI appearance is described. One of our patients presented with subcoracoid impingement related to the presence of an ACB.
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Coracobrachialis Myofascial Flap. Ann Plast Surg 2012. [DOI: 10.1097/sap.0b013e31821b6cce] [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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Gupta G, Singh K, Chhabra S, Srivastava SK, Gupta V. Accessory coracobrachialis: a case report with its morphological and clinical significance. Surg Radiol Anat 2012; 34:655-9. [DOI: 10.1007/s00276-011-0931-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022]
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Kervancioglu P, Orhan M, Kilinc N. Patterns of motor branching of the musculocutaneous nerve in human fetuses and clinical significance. Clin Anat 2011; 24:168-78. [PMID: 21268120 DOI: 10.1002/ca.21095] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 09/29/2010] [Accepted: 10/05/2010] [Indexed: 11/08/2022]
Abstract
The purpose of this morphologic study is to investigate the course and the branching pattern of motor branches of musculocutaneous nerve (MCN) in human fetuses. Twenty upper limbs (10 right, 10 left) of spontaneously aborted formalin-fixed fetuses were dissected under a stereomicroscope to determine motor branches for the biceps brachii and brachialis and the communicating branches between the MCN and median nerve (MN). The MCN entered the proximal and middle part of coracobrachialis in 13/20 and 5/20 of arms, respectively, and the remaining 2/20 did not pierce coracobrachialis. The communication between MCN and MN was observed in 5/20 of the arms and detected only in the distal part of the coracobrachialis. The most frequently observed innervation is the type wherein a single branch to biceps brachii, which bifurcated for supplying the short and long heads (12/20). For the innervation of brachialis, the most frequent type was a single branch from the main trunk of the MCN (15/20). During the dissections, the distance between the acromion and the emerging point of the motor branches was measured. The mean distance between the acromion and the emerging point of the all motor branches for biceps brachii in all types of specimens was 33.8 ± 6.1% of acromion-lateral epicondyle length and for brachialis was 50.6 ± 11.5% of acromion-lateral epicondyle length. The data of the MCN variations in the human fetus may be useful for the clinicians and pediatric surgery.
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Affiliation(s)
- Piraye Kervancioglu
- Anatomy Department, Gaziantep University Medical Faculty, Sehitkamil/Gaziantep, Turkey.
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Ray B, Rai AL, Roy TS. Unusual insertion of the coracobrachialis muscle to the brachial fascia associated with high division of brachial artery. Clin Anat 2005; 17:672-6. [PMID: 15495166 DOI: 10.1002/ca.20024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Anatomical variations of the coracobrachialis muscle (CBM) are common. We detected an abnormal form of the CBM of the left arm during human cadaver dissection. The CBM originated from the tip of the coracoid process of the scapula and divided into muscular and musculo-aponeurotic bellies. The muscular belly inserted into the middle of the anteromedial surface of the humerus, which is the normal anatomic insertion point of the CBM. The musculo-aponeurotic belly inserted into the medial intermuscular septum as well as the brachial fascia, creating a tunnel for the passage of the brachial artery. Inside the tunnel, the brachial artery bifurcated into the radial and ulnar arteries. No abnormality of the CBM, the brachial artery, or the median nerve was detected in the contralateral arm. The phylogenic, ontogenic, functional, and clinical importance of this variant muscle is described. Knowledge of such variations is of considerable importance during invasive and non-invasive investigative procedures or orthopedic, reconstructive, or surgical procedures.
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Affiliation(s)
- Bappaditya Ray
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi 110 029, India
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Kopuz C, Içten N, Yildirim M. A rare accessory coracobrachialis muscle: a review of the literature. Surg Radiol Anat 2003; 24:406-10. [PMID: 12652369 DOI: 10.1007/s00276-002-0079-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2001] [Accepted: 07/29/2002] [Indexed: 11/30/2022]
Abstract
During previous dissections to investigate the incidence of the third head of the biceps brachii in neonate cadavers an accessory coracobrachialis muscle was unilaterally found in a neonate male cadaver. This muscle originated from the coracoid process and the capsule of the shoulder joint. It was inserted into the antebrachial fascia and the medial epicondyle of the humerus. The coracobrachialis muscle is used as a transposition flap in deformities of infraclavicular and axillary areas and in postmastectomy reconstruction. It is also a guide to the axillary artery during surgery and anesthesia. This additional muscle may cause musculocutaneous or high median nerve paralysis. We were unable to find any similar case in the published literature. The anatomic variations of the coracobrachialis muscle may cause confusion during surgery or evaluation of CT and MRI scans.
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Affiliation(s)
- C Kopuz
- Department of Anatomy, Medical School Ondokuz Mayis University, Samsun, Turkey.
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