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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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Maślanka K, Zielinska N, Koptas K, Olewnik Ł, Łabętowicz P. An unreported innervation of the coracobrachialis longus by the radial nerve: a potential pitfall for clinicians. Surg Radiol Anat 2023:10.1007/s00276-023-03166-z. [PMID: 37195301 PMCID: PMC10317868 DOI: 10.1007/s00276-023-03166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/10/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE The aim of the presented case is to describe an unprecedented innervation of the coracobrachialis longus muscle by the radial nerve. METHODS An 82-year-old body donor at death was subjected to a routine anatomical dissection for teaching and research purposes at the Department of Anatomical Dissection and Donation in Lodz, Poland. RESULTS We have found an additional branch of the radial nerve, which departed from it just below its beginning. Its initial section ran alongside the radial nerve in the axilla, then headed medially accompanying superior ulnar collateral artery. Then, it reaches the coracobrachialis longus muscle and is the only one to innervate it. CONCLUSIONS The brachial plexus (BP) is very variable and well understood. Nevertheless, we must remember that there may still be variations in its structure, which may involve problems at every stage of diagnosis and treatment of diseases associated with its structures. Their knowledge is extremely important.
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Affiliation(s)
- Krystian Maślanka
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Krzysztof Koptas
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
| | - Piotr Łabętowicz
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
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Schwabl C, Hörmann R, Strolz CJ, Drakonaki E, Zimmermann R, Klauser AS. Anatomical Variants of the Upper Limb Nerves: Clinical and Preoperative Relevance. Semin Musculoskelet Radiol 2023; 27:129-135. [PMID: 37011614 PMCID: PMC10069954 DOI: 10.1055/s-0043-1761952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Profound knowledge of nerve variations is essential for clinical practice. It is crucial for interpreting the large variability of a patient's clinical presentation and the different mechanisms of nerve injury. Awareness of nerve variations facilitates surgical safety and efficacy. Clinically significant anatomical variations can be classified into two main groups: variability in the course of the nerve and variability of structures surrounding the nerve. In this review article we focus on the most common nerve variants of the upper extremity and their clinical relevance.
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Affiliation(s)
- Christoph Schwabl
- Radiology Department, Medical University of Innsbruck, Innsbruck, Austria
| | - Romed Hörmann
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Elena Drakonaki
- Independent MSK Radiology Practice, Heraklion, Crete, Greece
| | - Robert Zimmermann
- Department of Surgery, University Hospital for Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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A rare bilateral variant of the coracobrachialis muscle with supernumerary heads and coexisted variant branching patterns of the brachial plexus and the axillary artery. Surg Radiol Anat 2023; 45:277-282. [PMID: 36693910 PMCID: PMC9981499 DOI: 10.1007/s00276-023-03088-w] [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] [Received: 12/31/2022] [Accepted: 01/14/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE The study report describes a rare bilateral variant of a six- and five-headed coracobrachialis muscle (CB). The musculocutaneous nerve (MCN) (bilaterally) and the median nerve (MN) lateral root (unilaterally) pierced CB heads, separating superficial from deep heads. METHODS The variant bilateral CB was identified in a 78-year-old formalin-embalmed male cadaver, derived from a body donation program after a signed informed consent. RESULTS At the right side: The 6-headed CB was pierced by the MCN, while the MN lateral root pierced the one superficial and deep head. CB was supplied by the lateral cord and the MCN. At the left side: A 5-headed CB was identified with three superficial distinct origins that fused into a common superficial head coursing anterior to MCN. The variant CB bilaterally (with 11 heads in total) coexisted with a MN variant formation, an atypical course of the MN lateral root through CB (right side), a connection of the MN lateral root with the MCN (left side) and a variant axillary artery branching pattern (bilaterally). CONCLUSIONS Course and direction of the accessory CB heads may occasionally entrap the MCN and/or adjacent structures (brachial artery and MN). The MCN compression results in problems in the glenohumeral joint flexion and adduction, and tingling or numbness of the elbow joint, the forearm lateral parts and the hand.
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Szewczyk B, Konschake M, Podgórski M, Zielinska N, Markanicz M, Borowski A, Olewnik Ł. A proposal for a new classification of the long head of the biceps brachii. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:963-970. [PMID: 35788885 DOI: 10.1007/s00276-022-02961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The anterior compartment of the arm consists of three muscles: the biceps brachii, brachialis and coracobrachialis. The aim of the present study was to characterize possible variations in the morphology of the proximal attachments of the long head of the biceps brachii and to propose an accurate classification of the area which can be useful for planning surgical procedures and planning rehabilitation in the region. MATERIALS AND METHODS Eighty (40 left and 40 right, 40 female, 40 male) upper limbs fixed in 10% formalin solution were examined. RESULTS The main tendon of the long head of the biceps brachii demonstrated three types of attachment. The most common type, Type I (53.75%), was characterized by a single attachment only for the supraglenoid tubercle. Type III (33.75%) was characterized by a single attachment to the glenoid labrum. Type II (12.5%) was characterized by a double attachment to the glenoid labrum and the supraglenoid tubercle. Additionally, two types of the accessory tendon of the long head of the biceps brachii were identified (Type A-B). Type A (14 cases) was attached to the capsule of the humeral joint, and Type B (six cases) was attached to the greater tubercle of the humerus. CONCLUSION The long head of the biceps brachii is characterized by high morphological variability. The new classification proposes three types of proximal attachment (I-III), with two types of accessory long head of the biceps brachii (A-B) tendon. A thorough understanding of the morphological variability of the long head of the biceps brachii is necessary when planning arthroscopic procedures or even planning rehabilitation procedures.
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Affiliation(s)
- Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Michał Podgórski
- Department of Diagnostic Imaging and Interventional Radiology, Medical University of Lodz, Lodz, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Maja Markanicz
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Andrzej Borowski
- Orthopaedics and Paediatric Orthopaedics Department, Medical University of Lodz, Lodz, Poland
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
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A Proposal for a New Classification of the Supernumerary Heads of the Biceps Brachii Muscle. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1510363. [PMID: 35496043 PMCID: PMC9054453 DOI: 10.1155/2022/1510363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/18/2022]
Abstract
Introduction The anterior compartment of the arm consists of three muscles: the biceps brachii (BB), brachialis, and coracobrachialis muscle. The aim of the present study was to characterize possible variations in the supernumerary heads of the biceps brachii and use these to prepare an accurate classification of the area that could be used for planning surgical procedures in the region. Material and Methods. One hundred (51 left and 49 right, 52 females and 48 males) upper limbs fixed in 10% formalin solution were examined. Results Four types of supernumerary BB heads were identified, with subtypes. Type I was the most common type, characterized by the two heads (64%); this was subdivided into Type IA, with a single muscle belly, and Type IB with two muscle bellies. The second most common type was Type II, which was characterized by the three BB heads (26%). This type was divided into four subtypes (A-D): Type IIa characterized by attachment to the middle part of the shaft of the humerus; Type IIb characterized by the origin to the coracoid process together with the short head of the BB; Type IIc characterized by origin to the tendon of the pectoralis major muscle; and Type IId characterized by the attachment to the capsule of the humeral joint. The third most common type was Type III, which was characterized by four heads (6%); this was divided into Type IIIa, where two heads originated from the humerus bone, and Type IIIb, where one head originated from the short heads and the second from the long head of the BB. The rarest type was Type IV (4%) which was characterized by five heads: the short head originated from the coracoid process and the long head originated from the supraglenoid tubercle, the third and fourth head originated from the shaft of the humerus, while the fifth head originated from the pectoralis major muscle. Conclusion The biceps brachii is characterized by very high morphological variability. The new classification proposes four types of supernumerary head arrangement (I-IV), divided into subtypes. This classification has both clinical and anatomical significance.
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Relationships among Coracobrachialis, Biceps Brachii, and Pectoralis Minor Muscles and Their Correlation with Bifurcated Coracoid Process. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8939359. [PMID: 35419460 PMCID: PMC9001095 DOI: 10.1155/2022/8939359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
Abstract
The aim of this study is to demonstrate the relationship between the proximal attachment of the coracobrachialis muscle and the short head of the biceps brachii and the distal attachment of the pectoralis minor. Their correlation with the bifurcated coracoid process (CP) will be also assessed. On the basis of these observations, a new classification of structures attached to the coracoid process is proposed. Classical anatomical dissection was performed on one hundred forty-five upper limbs. Three types of relationship between the coracobrachialis muscle and the short head of the biceps brachii were observed in the cadavers. In type I (occurring in 54%), the coracobrachialis and the short head of the biceps brachii created a common junction attached to a single CP. Type II was divided into two subtypes (a and b). Subtype IIa (frequency 10%) was represented by independent proximal attachments of the short head of the biceps brachii and the coracobrachialis muscles to the CP. In subtype IIb (frequency 5%), the coracobrachialis muscle was two-headed (the first head located under the second) and not connected to the short head of the biceps brachii; all heads were attached to a single CP. Type III (frequency 31%) was characterized by a two-headed coracobrachialis muscle, the first head originating from a bifurcated CP laterally to the short head of the biceps brachii and the second medially to this structure. Different variations connected with the mentioned structures could be problematic for surgeons during operations, so detailed knowledge of them could contribute to more efficient procedures.
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The Subscapularis Muscle: A Proposed Classification System. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7450000. [PMID: 34931169 PMCID: PMC8684517 DOI: 10.1155/2021/7450000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/30/2021] [Accepted: 11/13/2021] [Indexed: 11/29/2022]
Abstract
Background On the basis of the available literature, we proposed the hypothesis that the number of muscle bellies is morphologically constant. The main purpose of this study was to examine the morphological variability of the SM and to create a new classification of it based on number of muscle bellies. Methods Sixty-six adult cadavers of Central European population (45 females, 21 males) were obtained and fixed in 10% formalin before examination. Results The SM was found in all 66 specimens (45 females, 21 males, 31 left and 35 right sides). After meticulous dissection, we distinguished nine types on the basis of number of bellies. Type I was characterized by single belly and occurred in 1.5%. Type II had a double belly and was present in 3%. Type III, the most common type, occurring in almost 32% of the studied population, had three bellies. The frequency of type IV, characterized by four bellies, was also high, just over 30%. The following types were less frequent: type V with five bellies (18.2%), type VI with six bellies (7.6%), type VII with seven bellies (3%), type VIII with eight bellies (1.5%), and type IX with nine bellies (3%). All of the types had origin on the anterior surface of the scapula. Conclusions The SM is morphologically variable in the number of its bellies. Evolutionary changes are probably the reason. The most common type was the SM with three bellies, in line with Larson's model of the division of the SM into three parts. Subsequent studies should be carried out based on MRI or ultrasonography examination to confirm if it is possible to show all types (presented in this study) among group of patients during MRI.
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Węgiel A, Zielinska N, Tubbs RS, Olewnik Ł. Possible points of compression of the ulnar nerve: Tricks and traps that await clinicians from an anatomical point of view. Clin Anat 2021; 35:155-173. [PMID: 34610170 DOI: 10.1002/ca.23798] [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: 06/04/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022]
Abstract
The ulnar nerve can be subject to numerous types of compression. The most common are cubital tunnel and ulnar tunnel syndromes, but there are many others with more uncommon etiologies. The existence of additional communicating branches, median nerve involvement, various types of injuries, and unusual anatomical variations can be a challenge for both diagnosis and treatment. This review presents a comprehensive depiction of ulnar nerve entrapment syndromes with particular reference to their anatomical background, risk factors, and clinical evaluation. Even common disorders can result from atypical morphological changes. It is important to be familiar with them as it is a key ability in daily medical practice.
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Affiliation(s)
- Andrzej Węgiel
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Łódź, Poland
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Łódź, Poland
| | - Richard Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, True Blue, Grenada
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Łódź, Poland
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Zielinska N, Tubbs RS, Konschake M, Olewnik Ł. Unknown variant of the accessory subscapularis muscle? Anat Sci Int 2021; 97:138-142. [PMID: 34591277 PMCID: PMC8732899 DOI: 10.1007/s12565-021-00633-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
Acting in medial rotation of the arm, the subscapularis (SM) is the most powerful and largest muscle of the rotator cuff. It is morphologically variable, especially in the number of tendons, place of insertion, and number of bellies, and it is sometimes fused with another muscle. An accessory subscapularis muscle (ASM) is among the morphological variations of the SM, but it is a really rare variant. The present case describes a very rare ASM that is divided into proximal tendinous attachment, intermediate fleshy muscular belly and distal tendinous attachment. Its origin is located on the lateral border of the scapula, but some fibers are connected with the muscular part of the SM. Its distal attachment is fused with the capsule of shoulder joint, above the tendinous insertion of the SM. Such an arrangement allows for greater stabilization of the joint. Moreover, there is a possibility that it could be used during treatment of ruptured SM tendons.
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Affiliation(s)
- Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA USA
- Department of Anatomical Sciences, St. George’s University, West Indies, Grenada
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA USA
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
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Olewnik Ł, Zielinska N, Gołek Ł, Aragonés P, Sanudo JR. Is it the coracobrachialis superior muscle, or is it an unidentified rare variant of coracobrachialis muscle? Surg Radiol Anat 2021; 43:1581-1586. [PMID: 34037825 PMCID: PMC8455378 DOI: 10.1007/s00276-021-02773-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
The coracobrachialis muscle (CBM) originates from the apex of the coracoid process, in common with the short head of the biceps brachii muscle, and from the intermuscular septum. The CBM demonstrates variability in both the proximal and distal attachment, with some extremely rare varieties, such as the coracobrachialis superior, coracobrachialis longus and coracocapsularis muscle. This case report describes an extremely rare variant of the coracobrachialis superior muscle, or a very rare variant of the CBM. Our findings highlight the importance of muscle variants in the shoulder region, especially the coracoid region, and are significant for radiologists, anatomists, physiotherapists and surgeons specializing in the shoulder joint.
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Affiliation(s)
- Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland.
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Łukasz Gołek
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Paloma Aragonés
- Department of Orthopedics Surgery. Hospital Santa Cristina, Madrid, Spain.,Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose Ramon Sanudo
- Department of Human Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Zielinska N, Szewczyk B, Tubbs RS, Olewnik Ł. Coexistence of two accessory flexor pollicis longus heads or coexistence of two-headed flexor pollicis longus with an unrecognized anatomical structure? Surg Radiol Anat 2021; 43:763-769. [PMID: 33656594 PMCID: PMC8105208 DOI: 10.1007/s00276-021-02721-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/18/2021] [Indexed: 02/01/2023]
Abstract
The flexor pollicis longus (FPL) is located in the anterior compartment of the forearm. It is morphologically variable in both point of origin and insertion. An additional head of the FPL can lead to anterior interosseous syndrome. This report presents a morphological variation of the FPL (additional head in proximal attachment and bifurcated tendinous insertion in distal attachment) and an unrecognized structure that has not so far been described in the literature. This structure originates in six heads (attached to the FPL or interosseous membrane) that merge together, and inserts on to the FPL. All the variations noted have clinical significance, ranging from potential nerve compression to prevention of tendon rupture.
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Affiliation(s)
- Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Bartłomiej Szewczyk
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA USA
- Department of Anatomical Sciences, St. George’s University, West Indies, Grenada
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
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Two muscular variations in the elbow associated with the anterior interosseous nerve. Surg Radiol Anat 2021; 43:735-739. [PMID: 33590265 PMCID: PMC8105242 DOI: 10.1007/s00276-021-02706-9] [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: 11/04/2020] [Accepted: 02/02/2021] [Indexed: 10/25/2022]
Abstract
The coexistence of different muscular-neurovascular variations is of significant clinical importance. A male cadaver, 76 years old at death, was subjected to routine anatomical dissection; the procedure was performed for research and teaching purposes at the Department of Anatomical Dissection and Donation, Medical University of Lodz. The right forearm and hand were dissected using standard techniques according to a strictly specified protocol. The presence accessory head of the flexor pollicis longus may potentially compress the anterior interosseous nerve. The present case report describes a rare variant of the ulnar head of the pronator teres, characterized by two independent bands (i.e., two proximal attachments). The main band originates from the coronoid process and the second originates from the tendon of the biceps brachii. This type of attachment could potentially affect the compression of the ulnar artery running between the two bands. Additionally, the accessory head of the flexor pollicis longus was observed, which started on the medial epicondyle; its coexistence with a high division median nerve creates a potential pressure site on the anterior interesosseous nerve.
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A proposal for a new classification of coracobrachialis muscle morphology. Surg Radiol Anat 2021; 43:679-688. [PMID: 33564931 PMCID: PMC8105249 DOI: 10.1007/s00276-021-02700-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
Introduction The coracobrachialis muscle (CRM) originates from the apex of the coracoid process, in common with the short head of the biceps brachii muscle, and from the intermuscular septum. It inserts to the medial part of the humerus between the attachment of the medial head of the triceps brachii and the brachial muscle. Both the proximal and distal attachments of the CRM, as well as its relationship with the musculocutaneus nerve, demonstrate morphological variability. Material and methods One hundred and one upper limbs (52 left, and 49 right) fixed in 10% formalin solution were examined. Results Three main types, with subtypes, were identified. The most common was Type I (49.5), characterized by a single muscle belly with a classical origin from the coracoid process, medially and posteriorly to the tendon of the biceps brachii. Type II (42.6%), characterized by two heads, was divided into two subtypes (A-B) depending on its origin: Type IIA, where one head originated from the coracoid process posteriorly to the tendon of the biceps brachii and the second head from the short head of the biceps brachii, and Type IIB, in which both heads originated from the coracoid process; however, the superficial head fused with the insertion of a short head of the biceps brachii, while the deep head was directly originating. Finally, Type III (7.9%) was characterized by three heads: two originated from the coracoid process (superficial and deep), and the third from a short head of the biceps brachii. Two types of insertion and two types of musculocutaneous nerve (MCN) relative to CRM could be distinguished. Conclusion An adapted classification is needed for all clinicians working in this area, as well as for anatomists. The CRM demonstrates morphological variability in both its proximal and distal attachments, as well as the variable course of the MCN relative to the CRM. What is known about this subject "and" What this study adds to existing knowledge Not much is known about the variability of coracobrachialis muscle. The present paper introduces a completely new classification, both clinical and anatomical.
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