Multiple variations in the course and motor branching pattern of the musculocutaneous nerve with unusual communication with the median nerve

• Autorzy: Chentanez V. , Jaruprat P. , Udomchaisaku P. , Agthong S. , Huanmanop T.
• Języki publikacji: EN

Abstrakty

EN

Anatomic variations in course and motor branching pattern of the musculocutaneous nerve (MCN) with unusual communication with the median nerve were determined on the left arm of a 62-year-old formalin fixed male cadaver. The MCN did not pierce the coracobrachialis muscle. It provided 4 primary motor branches. The first branch emerged 1.5 cm inferior to the coracoid process to innervate the coracobrachialis muscle. The second branch emerged 8 cm inferior to the coracoid process to innervate the biceps brachii muscle. The third branch to brachialis muscle emerged 13.9 cm inferior to the coracoid process. The last branch to the common belly of biceps brachii muscle emerged 19.6 cm inferior to the coracoid process. Two communications with the median nerve were observed. The proximal thick communicating branch had the direction from the MCN to the median nerve while the distal one was a small nerve bundle with a direction from the median nerve to the MCN. The present report provided evidence of multiple variations in one MCN which had not been reported previously. Anatomic variation in this case has clinical implications, considering that injury of the MCN in the upper part of arm would cause unexpected paralysis of flexor muscles of forearm and thenar muscle due to communications between this and median nerve. (Folia Morphol 2016; 75, 4: 555–559)

• Wydawca: -
• Czasopismo: Folia Morphologica
• Rocznik: 2016
• Tom: 75
• Numer: 4
• Opis fizyczny: p.555-559,fig.,ref.

Twórcy

autor

Chentanez V.

• Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand

autor

Jaruprat P.

• Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand

autor

Udomchaisaku P.

autor

Agthong S.

• Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand

autor

Huanmanop T.

• Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand

Bibliografia

• 1. Abu-Hijleh MF (2005) Three headed biceps brachii muscle associated with duplicated musculocutaneous nerve. Clin Anat, 18: 376–379.
• 2. Aydin ME, Kale A, Edizer M, Kopuz C, Demir MT, Çorumlu U (2006) Absence of the musculocutaneous nerve together with unusual innervation of the median nerve. Folia Morphol, 65: 228–231.
• 3. Ballesteros LE, Foreero PL, Buitrago ER (2015) Communication between the musculocutaneous and median nerves in the arm: an anatomical study and clinical implications. Rev Bras Ortop, 50: 567–572 doi: 10.1016/j.rboe.2014.08.009.
• 4. Bhanu PS, Sankar KD (2012) Bilateral absence of musculocutaneous nerve with unusual branching pattern of lateral cord and median nerve of brachial plexus. Anat Cell Biol, 45: 207–210.
• 5. Bhattarai C, Poudel PP (2009) Unusual variation in musculocutaneous nerves in Nepalese. Kathmandu Univ Med J, 28:408–410.
• 6. Chauhan R, Roy TS (2002) Communication between median and musculocutaneous nerve: a case report. J Anat Soc Ind, 51: 72–75.
• 7. Chiarapattanakom P, Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P (1998) Anatomy and internal topography of the musculocutaneous nerve: the nerve to the biceps and brachialis muscle. J Hand Surg Am, 23: 250–255.
• 8. Choi D, Rodriguez-Niedenführ M, Vázquez T, Parkin I, Sañudo JR (2002) Patterns of communications between the musculocutaneous and median nerves in the axilla and arm. Clin Anat, 15: 11–17.
• 9. Combon-Binder A, Leclercq C (2015) Anatomical study of the musculocutaneous nerve branching pattern: application for selective neurectomy in the treatment of elbow flexors spasticity. Surg Radiol Anat, 37: 341–348. doi: 10.1007/s00276-014-1371-x.
• 10. Fregnani JH, Macéa MI, Pereira CS, Barros MD, Macéa JR (2008) Absence of the musculocutaneous nerve: a rarebanatomical variation with possible clinical-surgical implication. Sao Paulo Med J, 126: 288–290.
• 11. Guerri-Guttenberg RA, Ingolotti M (2009) Classifying musculocutaneous nerve variations. Clin Anat, 22: 671–683.
• 12. Gumusburun E, Adiguzel E (2000) A variation of brachial plexus characterized by the absence of the musculocutaneous nerve: a case report. Surg Radiol Anat, 22: 63–65.
• 13. Iwata H (1960) Studies on the development of brachial plexus in Japanese embryo. Rep Dept Anat Mie Prefect Univ Sch Med, 13: 129–144.
• 14. Kaus M, Wotowicz Z (1995) Communication branch between the musculocutaneous and median nerve in human. Folia Morphol, 54: 273–277.
• 15. Kervancioglu P, Orhan M, Kilinc N (2011) Patterns of motor branching of the musculocutaneous nerve in human fetuses and clinical significance. Clin Anat, 24: 168–178.
• 16. Kirazli Ö, Tatarli N, Ceylan D, Hacioğlu H, Uygun S, Şeker A, Keleş E, Çavdar S (2013) A variation of the cords of the brachial plexus on the right and a communication between the musculocutaneous and median nerves on the left upper limb: a unique case. J Neurol Surg A Cent Eur Neurosurg, 74 (suppl. 1): e176–e179. doi: 1055/s-0032-1333416.
• 17. Kumar N, Guru A, D’Souza MR, Patil J, Nayak BS (2013) Incidences and clinical implications of communications between musculocutaneous nerve and median nerve in the arm-A cadaveric study. West Indian Med J, 62:744–747. doi: 107727/wimj2013.175.
• 18. Kwolczak-Mc Grath A, Kolesnik A, Ciszek B (2008) Anatomy of branches of the musculocutaneous nerve to the biceps and brachialis in human fetuses. Clin Anat, 21: 142–146.
• 19. Lee JH, Kim HW, Im S, An X, Lee MS, Lee UY, Han SH (2010) Localization of motor entry points and terminal intramuscular nerve endings of the musculocutaneous nerve to biceps and brachialis muscles. Surg Radiol Anat, 32: 213–220. doi: 10.1007/s00276-009-0561-4.
• 20. Maeda S, Kawai K, Koizumi M, Ide J, Tokiyoshi A, Mizuta H, Kodama K (2009) Morphological study of the communication between the musculocutaneous and median nerves. Anat Sci Int, 84: 34–40. doi: 10.1007/s125-12565-008-0005-y.
• 21. Miller RA (1932) Comparative studies upon the morphology and distribution of the brachial plexus. Am J Anat, 54: 143–166.
• 22. Nakatani T, Tanaka S, Mizukami S (1997) Absence of the musculocutaneous nerve with innervation of coracobrachialis, biceps brachii, brachialis and the lateral border of the forearm by branches from the lateral cord of the brachial plexus. J Anat, 191: 459–460.
• 23. Oberlin C, Béal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ (1994) Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of brachial plexus: anatomical study and report of four cases. J Hand Surg Am, 19: 232–237.
• 24. Pacha Vicente D, Forcada Calvet P, Carrera Burgaya A, Llusá Pérez M (2005) Innervation of biceps brachii and brachialis: anatomical and surgical approach. Clin Anat, 18: 186–194.
• 25. Pacholczyk R, Klimek-Piotrowska Walocha JA (2011) Absence of the Musculocutaneous nerve associated with a supernumerary head of biceps brachii: a case report. Surg Radiol Anat, 33: 551–554. doi: 10.1007/s00276-010-0771-9.
• 26. Parchand MP, Patil ST (2013) Absence of the musculocutaneous nerve with variations in course and distribution of the median nerve. Anat Sci. Int, 88: 58–60. doi: 10.1007/s12565-011-0126-6.
• 27. Pontell M, Scali F, Marshall E (2011) A unique variation in the course of the musculocutaneous nerve. Clin Anat, 24: 968–970.
• 28. Radunovic M, Vukasanovic-Bozaric A, Radojevic N, Vukadinovic T (2013) A new anatomical variation of the musculocutaneous nerve and the median nerve anastomosis. Folia Morphol, 72: 176–179. Doi: 10.5603/FM.2013.0030.
• 29. Sadler TW (2015) Langman’s medical embryology. 13th Ed. Wolter Kluwer Health, 166–167.
• 30. Saeed M, Rufai AA (2003) Median and musculocutaneous nerves; Variant formation and distribution. Clin Anat, 16: 453–457.
• 31. Song WC, Jung HS, Kim HJ, Shin C, Lee BY, Koh KS (2003) A variation of musculocutaneous nerve absent. Yonsei Med J, 44: 1110–1113.
• 32. Troupis Th, Michalinos A, Protogerou V, Mazarakis A, Skandalakis P (2015) Complex anatomic variation in the brachial region. Folia Morphol, 74: 118–121. doi: 10.5603/FM.2015.0015.
• 33. Venieratos D, Anagnostopoulou S (1998) Classification of communications between the musculocutaneous and median nerves. Clin Anat, 11: 327–331.
• 34. Yang ZX, Pho RWH, Kour AK, Med M, Pereira BP, Eng B (1995) The musculocutaneous nerve and its branches to the biceps and brachialis muscles. J Hand Surg Am, 20: 671–675.

Identyfikatory

DOI

10.5603/FM.a2016.0014