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Since the significance of a superficial subscapular artery was reported by Yamada [22], macroscopic anatomical studies of axillary artery morphogenesis have been conducted by many authors. Notably, Japanese anatomists have reported important and groundbreaking theories on the morphogenesis of normal and aberrant axillary arteries. These include a description of the superficial brachial artery (BS) and Adachi’s brachial plexus (AxC) by Chiba [6–7], the possible routes of the axillary artery by Aizawa et al. [3] and the morphological significance of the inferior pectoral artery (Pi) by Kodama et al. [16] and the deep axillary artery by Honma et al. [10, 11]. We have also identified 11 BS among 322 sides of 161 adult human cadavers. We traced the BS with the AxC in 1 case, the development of a superficial subscapular artery in 3 cases, the development of a Pi in 3 cases, an unclear situation in 3 cases and a lateral median superficial brachial artery (BSML) in 1 case. Moreover, we carried out a fibre analysis of the BSML in order to understand the morphology more completely. Our findings are discussed herein. We have therefore described our cases and compare them with references, presenting gross anatomical data on their morphogenesis in an effort to unify experimental embryological data.
Anomalies of the brachial plexus have previously been described in the literature. The coracobrachialis muscle is typically innervated by the musculocutaneous nerve. During a gross anatomy dissection we found that the coracobrachialis muscle was innervated by a branch from the lateral root of the median nerve. Knowledge of the anatomical variations of the peripheral nervous system is important in interpreting unusual clinical presentations. This report will assist clinicians and surgeons by pointing out anatomical anomalies associated with the musculocutaneous nerve, the median nerve and their branches to the anterior compartment muscles of the upper arm.
During dissection of the brachial plexus variations have frequently been observed in the formation and further ramification of the cords to form the musculocutaneous and median nerves (MCN and MN). The present study was undertaken to localise the connections (the communication pattern) of the MN and the MCN with respect to the point of entrance of the MCN to the coracobrachialis muscle. A total of 129 formalin-fixed cadavers were dissected for this purpose. For simplicity we classified the communication patterns as Types I, II, III and IV. In 82 (63.5%) of 129 cadavers 119 communications were found to be present. We were able to identify 4 different patterns of communication. Type I (54 communications, 45%): the communications were proximal to the point of entry of the MCN into the coracobrachialis, Type II (42 communications, 35%): the communications were distal to the point of entry of the MCN into the coracobrachialis, Type III (11 communications, 9%): the MCN did not pierce the coracobrachialis and Type IV (9 communications, 8%): the communications were proximal to the point of entry of the MCN into the coracobrachialis and additional communication took place distally. Precise knowledge of variations in MCN and MN communications may prove valuable in traumatology of the shoulder joint, as well as in plastic and reconstructive repair operations.
The aim of our study is to present a very rare accessory middle scalene muscle, leading to thoracic outlet syndrome. In particular, a muscular bundle was discovered on a male cadaver connecting the middle portion of the middle scalene muscle with the anterior scalene muscle insertion to Lisfranc’s tubercle. This triangular accessory muscle and, especially, its sharp medial border compressed the middle and lower trunk of the brachial plexus and the subclavian artery. This anomaly is of great importance because it emphasises the fact that it is not primarily the anterior scalene muscle that produces symptoms of thoracic outlet syndrome but the anterior displacement of the middle scalene muscle or its accessory muscular bands. We also present the relative international literature and the clinical significance of our finding.
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