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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.
On the right upper limb, during laboratory dissection the low division of the common trunk of the musculocutaneous nerve and the lateral root of the median nerve, low fusion of two roots of the median nerve as well as accessory heads of the coracobrachialis and biceps brachii muscles were found. The axillary and brachial arteries showed abnormal course.
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