A Study of Upper Limb Muscle Anomalies and Their Effects on the Neurovascular Structures

Abstract

Background: Variations in the morphology of the upper limb muscles are not uncommon. These variant muscles may compress the adjacent neurovascular structures by their anomalous positions. The knowledge of supernumerary heads of biceps brachii, variant bicipital aponeurosis and an abnormal tendinous insertion of coracobrachialis may cause clinical conditions like median nerve entrapment, compression of brachial artery, pronator syndrome etc. Materials and Methods: The present study was undertaken to observe the anomalous origin and insertion of upper limb muscles and their relation to neurovascular structures in vicinity. This study was carried out in 60 upper limbs of 30 formalin fixed human cadavers in the Department of Anatomy, KAPV Government Medical College, Trichy. Results: Among the sixty upper limbs, variations were found in three separate limbs. The variations included an accessory head of biceps brachii, a muscular slip from the bicipital aponeurosis which gave extensions to the forearm muscles and an anomalous origin and tendinous extension of coracobrachialis muscle to the medial epicondyle of humerus. Conclusion: Knowledge of supernumerary heads of biceps brachii, accessory slips from bicipital aponeurosis and anomalous origin and insertion of coracobrachialis is essential in preoperative diagnosis and surgery of upper limbs, as they may cause compression of neurovascular structures like brachial artery, median nerve and ulnar nerve.

Accessory heads of the biceps brachii muscle: A systematic review and meta‐analysis

“…The side distribution was sufficiently described in 51 studies (5877 upper limbs) (Agarwal & Gopal, 2020; Al‐Kushi, 2013; Asvat et al, 1993; Avadhani & Chakravarthi, 2012; Bagoji et al, 2014; Ballesteros et al, 2014; Bharambe et al, 2015; Chandrupatla & Sultana, 2016; Chauhan, 2010; Cheema & Singla, 2011; Chitra & Kalaiyarasi, 2016; da Silva, 2016; Duran & Arquez, 2016; Gindha et al, 2015; Guerrero et al, 2018; Gupta & D'Souza, 2014; Gupta et al, 2020; Kervancioglu & Orhan, 2011; Khaledpour, 1985; Kopuz et al, 1999; Kosugi et al, 1992; Kudo & Bando, 1965; Kumar et al, 2008; Kumar et al, 2012; Kumar & Baidya, 2018; Lingaswamy et al, 2015; Manoj et al, 2012; Mantraratnam & Bhattam, 2016; Morampuri et al, 2015; Nalluri et al, 2016; Nasr & Hussein, 2013; Nayak et al, 2006; Patel et al, 2016; Pathak et al, 2016; Poudel & Bhattarai, 2009; Radhika et al, 2017; Rai et al, 2007; Ravi et al, 2020; Rodriguez‐Niedenführ et al, 2003; Salve et al, 2013; Sandeep et al, 2012; Sato, 1969; Schwalbe & Pfitzner, 1894; Sthapak et al, 2016; Sugavasi et al, 2015; Suhani et al, 2013; Tenchini, 1879; Ughade et al, 2012; Varlekar et al, 2011; Verma & Sakthivel, 2019; Wahengbam et al, 2015; Zlabek, 1933). The accessory heads occur on the right side with an overall prevalence of 3.4% (95% CI 2–4%), and 3.2% (95% CI 2–4%) on the left side (Table…”

“…The accessory heads express a wide spectrum of possible origins. A total of 69 studies (9054 upper limbs) provided detailed description of the various origin sites (Adachi, 1909; Agarwal & Gopal, 2020; Al‐Kushi, 2013; Asvat et al, 1993; Avadhani & Chakravarthi, 2012; Bagoji et al, 2014; Ballesteros et al, 2014; Bharambe et al, 2015; Chandrupatla & Sultana, 2016; Chauhan, 2010; Cheema & Singla, 2011; Chitra & Kalaiyarasi, 2016; Cucca et al, 2010; da Silva, 2016; da Silva Leal, 1926; Duran & Arquez, 2016; Gheno et al, 2010; Gindha et al, 2015; Greig et al, 1952; Guerrero et al, 2018; Gupta & D'Souza, 2014; Gupta et al, 2020; Ilayperuma et al, 2011; Kervancioglu & Orhan, 2011; Khaledpour, 1985; Kopuz et al, 1999; Kosugi et al, 1992; Kumar et al, 2008; Kumar et al, 2012; Kumar & Baidya, 2018; Le Double, 1897; Lee, 2013; Lingaswamy et al, 2015; Manoj et al, 2012; Mantraratnam & Bhattam, 2016; Morampuri et al, 2015; Mori, 1964; Nalluri et al, 2016; Nasr & Hussein, 2013; Nayak et al, 2006; Neto et al, 1998; Patel et al, 2016; Pathak et al, 2016; Poudel & Bhattarai, 2009; Radhika et al, 2017; Rai et al, 2007; Ravi et al, 2020; Rincon et al, 2002; Rodriguez‐Niedenführ et al, 2003; Ruiz et al, 2017; Salve et al, 2013; Sandeep et al, 2012; Sato, 1969; Sawant et al, 2012; Schwerdtf...…”

“…Proportional analysis was performed with the use of 36 studies (628 upper limbs with the accessory head of the biceps brachii muscle) (Al‐Kushi, 2013; Asvat et al, 1993; Chandrupatla & Sultana, 2016; Cheema & Singla, 2011; Chitra & Kalaiyarasi, 2016; da Silva Leal, 1926; Duran & Arquez, 2016; Gindha et al, 2015; Gupta & D'Souza, 2014; Ilayperuma et al, 2011; Kervancioglu & Orhan, 2011; Koganei et al, 1903; Koizumi, 1934; Kopuz et al, 1999; Kosugi et al, 1992; Kumar et al, 2008; Kumar & Baidya, 2018; Le Double, 1897; Lee, 2013; Nasr & Hussein, 2013; Nayak et al, 2006; Poudel & Bhattarai, 2009; Rai et al, 2007; Rodriguez‐Niedenführ et al, 2003; Salve et al, 2013; Sato, 1969; Sawant et al, 2012; Schwalbe & Pfitzner, 1894; Schwerdtfeger et al, 2018; Shalini & Anupama, 2013; Techataweewan et al, 2016; Ughade et al, 2012; Varlekar et al, 2011; Verma & Sakthivel, 2019; Wahengbam et al, 2015; Wood, 1868). The number of studies is higher than in the overall gender prevalence analysis because several studies had to be excluded from the overall investigation since the gender of the cohort was not mentioned in the material and methods section and the gender was reported only in the results section in relation to the findings so that the overall male to female ratio could not be obtained for the prevalence investigation.…”

“…Further analysis of 46 studies (4782 upper limbs) showed that accessory heads are found more frequently unilaterally (4.4%; 96% CI 3–6%) than bilaterally (2.6%; 95% CI 2–3%) (Al‐Kushi, 2013; Asvat et al, 1993; Avadhani & Chakravarthi, 2012; Bagoji et al, 2014; Ballesteros et al, 2014; Chandrupatla & Sultana, 2016; Chauhan, 2010; Cheema & Singla, 2011; Chitra & Kalaiyarasi, 2016; da Silva, 2016; da Silva Leal, 1926; Duran & Arquez, 2016; Gindha et al, 2015; Guerrero et al, 2018; Gupta & D'Souza, 2014; Gupta et al, 2020; Kervancioglu & Orhan, 2011; Kopuz et al, 1999; Kosugi et al, 1992; Kumar et al, 2008; Kumar et al, 2012; Kumar & Baidya, 2018; Le Double, 1897; Lingaswamy et al, 2015; Manoj et al, 2012; Mantraratnam & Bhattam, 2016; Morampuri et al, 2015; Nalluri et al, 2016; Nayak et al, 2006; Patel et al, 2016; Pathak et al, 2016; Poudel & Bhattarai, 2009; Radhika et al, 2017; Ravi et al, 2020; Salve et al, 2013; Sandeep et al, 2012; Sawant et al, 2012; Schwerdtfeger et al, 2018; Shalini & Anupama, 2013; Sthapak et al, 2016; Sugavasi et al, 2015; Suhani et al, 2013; Techataweewan et al, 2016; Ughade et al, 2012; Varlekar et al, 2011; Wahengbam et al, 2015). Detailed results are shown in Table 3.…”

“…A total of 42 studies (271 upper limbs with accessory heads) reported data on the innervation of the accessory heads of the biceps brachii muscle (Agarwal & Gopal, 2020; Al‐Kushi, 2013; Asvat et al, 1993; Ballesteros et al, 2014; Bharambe et al, 2015; Chandrupatla & Sultana, 2016; Chauhan, 2010; Cheema & Singla, 2011; Chitra & Kalaiyarasi, 2016; Duran & Arquez, 2016; Gindha et al, 2015; Gupta et al, 2020; Ilayperuma et al, 2011; Kervancioglu & Orhan, 2011; Kumar et al, 2008; Kumar et al, 2012; Kumar & Baidya, 2018; Lee, 2013; Lingaswamy et al, 2015; Manoj et al, 2012; Mantraratnam & Bhattam, 2016; Morampuri et al, 2015; Nalluri et al, 2016; Nayak et al, 2006; Patel et al, 2016; Pathak et al, 2016; Poudel & Bhattarai, 2009; Ravi et al, 2020; Rincon et al, 2002; Rodriguez‐Niedenführ et al, 2003; Ruiz et al, 2017; Salve et al, 2013; Sawant et al, 2012; Schwerdtfeger et al, 2018; Sthapak et al, 2016; Sugavasi et al, 2015; Suhani et al, 2013; Tenchini, 1879; Ughade et al, 2012; Varlekar et al, 2011; Verma & Sakthivel, 2019; Wahengbam et al, 2015). The accessory head most commonly receives innervation from the musculocutaneous nerve (94.4%; 95% CI 89–99%).…”