Bilateral variations of brachial plexus involving the median nerve and lateral cord: An anatomical case study with clinical implications

Butz, James J; Shiwlochan, Devina; Brown, Kevin C.; Prasad, AM; Murlimanju, B. V.; Viswanath, Srikanteswara

doi:10.21767/amj.2014.2070

Cited by 5 publications

(6 citation statements)

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“…The brachial plexus has been known to exhibit variation from the typical pattern, with many anomalies that have been previously described [1][2][3][4]. The prosected anatomical donor discussed here was found to have an atypical branching pattern not noted in the literature.…”

Section: Introductionmentioning

confidence: 62%

“…This seems to be a fairly typical anomaly [1]. In another instance, the lateral cord pierced the coracobrachialis muscle, and the lateral root of the median nerve branched below the attachment of the coracobrachialis on the scapula [2]. There are also cases in which the median nerve is only derived from the medial cord rather than from the medial and lateral cords [2].…”

Section: Discussionmentioning

confidence: 98%

“…In another instance, the lateral cord pierced the coracobrachialis muscle, and the lateral root of the median nerve branched below the attachment of the coracobrachialis on the scapula [2]. There are also cases in which the median nerve is only derived from the medial cord rather than from the medial and lateral cords [2]. Finally, there are several cases in which the brachial plexus receives little to no input from T1 but has contributions from C4 (so-called 'pre-fixed') (25.5% of cases investigated) or receives little to no input from C5 but has contributions from T2 ('post-fixed') (2.5% of cases investigated) [4].…”

Section: Discussionmentioning

confidence: 99%

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A Case Report on Brachial Plexus Anomaly, Embryological Basis, and Clinical Implications

Nichols,

Patel,

Geske

et al. 2023

Cureus

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This study presents the routine prosection findings of a 74-year-old male anatomical donor, whose cause of death was attributed to anoxic brain injury secondary to cardiac arrest and acute exacerbation of chronic obstructive pulmonary disease (COPD). The patient exhibited a significant medical history, including severe COPD, chronic heart failure, atrial fibrillation, hypertension, stage III chronic kidney disease, heavy alcohol abuse, obesity, coronary artery disease, peripheral edema, triple bypass surgery, and right hip replacement. A detailed examination of the upper extremities revealed anomalies within the brachial plexus, with a more pronounced presence on the left side. This particular donor deviates from the expected "typical" brachial plexus anatomy, with a lack of convergence into a lateral cord and an anomalous convergence into a superior trunk. To ensure optimal patient care and procedural outcomes, a collaborative approach between surgeons and anesthesiologists that is grounded in a comprehensive understanding of these anatomical nuances is essential. Therefore, this study aims to comprehensively investigate the identified brachial plexus anomalies, elucidate their embryological origins, and explore their clinical implications. Through these objectives, this research contributes to a broader understanding of anatomical variations and their relevance in medical practice.

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Section: Introductionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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A Case Report on Brachial Plexus Anomaly, Embryological Basis, and Clinical Implications

Nichols,

Patel,

Geske

et al. 2023

Cureus

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“…Henceforth awareness regarding the brachial nerves piercing the coracobrachialis is essential, to avoid inadvertent damage. 16 Restoration of elbow flexion is of surgical importance in patients with traumatic brachial plexus injuries. Therapeutic nerve grafting procedures results in successful outcomes, for restoring plexus injuries.…”

Section: Discussionmentioning

confidence: 99%

Bilateral cadaveric variations of musculocutaneous nerve and median nerve in the anterior brachium: a case report

Periyasamy,

Kishore,

Ramachandra

2024

Int J Res Med Sci

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Formation of the brachial plexus is by the union of ventral rami of C5-T1 spinal nerves. The musculocutaneous nerve is a continuation of the lateral cord, pierces the coracobrachialis and supplies the flexor compartment of the arm. Our case report presents a unique bilateral cadaveric variation in the musculocutaneous nerve and median nerve branching patterns, in the flexor compartment of the arm. A case report of bilateral variations of musculocutaneous nerve and median nerve (R-Right, L-Left) was found during the routine dissection in the Department of Anatomy, Shridevi Institute of Medical Sciences and Research Hospital, Tumakuru. From the right lateral cord, separation of few nerve fibres forming the lateral root of the median nerve was appreciated. The lateral root joins the medial root of the medial cord, after emerging out of the ulnar nerve and forms the initial segment of median nerve. Before the union of lateral and medial roots of initial segment of median nerve, ulnar nerve, medial cutaneous nerve of arm and medial cutaneous nerve of forearm descends along the medial aspect of the right arm. From the left lateral cord musculocutaneous nerve pierces the coracobrachialis. Before piercing the muscle, it gives one vascular branch and a motor branch. After piercing, the musculocutaneous nerve runs downwards and gives a motor branch to left biceps brachii. Variations of brachial plexus are frequently subjected to compression neuropathy. During surgical approaches to the brachium region, awareness about the anatomical variations of lateral and medial cords is mandatory for diagnosing the peripheral nerve entrapment syndrome. An integrated understanding of these branches prevent iatrogenic injuries during surgical procedures.

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“…Median nerve is most frequently formed by two roots: Single lateral root from the lateral cord and single medial root from the medial cord, which unite anterior or lateral to the axillary artery. 1 Abhaya et al 5 and Butz et al 6 reported cases of lateral cord of median nerve piercing the coracobrachialis muscle before its bifurcation into musculocutaneous and LRMN. However, they did not describe the course of two terminal branches of lateral cord within the muscle.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Variation of Lateral Root of Median Nerve traversing through Coracobrachialis Muscle

Sahni¹,

Gupta²,

Aggarwal³

et al. 2016

Journal of Postgraduate Medicine, Education and Research

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An unusual bilateral variation of lateral root of median nerve piercing through coracobrachialis muscle is presented. Two nerve filaments to coracobrachialis muscle took unusual origin from medial cord, which crossed the axillary artery from medial to lateral side before entering the muscle. Variation of lateral root of median nerve may be clinically significant, as hitherto unreported entrapment neuropathy of median nerve along with musculocutaneous may occur at the arm level while passing through coracobrachialis muscle or it may be injured during any surgical intervention around shoulder joint. Nerves to coracobrachialis are at risk during unusual abduction of arm or surgical manipulation of axillary artery. How to cite this article Aggarwal A, Gupta T, Aggarwal A, Sahni D. Bilateral Variation of Lateral Root of Median Nerve traversing through Coracobrachialis Muscle. J Postgrad Med Edu Res 2016;50(3):159-161.

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Bilateral variations of brachial plexus involving the median nerve and lateral cord: An anatomical case study with clinical implications

Cited by 5 publications

References 0 publications

A Case Report on Brachial Plexus Anomaly, Embryological Basis, and Clinical Implications

A Case Report on Brachial Plexus Anomaly, Embryological Basis, and Clinical Implications

Bilateral cadaveric variations of musculocutaneous nerve and median nerve in the anterior brachium: a case report

Bilateral Variation of Lateral Root of Median Nerve traversing through Coracobrachialis Muscle

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