Distal Insertional Footprint of the Brachialis Muscle: 3D Morphometric Study

Kamineni, Srinath; Bachoura, Abdo; Behrens, William; Kamineni, Ellora P; Deane, Andrew S.

doi:10.1155/2015/786508

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…Here, the distal insertion of the brachialis muscle is considered as a precious and reproducible landmark, of particular relevance for surgeons not routinely dealing with medial elbow approaches, such as frequently occurs in traumatology departments. The ulnar insertion varies in shape between individuals, with an average length ranging between 21 and 44 mm across different studies [36,37]. The measurements of the brachialis insertion length we obtained fall between the ranges of previously published studies, confirming the reliability of this structure as a reproducible landmark.…”

Section: Discussionsupporting

confidence: 80%

Anatomic relations of the median nerve to the ulnar insertion of the brachialis muscle: safety issues and implications for medial approaches to the elbow joint

Cucchi

Luceri

Menon

et al. 2021

Arch Orthop Trauma Surg

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Introduction Preventing nerve injury is critical in elbow surgery. Distal extension of medial approaches, required for coronoid fracture fixation and graft-replacement, may endanger the median nerve. This study aims to describe an easily identifiable and reproducible anatomical landmark to localize the median nerve distal to the joint line and to delineate how its relative position changes with elbow flexion and forearm rotation. Materials and methods The median nerve and the ulnar insertion of the brachialis muscle were identified in eleven fresh-frozen cadaveric specimens after dissection over an extended medial approach. The elbow was brought first in full extension and then in 90° flexion, and the shortest distance between the two structures was measured while rotating the forearm in full pronation, neutral position and full supination. Results The distance between the median nerve and the brachialis insertion was highest with the elbow flexed and the forearm in neutral position. All distances measured in flexion were larger than those in extension, and all distances measured from the most proximal point of the brachialis insertion were larger than those from the most distal point. Distances in pronation and in supination were smaller than to those in neutral forearm position. Conclusions The ulnar insertion of the brachialis is a reliable landmark to localize and protect the median nerve at the level of the coronoid base. Elbow flexion and neutral forearm position increase significantly the safety margins between the two structures; this information suggests some modifications to the previously described medial elbow approaches. Level of evidence Basic Science Study.

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Section: Discussionsupporting

confidence: 80%

Anatomic relations of the median nerve to the ulnar insertion of the brachialis muscle: safety issues and implications for medial approaches to the elbow joint

Cucchi

Luceri

Menon

et al. 2021

Arch Orthop Trauma Surg

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“…Contrariwise to the current case, where all heads of the BM formed a common tendon and were inserted into the ulnar tuberosity. Kaminemi et al [10] in a detailed three-dimensional (3D) reconstruction study, identi ed the two-headed BM insertion into the ulnar tuberosity as a single structure, similar to the current case. Loukas et al [11] presented an accessory BM that crossed the brachial artery and the MN, and Kaliappan et al [9] described an accessory BM that descended distally to the forearm, fused with the pronator teres, and crossed the cubital fossa neurovascular bundle.…”

Section: Morphological Variability Of Brachialis Muscle (Bm)supporting

confidence: 65%

“…According to classical anatomy textbooks, the BM typically is a one-headed muscle, while some cadaveric studies have disputed this theory [8,10]. The BM seems to be divided into two heads, one super cial and one deep [1,18].…”

Section: Introductionmentioning

confidence: 99%

A bilateral four-headed brachialis muscle with variant innervation: a cadaveric report with possible clinical implications

PIAGKOU,

Triantafyllou,

Koutsougeras

et al. 2024

Preprint

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Purpose: Anterior compartment muscles of the arm present high morphological variability, with possible clinical significance. The current cadaveric report aims to describe a bilateral four-headed brachialis muscle (BM) with aberrant innervation. Analysis of the embryological background and possible clinical significance of the BM variant is also provided. Methods: Classical dissection of the upper limb was performed on an 84-year-old donated male cadaver. The cadaver belonged to the Anatomy Department of the National and Kapodistrian University of Athens. Results: On the left upper limb, the four-headed BM was supplied by the musculocutaneous and the median nerves after their interconnection. On the right upper limb, the four-headed BM received its innervation from the median nerve due to the musculocutaneous nerve absence. A bilateral muscular tunnel for the radial nerve passage was identified, between the BM accessory heads and the brachioradialis muscle. Conclusion: BM has clinical significance, due to its proximity to important neurovascular structures and frequent surgeries at the humerus. Hence, knowledge of these variants should keep orthopedic surgeons alert when intervening in this area.

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“…It lies beneath the biceps, originating along the distal aspect of the anterior humeral shaft and inserting distally on the ulnar tuberosity and the coronoid process by a short and large tendon. 25,26 For some authors, two heads of the brachialis (superficial and deep) can be distinguished. The brachialis muscle is innervated by the musculocutaneous nerves (C5 and C6).…”

Section: Brachialis Anatomymentioning

confidence: 99%

Biceps, Brachialis, and Triceps

Willaume

Bierry

2021

Semin Musculoskelet Radiol

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Tendon injuries at the elbow affect mostly the distal biceps and can progressively degenerate over time or rupture in an acute event. The degree of retraction may depend on the integrity of the lacertus fibrosus, a fibrous expansion that merges with the forearm flexor fascia. Biceps disorders are frequently associated with fluid or synovitis of the adjacent bicipital bursa; primary bursal disorders (primary inflammatory synovitis) can also be observed. Distal triceps is less frequently injured than the distal biceps, and tears usually manifest as distal ruptures with avulsion of a small flake of bone from the tip of the olecranon. Brachialis injuries are uncommon and the consequence of sudden muscle stretching during forced elbow hyperextension, as in posterior elbow luxation.

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Distal Insertional Footprint of the Brachialis Muscle: 3D Morphometric Study

Cited by 5 publications

References 10 publications

Anatomic relations of the median nerve to the ulnar insertion of the brachialis muscle: safety issues and implications for medial approaches to the elbow joint

Anatomic relations of the median nerve to the ulnar insertion of the brachialis muscle: safety issues and implications for medial approaches to the elbow joint

A bilateral four-headed brachialis muscle with variant innervation: a cadaveric report with possible clinical implications

Biceps, Brachialis, and Triceps

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