Relation of Median Nerve With Brachial Artery: A Cadaveric Study

Abstract

Introduction: Variation in neurovascular structure are commonly encountered in routine dissection. Brachial artery is the main artery of upper limb. In the arm, the median nerve passes at first lateral to brachial artery (near the insertion of coracobrachialis muscle), then crosses in front of the artery, descending medial to it in the cubital fossa. The knowledge of these variation could be helpful to vascular, plastic, general surgeons and orthopedicians. It is also important to prevent iatrogenic injuries. The aim of this study was to evaluate anatomical variations in course and relation of median nerve to brachial artery in the arm. Material & Methods: The study was conducted in 50 cadavers (100 upper limbs) in duration of two years. Proper cadaveric dissection was done in the Department of Anatomy, Dr. RML Institute of Medical Sciences, Lucknow, and Era’s Lucknow Medical College, Lucknow. Observation & Results: In the present series, median nerve was found to cross behind the brachial artery at about the middle of the arm in 8% cadavers. Median nerve entered the arm at first lateral to brachial artery, near the insertion of coracobrachialis. In 46 cadavers (96 upper limbs), it crossed in front of the artery from lateral to medial side. In four cadavers (5 upper limbs), it passed posterior to the brachial artery in the arm. Conclusion: Knowledge of the brachial artery and their variations are of clinical and surgical importance. An awareness of such a presence is valuable for the surgeons and radiologists in evaluation of angiographic images, vascular and re-constructive surgery or appropriate treatment for compressive neuropathies.

Variation of the brachial artery emerging through an opening in the median nerve: a case report

“…The variation described in this report is unique because the MN is penetrated by the BA, which features normal formation and branching. Additional variations of the arm include the MN crossing posterior to the BA [9]. The observed variant, as well as other variations described in this report, may lead to several clinical implications.…”

Ultrasonographic evaluation of the median nerve: normal and variant anatomy and appearance

“…In most cases (92%), at the level of insertion of the coracobrachialis muscle (anteriomedial surface of humerus distal to lesser tubercle) the median nerve crosses the brachial artery in front from the lateral to medial sides. In some cases, the median nerve can cross the brachial artery posteriorly (6) . Type III or transligamentous (about 25%) where the recurrent branch divides in the carpal tunnel and crosses the flexor retinaculum.…”