Unilateral Intercordal Neural Communication Coexistent with Variant Branching Pattern of Posterior Cord of Brachial Plexus

Abstract

Summary:Variant branching pattern of the cords of brachial plexus coupled with erroneous communications has been an area of concern for surgeons opting to explore this region. Anaesthetic blocks and surgical approaches are the highlights of these interventions, where a keen familiarization of the anatomy of this region is mandatory. The present case description reports a unilateral variant branching pattern of the posterior cord coexistent with a neural communication between lateral and medial cords in an adult male cadaver. This intercordal neural communication between lateral and medial cords was oriented obliquely and measured 2.2 cm in length. Furthermore, the posterior cord revealed a variant branching pattern. It branched into three upper subscapular nerves and a common trunk for the thoracodorsal and lower subscapular nerves. The lowest of the three upper subscapular nerves gave a communicating twig to the thoracodorsal nerve. Inspite of uncountable reports on variations of brachial plexus, descriptions regarding anomalous branching patterns hold enormous clinical significance for the radiologists, anesthetists and surgeons, besides being of academic interest for the anatomists.

Study of Variations in the Branching Pattern and Distance of Origin of Branches of Posterior Cord of Brachial Plexus

“…Baliyan R. et al studied that the posterior cord branched into three upper subscapular nerves and a common trunk for the thoracodorsal nerve and lower subscapular nerve [26].…”

Five Roots Pattern of Median Nerve Formation

“…The contact between these nerves and the differentiating mesodermal condensations is mandatory for accomplishing the functional differentiation. Any disturbance of coordination of these processes may result in variations in morphology of brachial plexus (4,16).…”

Multiple unilateral variations in medial and lateral cords of brachial plexus and their branches

“…The presence of intercordal neural communications bet ween medial and lateral cord of brachial plexus are uncommon [11]. Surgeons dealing with neoplasm or trauma repair need to be aware of these variations when they handle cases involving axillary artery and brachial plexus cords.…”