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Variations in branching of the posterior cord of brachial plexus in a Kenyan population

DOI: 10.1186/1749-7221-6-1

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Abstract:

To describe the branching pattern of the posterior cord in a Kenyan population.Seventy-five brachial plexuses from 68 formalin fixed cadavers were explored by gross dissection. Origin and order of branching of the posterior cord was recorded. Representative photographs were then taken using a digital camera (Sony Cybershot R, W200, 7.2 Megapixels).Only 8 out of 75 (10.7%) posterior cords showed the classical branching pattern. Forty three (57.3%) lower subscapular, 8(10.3%) thoracodorsal and 8(10.3%) upper subscapular nerves came from the axillary nerve instead of directly from posterior cord. A new finding was that in 4(5.3%) and in 3(4%) the medial cutaneous nerves of the arm and forearm respectively originated from the posterior cord in contrast to their usual origin from the medial cord.Majority of posterior cords in studied population display a wide range of variations. Anesthesiologists administering local anesthetic blocks, clinicians interpreting effects of nerve injuries of the upper limb and surgeons operating in the axilla should be aware of these patterns to avoid inadvertent injury. A wider study of the branching pattern of infraclavicular brachial plexus is recommended.The posterior cord of the brachial plexus usually gives upper subscapular, thoracodorsal, lower subscapular and axillary nerves in the axilla, continuing distally as the radial nerve [1]. Variations from this classical branching pattern differ in prevalence between populations [2-4]. In clinical practice, injuries to branches of the posterior cord are common and associated with each other [5]. Knowledge of possible variations may help in the management of such injuries. Further, understanding of the variations is valuable in the administration of anaesthetic blocks [4,6], surgical approaches to the neck, axilla and upper arm, interpretation of nervous compressions by tumours or aneurysms [4] and use of the subscapular branches in neurotization procedures for repair of plexus injuries due

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