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Formation of median nerve without the medial root of medial cord and associated variations of the brachial plexus  [PDF]
Bhanu SP,Sankar DK,Susan PJ
International Journal of Anatomical Variations , 2010,
Abstract: The anatomical variations in the formation, course and termination of brachial plexus are well documented and have clinical significance to surgeons, neurologists and anatomists. The present case report describes the unusual origin of median nerve, arising directly from the lateral cord without the union of lateral and medial roots of brachial plexus. A communicating branch existed between the ulnar nerve and anterior division of middle trunk. The lateral pectoral nerve was arising from anterior divisions of upper and middle trunks as two separate branches instead from lateral cord. The branches then joined together to form the lateral pectoral nerve. The medial cord instead of its five terminal branches, had only three branches, the ulnar nerve, medial pectoral nerve and a single trunk for the medial cutaneous nerve of arm and forearm which got separated at the middle of the arm. The variations of the lateral cord and its branches make it a complicated clinical and surgical approach which is discussed with the developmental background.
Replacement of the medial and lateral cords of the brachial plexus by a common cord and its trifurcation into major branches
Shankar N,Veeramani R
International Journal of Anatomical Variations , 2010,
Abstract: During routine dissection of the brachial plexus of an elderly female cadaver of Indian origin, an unusual variation was noted on the left side. The roots and trunks were formed as routinely described in textbooks. The upper and lower trunks, each divided into anterior and posterior divisions. However, the middle trunk divided into two branches, an upper and lower, each of which gave an anterior and posterior division. The four anterior divisions so formed fused to form a common cord, which replaced the medial and lateral cords. This common cord was observed lateral to the 2nd part of the axillary artery and trifurcated to form the musculocutaneous, median and ulnar nerves. Associated with this variation were other less striking variations of the brachial plexus and the axillary artery. Such a variant cord and its relationship to the axillary artery needs to be kept in mind while performing surgeries in this region.
Two cord stage in the infraclavicular part of the brachial plexus
Jamuna M,Amudha G
International Journal of Anatomical Variations , 2010,
Abstract: Anatomical variations in the formation, course and distribution of brachial plexus are reported in the literature. We encountered a brachial plexus with two cords – anterior and posterior instead of lateral, medial and posterior cords which were present lateral to axillary artery during routine dissection of embalmed adult cadaver in the left upper limb. The anterior cord was giving off the branches of the lateral and medial cord. The posterior cord was giving off the radial and axillary nerves. The clinical significance and the embryological reasons are discussed.
MEDIAL BRACHIAL CUTANEOUS NERVE CONDUCTION VELOCITY: A DIAGNOSTIC METHOD FOR MEDIAL CORD LESIONS  [cached]
B TAVANA,R ROUSHAN PAZHOUH,F REZAEI MOGHADAM
Journal of Research in Medical Sciences , 2000,
Abstract: Introduction. Regarding to the absence of doccumented studies concerning medial brachial coetaneous nerve conduction, the present study was conducted to evaluate this parameter as a diagnostic method for injuries to medial cord and lower trunk of brachial plexus. Methods. The sensory nerve action potential of median, ulnar and medial antebrachial cutaneous nerves were recorded to show these roots (Cs-TV are intact. Then, the medial brachial cutaneous nerve was stimulated on the line that connects axilla to medial epicondyle (parallel with mid axillary line) at the junction site of coracobrachialis muscle to humerus recording was done 2 cm above the medial epicondyle (10 cm under stimulating site). Results. In all cases the wave was biphasic with primary negative phase. The latency was 2±0.3 ms-1 (range 1.4-2.6 ms-1) and the amplitude of SNAP was 30±10 mv (range 10-50 mV). The nerve conduction velocity was 61±4 ms-1 (range 53-69 ms-1). Discussion. With regard to the intensity and site of stimulation and recording area, this wave is not due to compound nerve action potential of median or ulnar nerve. This study may be useful in evaluation of T1 root and in differential diagnosis of medial cord and lower trunk lesions with ulnar and medial part of median nerve injuries.
Variations in branching of the posterior cord of brachial plexus in a Kenyan population
Johnstone M Muthoka, Simeon R Sinkeet, Swaleh H Shahbal, Ludia C Matakwa, Julius A Ogeng'o
Journal of Brachial Plexus and Peripheral Nerve Injury , 2011, DOI: 10.1186/1749-7221-6-1
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
Variation in the branching pattern of posterior cord of brachial plexus  [PDF]
Bhat KMR,Girijavallabhan V
Neuroanatomy , 2008,
Abstract: During the routine dissection in the department of Anatomy, KMC, Manipal, we found a rare and unreportedvariation in the branching pattern of the posterior cord of brachial plexus. Normally, a single posterior cord isformed by the union of posterior divisions of the trunks of the brachial plexus. All the branches of the posteriorcord arise from this single cord. Here we report that, after formation of posterior cord, the cord has dividedagain into two roots, and enclosed the subscapular artery. Then, these two roots fused to continue as radialnerve. In this report, we also describe the variations in the branching pattern of the posterior cord and clinicalrelevance of this variation.
Bilateral Presence of Axillary Arch Muscle Passing Through the Posterior Cord of the Brachial Plexus
Pillay,Minnie; Jacob,Suja Mary;
International Journal of Morphology , 2009, DOI: 10.4067/S0717-95022009000400015
Abstract: the axillary arch can be described as an anomalous muscular slip of latissimus dorsi muscle. in this paper, a rare case of bilateral axillary arch is reported during routine dissection of the axillary region of a 57-year old male cadaver. on both sides, the axillary arch muscle took origin from latissimus dorsi and teres major, and passed upwards through the posterior cord of the brachial plexus, but posterior to the bulk of axillary neurovascular bundle. it then split into two slips: the medial slip was inserted into the root of the coracoid process, while the lateral slip which was intracapsular, was attached to the lesser tubercle, above the attachment of subscapularis. the presence of the muscle has important clinical implications, and the position, bilateral presence, penetration of the posterior cord, and multiple connective tissue attachments makes the case most unique. the anatomy, surgical implications, and embryology of the anomalous muscle are discussed in this paper.
A rare variation in the mode of termination of posterior cord of brachial plexus
Jamuna M
International Journal of Anatomical Variations , 2010,
Abstract: Anatomical variations in the formation of brachial plexus and its terminal branches have been reported in the literature. During the routine dissection of embalmed adult cadavers in the Institute of Anatomy, MMC, Madurai, a rare variation in the mode of termination of the posterior cord of the brachial plexus was noted. The posterior cord was terminating into two divisions, and the radial nerve was formed by the union of those divisions and the axillary nerve was arising from one of those divisions. The clinical implications of this variation are discussed.
Brachial Plexus Injuries in Adults: Evaluation and Diagnostic Approach  [PDF]
Vasileios I. Sakellariou,Nikolaos K. Badilas,George A. Mazis,Nikolaos A. Stavropoulos,Helias K. Kotoulas,Stamatios Kyriakopoulos,Ioannis Tagkalegkas,Ioannis P. Sofianos
ISRN Orthopedics , 2014, DOI: 10.1155/2014/726103
Abstract: The increased incidence of motor vehicle accidents during the past century has been associated with a significant increase in brachial plexus injuries. New imaging studies are currently available for the evaluation of brachial plexus injuries. Myelography, CT myelography, and magnetic resonance imaging (MRI) are indicated in the evaluation of brachial plexus. Moreover, a series of specialized electrodiagnostic and nerve conduction studies in association with the clinical findings during the neurologic examination can provide information regarding the location of the lesion, the severity of trauma, and expected clinical outcome. Improvements in diagnostic approaches and microsurgical techniques have dramatically changed the prognosis and functional outcome of these types of injuries. 1. Introduction Brachial plexus is a complex network of nerves, which is responsible for the innervation of the upper extremity. It is formed in the posterior cervical triangle by the union of ventral rami of 5th, 6th, 7th, and 8th cervical nerve roots and 1st thoracic nerve root. This composite nerve network can be divided into roots, trunks, divisions, and cords. The roots, trunks, and divisions lie in the posterior triangle of the neck, whereas the cords lie in the axillary fossa. Cords are further divided in the major nerve branches of the upper extremity [1] (Figure 1). Figure 1: Classic form of brachial plexus. Roots and trunks lie in the supraclavicular space; the divisions are located posterior to the clavicle, while cords and branches lie infraclavicularly [2]. Branches that arise from different portions of brachial plexus are shown in the following figure (Figure 2). Figure 2: Roots, trunks, divisions, cords, and terminal branches of brachial plexus. All three cords of the plexus lie above and laterally to the medial portion of axillary artery. Medial cord crosses the artery, passing inferiorly, to reach the medial surface of the middle portion of the artery. Posterior cord is located behind the middle portion of the artery and lateral cord lies laterally to the middle portion of the artery. The names of the cords of brachial plexus imply their relationship to the middle portion of the axillary artery (Figure 3). Figure 3: Relationships of brachial plexus and its portions of the axillary artery. Anatomic variants of brachial plexus are observed in more than 50% of the cases [3]. Most common variants are associated with the contribution of C4 (prefixed) or with the contribution of T2 nerve root to the plexus (postfixed) (Figure 4). It is estimated that C4 nerve root
Posterior Cord of Brachial Plexus and Its Branches: Anatomical Variations and Clinical Implication  [PDF]
Rakhi Rastogi,Virendra Budhiraja,Kshitij Bansal
ISRN Anatomy , 2013, DOI: 10.5402/2013/501813
Abstract: Background. Knowledge of anatomical variations of posterior cord and its branches is important not only for the administration of anaesthetic blocks but also for surgical approaches to the neck, axilla, and upper arm. The present study aimed to record the prevalence of such variations with embryological explanation and clinical implication. Material and Method. 37 formalin-preserved cadavers, that is, 74 upper extremities from the Indian population, constituted the material for the study. Cadavers were dissected during routine anatomy classes for medical undergraduate. Dissection includes surgical incision in the axilla, followed by retraction of various muscles, to observe and record the formation and branching pattern of posterior cord of brachial plexus. Results. Posterior cord was formed by union of posterior division of C5 and C6 roots with posterior division of middle and lower trunk (there was no upper trunk) in 16.2% of upper extremities. Posterior cord of brachial plexus was present lateral to the second part of axillary artery in 18.9% of upper extremities. Axillary nerve was taking origin from posterior division of upper trunk in 10.8% upper extremities and thoracodorsal nerve arising from axillary nerve in 22.9% upper extremities. Conclusion. It is important to be aware of such variations while planning a surgery in the region of axilla as these nerves are more liable to be injured during surgical procedures. 1. Introduction Posterior cord of brachial plexus is formed by union of posterior division of upper, middle, and lower trunk of brachial plexus. It lies posterior to, second part of axillary artery. The posterior cord of brachial plexus after giving upper subscapular, thoracodorsal, lower subscapular, and axillary nerve in the axilla continues distally as the radial nerve [1]. Knowledge of the variations of posterior cord and its branches is important for the administration of anaesthetic blocks, surgical approaches to the neck, axilla, and upper arm [2, 3]. The present study describes the variations of posterior cord observed in population from central India. 2. Material and Method The formalin-fixed 37 cadavers, that is, 74 upper extremities constitute the material for study. During routine dissection of axilla and supraclavicular region of medical undergraduates in L.N. Medical College Bhopal, the skin and various muscles were reflected and superficial fascia and deep fascia were separated to visualize the formation and branching pattern of posterior cord. 3. Results We recorded variations in the formation, location, and branching
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