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Anatomical variation of median nerve: cadaveric study in brachial plexus

  • 투고 : 2022.02.03
  • 심사 : 2022.03.17
  • 발행 : 2022.06.30

초록

Median nerve is formed by lateral root from lateral cord and medial root from medial cord of brachial plexus. Formation of median nerve occur in front or lateral to axillary artery in axilla. In the present study we observed anatomical variations of median nerve formation in the brachial plexus. We examined formalin fixed 60 upper limbs from 30 adult cadavers (15 males and 15 females) which were above the age 40 years from the department of Anatomy. All the cadavers were dissected on both sides according to Cunningham's Manual of Practical Anatomy. Normal formation of median nerve by two roots noted in 42 (70.0%) of upper limb specimen. Variation of median nerve formation noted in 18 (30.0%) upper limb specimen. Three roots taking part in the formation of median nerve in 13 (21.7%) upper limb specimen where additional root coming from lateral cord of brachial plexus. Four roots taking part in formation of median nerve in 3 (5.0%) upper limb specimen, where additional roots coming from lateral cord and posterior cord of brachial plexus. Lateral root crossed the axillary artery anteriorly to join with medial root lying medial to axillary artery. The median nerve formed medial to third part of axillary artery. Additional communication with musculocutaneous nerve with median nerve seen in 2 (3.3%) upper limb specimen. Knowledge of such anatomical variations is of interest to the anatomist and clinician alike. Surgeons who perform procedures involving neoplasm or repairing trauma need to be aware of these variations. Median nerve variation may lead to confusions in surgical procedures and axillary brachial plexus nerve block anesthesia.

키워드

과제정보

The authors wish to thankfully acknowledge the technician support received from the department of Anatomy to carry out the work.

참고문헌

  1. Ghosh B, Parashar V, Gaur N, Thakur B, Yadav S. Variation in median nerve formation associated with anomalous higher origin of profunda brachi artery. Int J Recent Sci Res 2015;6:5654-6.
  2. Datta AK. Essentials of human anatomy. Vol 3. 5th ed. Kolkata: Current Books International; 2017. p. 41.
  3. Standring S. Gray's anatomy: the anatomical basis of clinical practice. 41st ed. Philadelphia: Elsevier; 2016. p. 781-3.
  4. Taams KO. Martin-Gruber connections in South Africa. An anatomical study. J Hand Surg Br 1997;22:328-30. https://doi.org/10.1016/S0266-7681(97)80396-8
  5. Drake RL, Vogl W, Mitchell AWM. Gray's anatomy for students. Philadelphia: Elsevier/Churchill Livingstone; 2005. p. 661-3.
  6. Vollala VR, Raghunathan D, Rodrigues V. Nerve compressions in upper limb: a case report. Neuroanatomy 2005;4:35-6.
  7. Gacek RR. Neck dissection injury of a brachial plexus anatomical variant. Arch Otolaryngol Head Neck Surg 1990;116:356-8. https://doi.org/10.1001/archotol.1990.01870030120023
  8. Romanes GJ. Cunningham's manual of practical anatomy. Volume 1. Upper and lower limbs. 15th ed. Oxford: Oxford University Press; 1986. p. 28-30.
  9. Gupta M, Goyal N, Harjeet. Anomalous communications in the branches of brachial plexus. J Anat Soc India 2005;54:22-5.
  10. Budhiraja V, Rastogi R, Asthana AK. Anatomical variations of median nerve formation: embryological and clinical correlation. J Morphol Sci 2011;28:283-6.
  11. Nayak S. Absence of musculocutaneous nerve associated with clinically important variations in the formation, course and distribution of the median nerve- a case report. Neuroanatomy 2007;6:49-50.
  12. Uzun A, Bilgic S. Some variations in the formation of the brachial plexus in infants. Tr J Med Sci 1999;29:573-7.
  13. Chauhan R, Roy TS. Communication between the median and musculocutaneous nerve - a case report. J Anat Soc India 2002;51:72-5.
  14. Saeed M, Rufai AA. Median and musculocutaneous nerves: variant formation and distribution. Clin Anat 2003;16:453-7. https://doi.org/10.1002/ca.10096
  15. Sontakke BR, Tarnekar AM, Waghmare JE, Ingole IV. An unusual case of asymmetrical formation and distribution of median nerve. Int J Anat Var 2011;4:57-60.
  16. Pais D, Casal D, Santos A, O'Neill JG. A variation in the origin of the median nerve associated with an unusual origin of the deep brachial artery. J Morphol Sci 2010;27:35-8.
  17. Uzun A, Seelig LL Jr. A variation in the formation of the median nerve: communicating branch between the musculocutaneous and median nerves in man. Folia Morphol (Warsz) 2001;60:99-101.
  18. Haviarova Z, el Falougy HA, Killingerova A. Atypical course of the median nerve. Bratisl Lek Listy 2001;102:372-3.
  19. Pandey SK, Shukla VK. Anatomical variations of the cords of brachial plexus and the median nerve. Clin Anat 2007;20:150-6. https://doi.org/10.1002/ca.20365
  20. Choi D, Rodriguez-Niedenfuhr M, Vazquez T, Parkin I, Sanudo JR. Patterns of connections between the musculocutaneous and median nerves in the axilla and arm. Clin Anat 2002;15:11-7. https://doi.org/10.1002/ca.1085
  21. Yang ZX, Pho RW, Kour AK, Pereira BP. The musculocutaneous nerve and its branches to the biceps and brachialis muscles. J Hand Surg Am 1995;20:671-5.
  22. Larsen WJ. Human embryology. 2nd ed. New York: Churchill Livingstone; 1997. p. 311-39.
  23. Brown MC, Hopkins WG, Keynes RI. Essentials of neural development. Cambridge: Cambridge University Press; 1991. p. 46-66.
  24. Sanes DH, Reh TA, Harris WA. Development of the nervous system. San Diego: Academic Press; 2000. p. 189-97.