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CASE REPORTS
Published online: 2018-08-31
Submitted: 2018-07-08
Accepted: 2018-07-29
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An atypical biceps brachii and coracobrachialis muscles associated with multiple neurovascular aberrations: a case report with clinical significance

Maria Piagkou, Trifon Totlis, Nikolaos Anastasopoulos, Nikolaos Lazaridis, Konstantinos Natsis
DOI: 10.5603/FM.a2018.0081
·
Pubmed: 30178460

open access

Ahead of Print
CASE REPORTS
Published online: 2018-08-31
Submitted: 2018-07-08
Accepted: 2018-07-29

Abstract

Neural and vascular variations in the axilla and upper limb area are usually paired, but coexistence of muscular aberration on top of this is uncommon. The current case report emphasizes on the unilateral coexistence of a three-headed (tricipital) biceps brachii muscle, a two-headed coracobrachialis with an accessory muscle bundle joining the superficial and deep heads of coracobrachialis muscle. On the ipsilateral side of the 72-year old male cadaver, a connecting branch originated from the musculocutaneous nerve and joined the median nerve after surpassing the accessory muscle bundle. A large diameter subscapular trunk originated from the 2nd part of the axillary artery and after giving off the 1st lateral thoracic artery trifurcated into a common stem which gave off the 2nd and 3rd lateral thoracic arteries, the circumflex scapular artery and a common branch that gave off the 4th and 5th lateral thoracic arteries and the thoracodorsal artery, as the ultimate branch. All lateral thoracic arteries were accompanied by multiple intercostobrachial nerves. Documentation of such muscular and neurovascular variants and their embryologic origin increases awareness of their potential impact on diagnosis and treatment of upper limb pathology. To the best of our knowledge, the currently reported cadaveric observations seem to constitute a unique finding.

Abstract

Neural and vascular variations in the axilla and upper limb area are usually paired, but coexistence of muscular aberration on top of this is uncommon. The current case report emphasizes on the unilateral coexistence of a three-headed (tricipital) biceps brachii muscle, a two-headed coracobrachialis with an accessory muscle bundle joining the superficial and deep heads of coracobrachialis muscle. On the ipsilateral side of the 72-year old male cadaver, a connecting branch originated from the musculocutaneous nerve and joined the median nerve after surpassing the accessory muscle bundle. A large diameter subscapular trunk originated from the 2nd part of the axillary artery and after giving off the 1st lateral thoracic artery trifurcated into a common stem which gave off the 2nd and 3rd lateral thoracic arteries, the circumflex scapular artery and a common branch that gave off the 4th and 5th lateral thoracic arteries and the thoracodorsal artery, as the ultimate branch. All lateral thoracic arteries were accompanied by multiple intercostobrachial nerves. Documentation of such muscular and neurovascular variants and their embryologic origin increases awareness of their potential impact on diagnosis and treatment of upper limb pathology. To the best of our knowledge, the currently reported cadaveric observations seem to constitute a unique finding.

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Keywords

biceps brachii, variation, coracobrachialis, lateral thoracic artery, intercostobrachial nerve, anastomosis, median nerve, musculocutaneous nerve

About this article
Title

An atypical biceps brachii and coracobrachialis muscles associated with multiple neurovascular aberrations: a case report with clinical significance

Journal

Folia Morphologica

Issue

Ahead of Print

Published online

2018-08-31

DOI

10.5603/FM.a2018.0081

Pubmed

30178460

Keywords

biceps brachii
variation
coracobrachialis
lateral thoracic artery
intercostobrachial nerve
anastomosis
median nerve
musculocutaneous nerve

Authors

Maria Piagkou
Trifon Totlis
Nikolaos Anastasopoulos
Nikolaos Lazaridis
Konstantinos Natsis

References (24)
  1. Alashkham A, Alraddadi A, Soames R. Origin of the long head of biceps brachii from the supraglenoid tubercle and glenoid labrum. Eur J Anat. 2018; 22: 213–219.
  2. Ashraf Nasr Y, Adel Hussein M. Morphology and clinical implication of the extra-head of biceps brachii muscle. Folia Morphologica. 2013; 72(4): 349–356.
  3. Asvat R, Candler P, Sarmiento EE. High incidence of the third head of biceps brachii in South African populations. J Anat. 1993; 182 (Pt 1): 101–104.
  4. Bratschi HU, Haller U. [Significance of the intercostobrachial nerve in axillary lymph node excision]. Geburtshilfe Frauenheilkd. 1990; 50(9): 689–693.
  5. Cheema P, Singla R. Lower incidence of the third head of biceps brachii in North Indian Population. J Clin Diagnostic Res. 2011; 5(Suppl.2): 1323–1326.
  6. Kervancioglu P, Orhan M. An anatomical study on the three-headed biceps brachii in human foetuses, and clinical relevance. Folia Morphol. 2011; 70(2): 116–120.
  7. Kopuz C, Içten N, Yildirim M. A rare accessory coracobrachialis muscle: a review of the literature. Surg Radiol Anat. 2003; 24(6): 406–410.
  8. Kopuz C, Sancak B, Ozbenli S. On the incidence of third head of biceps brachii in Turkish neonates and adults. Kaibogaku Zasshi. 1999; 74(3): 301–305.
  9. Kosugi K, Shibata S, Yamashita H. Supernumerary head of biceps brachii and branching pattern of the musculocutaneus nerve in Japanese. Surg Radiol Anat. 1992; 14(2): 175–185.
  10. Kumar PA, Reddy DRK, Bapuji P. Multiple Intercostobrachial Nerves. J Evolution Med Dental Sciences. 2014; 57: 12978–12983.
  11. Lokanadham S, Subhadra Devi V. Unusual presentation of supernumerary head of biceps brachii muscle in South Indian population. World J Med Sciences. 2011; 6: 115.
  12. Loukas M, du Plessis M, Owens DG, et al. The lateral thoracic artery revisited. Surg Radiol Anat. 2013; 36(6): 543–549.
  13. Nakatani T, Tanaka S, Mizukami S. Bilateral four-headed biceps brachii muscles: the median nerve and brachial artery passing through a tunnel formed by a muscle slip from the accessory head. Clin Anat. 1998; 11(3): 209–212.
  14. Natsis K, Vlasis K, Tsakotos G, et al. case of a supernumerary third head of the biceps brachii muscle - clinical significance. Aristotle University Med J. 2010; 37: 39–41.
  15. Natsis K, Piagkou M, Panagiotopoulos NA, et al. An unusual high bifurcation and variable branching of the axillary artery in a Greek male cadaver. Springerplus. 2014; 3: 640.
  16. Nayak SR, Krishnamurthy A, Kumar MN, et al. Four-headed biceps and triceps brachii muscles, with neurovascular variation. Anat Sci Int. 2008; 83(2): 107–111.
  17. Nayak SR, Krishnamurthy A, Prabhu LV, et al. Multiple supernumerary muscles of the arm and its clinical significance. Bratisl Lek Listy. 2008; 109(2): 74–76.
  18. Ozan H, Atsev A. Sianau, A, Simsek, C, Basar R. An unusual insertion of the accessory biceps brachii muscle. Am Anat Nippon. 1997; 72: 515–519.
  19. Paraskevas G, Natsis K, Ioannidis O, et al. Accessory muscles in the lower part of the anterior compartment of the arm that may entrap neurovascular elements. Clin Anat. 2008; 21(3): 246–251.
  20. Rai R, Ranade AV, Prabhu LV, et al. Third head of biceps brachii in an Indian population. Singapore Med J. 2007; 48(10): 929–931.
  21. Rincón F, Rodríguez Z, Sánchez A, et al. The anatomic characteristics of the third head of biceps branchii muscle in a colombian population. Rev Chis Anat. 2002; 20(2): 197–200.
  22. Rodríguez-Niedenführ M, Vázquez T, Choi D, et al. Supernumerary humeral heads of the biceps brachii muscle revisited. Clin Anat. 2003; 16(3): 197–203.
  23. Sargon MF, Tuncali D, Celik HH. An unusual origin for the accessory head of biceps brachii muscle. Clin Anat. 1996; 9(3): 160–162.
  24. Vollala VR, Nagabhooshana S, Bhat SM, et al. Multiple arterial, neural and muscular variations in upper limb of a single cadaver. Rom J Morphol Embryol. 2009; 50(1): 129–135.

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