open access

Vol 82, No 1 (2023)
Original article
Submitted: 2021-09-30
Accepted: 2021-12-08
Published online: 2021-12-31
Get Citation

The pattern of branching and intercommunications of the musculocutaneous nerve for surgical issues: anatomical study

M. G. Al-Sobhi1, A. I. Zaki23, F. A. Abd El Hamid23, R. A Alshali2, H. N. Mustafa2
·
Pubmed: 35037697
·
Folia Morphol 2023;82(1):79-87.
Affiliations
  1. Master of Technical Anatomy and Histology, Department of Anatomy, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
  2. Department of Anatomy, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
  3. Department of Anatomy, Faculty of Medicine, Alexandria University, Alexandria, Egypt

open access

Vol 82, No 1 (2023)
ORIGINAL ARTICLES
Submitted: 2021-09-30
Accepted: 2021-12-08
Published online: 2021-12-31

Abstract

Background: The aim of the present work was to provide evidence about the anatomical variations as regard the origin, distribution, and branching pattern of the musculocutaneous nerve (MCN).
Materials and methods: Brachial plexus was dissected in 40 upper limbs of 20 male adult cadavers. The pattern of the MCN was photographed by a digital camera.
Results: The location and length of the nerve branches between left and right arms were recorded and statistically analysed. In 90% of specimens the MCN originates from the lateral cord of the brachial plexus, in 5% it arose from the median nerve (MN), while in the remaining 5% specimen, it was absent. The MCN pierced the coracobrachialis muscle in 90% of specimens, and in the remaining 10% did not pierce it. The motor branches to biceps brachii muscle were categorised into: type 1 (90%): one branch that divides to supply the two heads of biceps; type 2 (5%): double branches, innervating each head of biceps separately. The motor branches to brachialis muscle were categorised into: type 1 (82.9%): one branch; type 2 (14.2%): double branches and type 3 (2.9%): three branches that innervating brachialis muscle. Communications between the MCN and the MN were observed in 35% of specimens.
Conclusions: The knowledge of the common and uncommon MCN variations is important especially to the surgeons for carrying out surgical procedures in axilla and arm.

Abstract

Background: The aim of the present work was to provide evidence about the anatomical variations as regard the origin, distribution, and branching pattern of the musculocutaneous nerve (MCN).
Materials and methods: Brachial plexus was dissected in 40 upper limbs of 20 male adult cadavers. The pattern of the MCN was photographed by a digital camera.
Results: The location and length of the nerve branches between left and right arms were recorded and statistically analysed. In 90% of specimens the MCN originates from the lateral cord of the brachial plexus, in 5% it arose from the median nerve (MN), while in the remaining 5% specimen, it was absent. The MCN pierced the coracobrachialis muscle in 90% of specimens, and in the remaining 10% did not pierce it. The motor branches to biceps brachii muscle were categorised into: type 1 (90%): one branch that divides to supply the two heads of biceps; type 2 (5%): double branches, innervating each head of biceps separately. The motor branches to brachialis muscle were categorised into: type 1 (82.9%): one branch; type 2 (14.2%): double branches and type 3 (2.9%): three branches that innervating brachialis muscle. Communications between the MCN and the MN were observed in 35% of specimens.
Conclusions: The knowledge of the common and uncommon MCN variations is important especially to the surgeons for carrying out surgical procedures in axilla and arm.

Get Citation

Keywords

brachial plexus, musculocutaneous nerve, axilla, median nerve, anatomical variations

About this article
Title

The pattern of branching and intercommunications of the musculocutaneous nerve for surgical issues: anatomical study

Journal

Folia Morphologica

Issue

Vol 82, No 1 (2023)

Article type

Original article

Pages

79-87

Published online

2021-12-31

Page views

3408

Article views/downloads

1024

DOI

10.5603/FM.a2021.0139

Pubmed

35037697

Bibliographic record

Folia Morphol 2023;82(1):79-87.

Keywords

brachial plexus
musculocutaneous nerve
axilla
median nerve
anatomical variations

Authors

M. G. Al-Sobhi
A. I. Zaki
F. A. Abd El Hamid
R. A Alshali
H. N. Mustafa

References (35)
  1. Afshar A. An update on embryology of the upper limb. J Hand Surg Am. 2013; 38(11): 2304.
  2. Al-Qattan M, Kozin S. Update on embryology of the upper limb. J Hand Surg. 2013; 38(9): 1835–1844.
  3. Ballesteros LE, Forero PL, Buitrago ER. Communication between the musculocutaneous and median nerves in the arm: an anatomical study and clinical implications. Rev Bras Ortop. 2015; 50(5): 567–572.
  4. Bergman RA, Afifi AK, Miyauchi R. Illustrated Encyclopedia of Human Anatomic Variation. Opus III: Nervous System. 2015.
  5. Budhiraja V, Rastogi R, Kumar Asthana A, et al. Concurrent variations of median and musculocutaneous nerves and their clinical correlation--a cadaveric study. Ital J Anat Embryol. 2011; 116(2): 67–72.
  6. Butz JJ, Shiwlochan DG, Brown KC, et al. Bilateral variations of brachial plexus involving the median nerve and lateral cord: An anatomical case study with clinical implications. Australas Med J. 2014; 7(5): 227–231.
  7. Chelly JE. Peripheral nerve blocks: a color atlas. Lippincott Williams & Wilkins 2009.
  8. Choi D, Rodríguez-Niedenführ M, Vázquez T, et al. Patterns of connections between the musculocutaneous and median nerves in the axilla and arm. Clin Anat. 2002; 15(1): 11–17.
  9. Chrysikos D, Athanasopoulos A, Georgakopoulos P, et al. Anatomical variation of a communicating branch between the musculocutaneous and the median nerve: a case report. Acta Med Acad. 2020; 49(1): 71–74.
  10. Eglseder WA, Goldman M. Anatomic variations of the musculocutaneous nerve in the arm. Am J Orthop (Belle Mead NJ). 1997; 26(11): 777–780.
  11. El-Naggar MM, Al-Saggaf S. Variant of the coracobrachialis muscle with a tunnel for the median nerve and brachial artery. Clin Anat. 2004; 17(2): 139–143.
  12. Elgammal Y, Frolov A, Martin J. The branching pattern and internal topography of the musculocutaneous nerve. FASEB J. 2020; 34(S1): 1–1.
  13. Frazer EA, Hobson M, McDonald SW. The distribution of the radial and musculocutaneous nerves in the brachialis muscle. Clin Anat. 2007; 20(7): 785–789.
  14. Gelmi C, Pedrini F, Fermi M, et al. Communication between median and musculocutaneous nerve at the level of cubital fossa: a case report. Transl Res Anat. 2018; 11: 1–4.
  15. Gümüsburun E, Adigüzel E. A variation of the brachial plexus characterized by the absence of the musculocutaneous nerve: a case report. Surg Radiol Anat. 2000; 22(1): 63–65.
  16. Hunter D, Zdilla M. The absent musculocutaneous nerve: A systematic review. Transl Res Anat. 2021; 22: 100092.
  17. Iwanaga J, Singh V, Takeda S, et al. Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors. Clin Anat. 2021; 34(1): 2–4.
  18. Krishnamurthy A, Nayak SR, Venkatraya Prabhu L, et al. The branching pattern and communications of the musculocutaneous nerve. J Hand Surg Eur Vol. 2007; 32(5): 560–562.
  19. Macchi V, Tiengo C, Porzionato A, et al. Musculocutaneous nerve: histotopographic study and clinical implications. Clin Anat. 2007; 20(4): 400–406.
  20. Moore KL, Dalley AF. Clinically oriented anatomy. Wolters Kluwer india Pvt Ltd 2018.
  21. Nascimento SR, Ruiz CR, Pereira E, et al. Rare anatomical variation of the musculocutaneous nerve: case report. Rev Bras Ortop. 2016; 51(3): 366–369.
  22. Occhiboi E, Clement R. Anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty. JBJS J Orthop Physician Assist. 2020; 8(1): 0025.
  23. Orellana-Donoso M, Valenzuela-Fuenzalida J, Gold-Semmler M, et al. Neural entrapments associated with musculoskeletal anatomical variations of the upper limb: Literature review. Transl Res Anat. 2021; 22: 100094.
  24. Ozturk A, Bayraktar B, Taskara N, et al. Morphometric study of the nerves entering into the coracobrachialis muscle. Surg Radiol Anat. 2005; 27(4): 308–311.
  25. Oztürk NC, Uzmansel D, Oztürk H. An unreported pattern of musculocutaneous and median nerve communication with multiple variations of biceps brachii: a case report. Surg Radiol Anat. 2010; 32(9): 887–890.
  26. Pacha Vicente D, Forcada Calvet P, Carrera Burgaya A, et al. Innervation of biceps brachii and brachialis: Anatomical and surgical approach. Clin Anat. 2005; 18(3): 186–194.
  27. Pacholczak R, Klimek-Piotrowska W, Walocha JA. Absence of the musculocutaneous nerve associated with a supernumerary head of biceps brachii: a case report. Surg Radiol Anat. 2011; 33(6): 551–554.
  28. Pandey SK, Shukla VK. Anatomical variations of the cords of brachial plexus and the median nerve. Clin Anat. 2007; 20(2): 150–156.
  29. Parchand MP, Patil ST. Absence of musculocutaneous nerve with variations in course and distribution of the median nerve. Anat Sci Int. 2013; 88(1): 58–60.
  30. Schafhalter-Zoppoth I, Gray AT. The musculocutaneous nerve: ultrasound appearance for peripheral nerve block. Reg Anesth Pain Med. 2005; 30(4): 385–390.
  31. Snell RS. Snell’s Clinical Anatomy. Wolters Kluwer india Pvt Ltd 2018.
  32. Uysal II, Seker M, Karabulut AK, et al. Brachial plexus variations in human fetuses. Neurosurgery. 2003; 53(3): 676–684.
  33. Venieratos D, Anagnostopoulou S. Classification of communications between the musculocutaneous and median nerves. Clin Anat. 1998; 11(5): 327–331, doi: 10.1002/(SICI)1098-2353(1998)11:5<327::AID-CA6>3.0.CO;2-M.
  34. Vineyard AP, Gallucci AR, Imbus SR, et al. Residents case report: musculocutaneous nerve injury in a collegiate baseball pitcher. Int J Sports Phys Ther. 2020; 15(5): 804–813.
  35. Yang ZX, Pho R, Kour AK, et al. The musculocutaneous nerve and its branches to the biceps and brachialis muscles. J Hand Surg Am. 1995; 20(4): 671–675.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.: +48 58 320 94 94, faks: +48 58 320 94 60, e-mail: viamedica@viamedica.pl