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Bilateral anatomic variation in the relation of the upper trunk of the brachial plexus to the anterior scalene muscle
Affiliations- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
- Department of Forensic Medicine, Clinical Centre of Montenegro, Podgorica, Montenegro
open access
Abstract
The brachial plexus represents a field of many anatomical variations with impor- tant clinical implications, especially in the diagnosis and treatment of the thoracic outlet syndrome (TOS). The case described in this paper presented a novel bilateral variation in the relation of the upper trunk of the brachial plexus to the anterior scalene muscle. The ventral rami of the C5 and C6 spinal nerves perforated the anterior scalene muscle simultaneously through a common opening, and joined to form the upper trunk. Previous literature reports described variations of the brachial plexus and the scalene muscles, as well as the embryological basis for their presence. The case reported herein helps to improve the comprehension of the TOS, as well as the diagnostic and therapeutical approach to this syndrome.
Abstract
The brachial plexus represents a field of many anatomical variations with impor- tant clinical implications, especially in the diagnosis and treatment of the thoracic outlet syndrome (TOS). The case described in this paper presented a novel bilateral variation in the relation of the upper trunk of the brachial plexus to the anterior scalene muscle. The ventral rami of the C5 and C6 spinal nerves perforated the anterior scalene muscle simultaneously through a common opening, and joined to form the upper trunk. Previous literature reports described variations of the brachial plexus and the scalene muscles, as well as the embryological basis for their presence. The case reported herein helps to improve the comprehension of the TOS, as well as the diagnostic and therapeutical approach to this syndrome.
Keywords
anterior scalene muscle; brachial plexus; thoracic outlet syndrome; upper trunk; variation
About this articleTitle
Bilateral anatomic variation in the relation of the upper trunk of the brachial plexus to the anterior scalene muscle
Journal
Issue
Article type
Case report
Pages
195-198
Published online
2018-07-03
Page views
2647
Article views/downloads
1498
DOI
Pubmed
Bibliographic record
Folia Morphol 2019;78(1):195-198.
Keywords
anterior scalene muscle
brachial plexus
thoracic outlet syndrome
upper trunk
variation
Authors
M. Radunovic
B. Vukcevic
M. Abramovic
N. Vukcevic
N. Radojevic
A. Vuksanovic-Bozaric
References (25)- Abe M, Ichinohe K, Nishida J. Diagnosis, treatment, and complications of thoracic outlet syndrome. J Orthop Sci. 1999; 4(1): 66–69.
- Beheiry EE. Anatomical variations of the median nerve distribution and communication in the arm. Folia Morphol. 2004; 63(3): 313–318.
- Falyar CR, Shaffer KM, Perera RA. Localization of the brachial plexus: Sonography versus anatomic landmarks. J Clin Ultrasound. 2016; 44(7): 411–415.
- Fetty LK, Shea J, Toussaint CP, et al. A quantitative analysis of variability in brachial plexus anatomy. Clin Anat. 2010; 23(2): 210–215.
- Harry WG, Bennett JD, Guha SC. Scalene muscles and the brachial plexus: anatomical variations and their clinical significance. Clin Anat. 1997; 10(4): 250–252.
- Kattan AE, Borschel GH. Anatomy of the brachial plexus. J Pediatr Rehabil Med. 2011; 4(2): 107–111.
- Kirazlı Ö, Tatarlı N, Ceylan D, et al. A variation of the cords of the brachial plexus on the right and a communication between the musculocutaneous and median nerves on the left upper limb: a unique case. J Neurol Surg A Cent Eur Neurosurg. 2013; 74 Suppl 1: e176–e179.
- Kuhn JE, Lebus V GF, Bible JE. Thoracic outlet syndrome. J Am Acad Orthop Surg. 2015; 23(4): 222–232.
- Leonhard V, Smith R, Caldwell G, et al. Anatomical variations in the brachial plexus roots: implications for diagnosis of neurogenic thoracic outlet syndrome. Ann Anat. 2016; 206: 21–26.
- Leung S, Zlotolow DA, Kozin SH, et al. Surgical anatomy of the supraclavicular brachial plexus. J Bone Joint Surg Am. 2015; 97(13): 1067–1073.
- Lewis W. The development of the arm in man. Am J Anat. 1902; 1(2): 145–183.
- Makhoul RG, Machleder HI. Developmental anomalies at the thoracic outlet: an analysis of 200 consecutive cases. J Vasc Surg. 1992; 16(4): 534–42; discussion 542.
- Milliez PY, Sakka M. [Ontogenic basis of human predisposition to thoracic outlet syndrome. Cervicothoracic reconstruction of a 2.5 cm embryo]. Ann Chir Plast Esthet. 1993; 38(5): 573–583.
- Natsis K, Totlis T, Tsikaras P, et al. Variations of the course of the upper trunk of the brachial plexus and their clinical significance for the thoracic outlet syndrome: a study on 93 cadavers. Am Surg. 2006; 72(2): 188–192.
- Radunovic M, Vukasanovic-Bozaric A, Radojevic N, et al. A new anatomical variation of the musculocutaneous and the median nerve anastomosis. Folia Morphol. 2013; 72(2): 176–179.
- Roos DB. The place for scalenectomy and first-rib resection in thoracic outlet syndrome. Surgery. 1982; 92(6): 1077–1085.
- Sadowski M, Tułaza B, Lysenko L. Renaissance of supraclavicular brachial plexus block. Anaesthesiol Intensive Ther. 2014; 46(1): 37–41.
- Sakamoto Y. Spatial relationships between the morphologies and innervations of the scalene and anterior vertebral muscles. Ann Anat. 2012; 194(4): 381–388.
- Shinohara H, Naora H, Hashimoto R, et al. Development of the innervation pattern in the upper limb of staged human embryos. Acta Anat (Basel). 1990; 138(3): 265–269.
- Som PM, Laitman JT. Embryology, variations, and innervations of the human neck muscles. Neurographics. 2017; 7(3): 215–242.
- Takafuji T, Sato Y. Study on the subclavian artery and its branches in Japanese adults. Okajimas Folia Anat Jpn. 1991; 68(2-3): 171–185.
- Uemura M, Takemura A, Suwa F. Bilateral subclavian arteries passing in front of the scalenus anterior muscles. Anat Sci Int. 2007; 82(3): 180–185.
- Woźniak J, Kędzia A, Dudek K. Brachial plexus variations during the fetal period. Anat Sci Int. 2012; 87(4): 223–233.
- Xu S, Wang X, Lou X, et al. Novel double-superior-trunk injury of the brachial plexus: a case report. J Int Med Res. 2008; 36(3): 594–598.
- Yildiz S, Cömert A, Ozan H. A case of connected superior and middle trunks of the brachial plexus or with abnormal upper trunk. Rom J Morphol Embryol. 2011; 52(3 Suppl): 1157–1159.
