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A prefix brachial plexus with two trunks and one anterior cord
Affiliations- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Thessaloniki, Greece
- Department of Anatomy and Surgical Anatomy, School of Medicine, National and Kapodistrian University of Athens, Greece, Athens, Greece
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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Abstract
The brachial plexus presents a great variability in formation, division and branching pattern. Its variants are of immense importance during axillary and arm surgery and nerve blockade.
The current case highlights a unilateral atypical formation of brachial plexus, the so called prefix, in which the C4 root contributed a large branch to the superior trunk and further anastomosis with the inferior trunk. Thus, the prefix or high brachial plexus consisted of a superior and inferior trunk and one anterior cord.
Coexisting neural and arterial variations are also discussed in relation to the data literature.
Abstract
The brachial plexus presents a great variability in formation, division and branching pattern. Its variants are of immense importance during axillary and arm surgery and nerve blockade.
The current case highlights a unilateral atypical formation of brachial plexus, the so called prefix, in which the C4 root contributed a large branch to the superior trunk and further anastomosis with the inferior trunk. Thus, the prefix or high brachial plexus consisted of a superior and inferior trunk and one anterior cord.
Coexisting neural and arterial variations are also discussed in relation to the data literature.
Keywords
brachial plexus, variation, cords, nerve roots, trunks, prefix, surgery
About this articleTitle
A prefix brachial plexus with two trunks and one anterior cord
Journal
Issue
Article type
Case report
Pages
402-406
Published online
2019-07-17
Page views
1567
Article views/downloads
929
DOI
Pubmed
Bibliographic record
Folia Morphol 2020;79(2):402-406.
Keywords
brachial plexus
variation
cords
nerve roots
trunks
prefix
surgery
Authors
K. Natsis
M. Piagkou
T. Totlis
S. Kapetanakis
References (26)- Aktan ZA, Ozturk L, Bilge O, et al. A cadaveric study of the anatomic variations of the brachial plexus nerves in the axillar region and arm. Turk J Med Sci. 2001; 31: 147–150.
- Ballesteros L, Ramirez L. Variations of the origin of collateral branches emerging from the posterior aspect of the brachial plexus. J Brachial Plex Peripher Nerve Inj. 2014; 02(01): e22–e27.
- Benjamin K. Part 1. Injuries to the brachial plexus: mechanisms of injury and identification of risk factors. Adv Neonatal Care. 2005; 5(4): 181–189.
- Chaudhary P, Singla R, Kalsey G, et al. A four trunked brachial plexus and a post fixed brachial plexus: a conjunction or a co-incidence? Report of three cases. Clin Anat. 2012; 25(5): 593–600.
- Goyal N, Harjeet , Gupta M. Bilateral variant contributions in the formation of median nerve. Surg Radiol Anat. 2005; 27(6): 562–565.
- 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, doi: 10.1002/(SICI)1098-2353(1997)10:4<250::AID-CA6>3.0.CO;2-W.
- Hollinshead WH (William H. Anatomy for Surgeons. Harper & Row; 1982. https://openlibrary.org/books/OL4261216M/Anatomy_for_surgeons (Accessed January 29, 2019).
- Kerr A. The brachial plexus of nerves in man, the variations in its formation and branches. Am J Anat. 1918; 23(2): 285–395.
- Kocabiyik N, Yalcin B, Kilic COH. Multiple anomalies of the brachial plexus: a case report. Neuroanatomy. 2007; 8: 21–23.
- Lee HY, Chung IH, Sir WS, et al. Variations of the ventral rami of the brachial plexus. J Korean Med Sci. 1992; 7(1): 19–24.
- Matejcik V. Aberrant formation and clinical picture of brachial plexus from the point of view of a neurosurgeon. Bratisl Lek Listy. 2003; 104(10): 291–299.
- Miller R. Observations upon the arrangement of the axillary artery and brachial plexus. Am J Anat. 1939; 64(1): 143–163.
- Mukund Thatte R, Babhulkar S, Hiremath A. Brachial plexus injury in adults: Diagnosis and surgical treatment strategies. Ann Indian Acad Neurol. 2013; 16(1): 26–33.
- Nakatani T, Tanaka S, Mizukami S. Superficial brachial arteries observed in bilateral arms. Kaibogaku Zasshi. 1996; 71(4): 308–312.
- 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.
- Pandey SK, Shukla VK. Anatomical variations of the cords of brachial plexus and the median nerve. Clin Anat. 2007; 20(2): 150–156.
- Pellerin M, Kimball Z, Tubbs RS, et al. The prefixed and postfixed brachial plexus: a review with surgical implications. Surg Radiol Anat. 2010; 32(3): 251–260.
- Prabhu L V, Kumar J, Singh G. Brachial Plexus With Two Trunks and Double Axillary Veins: Applied Importance and Clinical Implications. www.firattipdergisi.com (Accessed January 29, 2019).
- Prasada Rao P, Chaudhary SC. Communication of the musculocutaneous nerve with the median nerve. East Afr Med J. 2000; 77(9): 498–503.
- Raphael DT, McIntee D, Tsuruda JS, et al. Frontal slab composite magnetic resonance neurography of the brachial plexus: implications for infraclavicular block approaches. Anesthesiology. 2005; 103(6): 1218–1224.
- Singla RK, Sharma RK, Shree B. A two trunked brachial plexus: a case report. J Clin Diagn Res. 2013; 7(4): 704–705.
- Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 39th Ed. Edinburgh E-CL, ed. Elsevier Health Sciences, UK 2005.
- Stevens JH. Brachial plexus paralysis. By J.H. Stevens, M.D., 1934. Clin Orthop Relat Res. 1988(237): 4–8.
- Suranyi L. Median nerve compression by Struthers ligament. J Neurol Neurosurg Psychiatry. 1983; 46(11): 1047–1049.
- Uysal II, Seker M, Karabulut AK, et al. Brachial plexus variations in human fetuses. Neurosurgery. 2003; 53(3): 676–84; discussion 684.
- Vilamere J, Goodwin S, Hincke MJA. A brachial plexus variation characterized by the absence of the superior trunk. Neuranatomy. 2009; 8: 4–6.
