open access
The ulnar head of the pronator teres muscle originating from the third head of the biceps brachii: a very rare case
Affiliations- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
- Department of Anatomical Sciences, St. George’s University, Grenada, West Indies
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States
- Department of Neurosurgery, Ochsner Medical Centre, New Orleans, LA, United States
open access
Abstract
The biceps brachii is located in the anterior compartment of the arm, which can show numerous morphological variations. During anatomical dissection, an interesting additional muscle was found: the third head of the biceps brachii originated from the short head of the same muscle. The 97.77 mm long muscle belly was directed medially over the arm and then passed into the common tendon (15.97 mm), which thereafter split into aponeurosis and tendon. The 26.33 mm aponeurosis passed and joined the fascia of the forearm. The tendon of the third head of the biceps brachii then gave rise to the ulnar head of the pronator teres muscle. Such an accessory structure could cause neurovascular compression involving the brachial artery and median nerve. Knowledge of the morphological variability of this region is essential not only for anatomists but also for clinicians.
Abstract
The biceps brachii is located in the anterior compartment of the arm, which can show numerous morphological variations. During anatomical dissection, an interesting additional muscle was found: the third head of the biceps brachii originated from the short head of the same muscle. The 97.77 mm long muscle belly was directed medially over the arm and then passed into the common tendon (15.97 mm), which thereafter split into aponeurosis and tendon. The 26.33 mm aponeurosis passed and joined the fascia of the forearm. The tendon of the third head of the biceps brachii then gave rise to the ulnar head of the pronator teres muscle. Such an accessory structure could cause neurovascular compression involving the brachial artery and median nerve. Knowledge of the morphological variability of this region is essential not only for anatomists but also for clinicians.
Keywords
anatomical variations, biceps brachii, third head
About this articleTitle
The ulnar head of the pronator teres muscle originating from the third head of the biceps brachii: a very rare case
Journal
Issue
Article type
Case report
Pages
225-230
Published online
2021-11-09
Page views
3543
Article views/downloads
925
DOI
Pubmed
Bibliographic record
Folia Morphol 2023;82(1):225-230.
Keywords
anatomical variations
biceps brachii
third head
Authors
Ł. Olewnik
N. Zielinska
B. Szewczyk
R. S. Tubbs
References (48)- Adachi b. Beitrage zur anatomie der Japaner. XII. Die statistic der muskelvarietten. Z Morphol Anthr. 1909: 261–312.
- Al-Kushi G. Anatomical study of the third head of biceps brachii muscle and its innervation by median nerve in human dissection. J Clin Med Res. 2013; 5(4): 47–52.
- Andreisek G, Crook DW, Burg D, et al. Peripheral neuropathies of the median, radial, and ulnar nerves: MR imaging features. Radiographics. 2006; 26(5): 1267–1287.
- Anson B. An Atlas of Human Anatomy, 2nd ed. WB Saunders Company, Philadelphia 1963.
- 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.
- Ballesteros LE, Forero PL, Buitrago ER. Evaluation of additional head of biceps brachii: a study with autopsy material. Folia Morphol. 2014; 73(2): 193–198.
- Bardeen C. Development and variation of the nerves and the musculature of the inferior extremity and of the neighboring regions of the trunk in man. Am J Anat. 1906; 6(1): 259–390.
- Bergman R, Afifi A, Miyauchi R. Illustrated encyclopedia of human anatomic variations. Anatomy Atlas 2017.
- Blasi M, de la Fuente J, Martinoli C, et al. Multidisciplinary approach to the persistent double distal tendon of the biceps brachii. Surg Radiol Anat. 2014; 36(1): 17–24.
- Cucca YY, McLay SVB, Okamoto T, et al. The biceps brachii muscle and its distal insertion: observations of surgical and evolutionary relevance. Surg Radiol Anat. 2010; 32(4): 371–375.
- Dong Q, Jacobson JA, Jamadar DA, et al. Entrapment neuropathies in the upper and lower limbs: anatomy and MRI features. Radiol Res Pract. 2012; 2012: 230679.
- Le Double A. Traité des variations du système musculaire de l’homme et de leur signification au point de vue de l’anthropologie zoologique. Schleicher frères, Paris 1897.
- 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.
- Garbelotti SA, Marques SR, Rocha PR, et al. An unusual case of accessory head of coracobrachialis muscle involving lateral cord of brachial plexus and its clinical significance. Folia Morphol. 2017; 76(4): 762–765.
- Greig HW, Anson BJ, Budinger JM. Variations in the form and attachments of the biceps brachii muscle. Q Bull Northwest Univ Med Sch. 1952; 26(3): 241–244.
- Gruber W. Die Musculi subscapulares (major et minor) und die neuen supernumären Schultermuskel des Menschen. Máemoires de I’Acadáemie Impáeriale des Sciences de Saint Páetersbourg par Divers Savans et Lus dans ses Assembláees, 4th ed, Sankt Petersburg 1859.
- Ilayperuma I, Nanayakkara G, Palahepitiya N. Incidence of humeral head of biceps brachii muscle: anatomical insight. Int J Morphol. 2011; 29(1): 221–225.
- Iwanaga J, Singh V, Ohtsuka A, et al. Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors. Clin Anat. 2021; 34(1): 2–4.
- Jeong JY, Park SM, Park YE, et al. Morphological classification of anatomical variants of the intra-articular portion of the long head of the biceps brachii tendon and analysis of the incidence and the relationship with shoulder disease for each subtype. J Orthop Surg (Hong Kong). 2017; 25(3): 1–6.
- De Jesus R, Dellon AL. Historic origin of the "Arcade of Struthers". J Hand Surg Am. 2003; 28(3): 528–531.
- Kopuz C, Sancak B, Ozbenli S. On the incidence of third head of biceps brachii in Turkish neonates and adults. Acta Anat Nippon. 1999; 74(3): 301–305.
- 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.
- Landa J, Bhandari S, Strauss EJ, et al. The effect of repair of the lacertus fibrosus on distal biceps tendon repairs: a biomechanical, functional, and anatomic study. Am J Sports Med. 2009; 37(1): 120–123.
- Loukas M, Aqueelah H. Musculocutaneous and median nerve connections within, proximal and distal to the coracobrachialis muscle. Folia Morphol. 2005; 64: 101–108.
- Macalister A. Additional observations on muscular anomalies in human anatomy. Transcations R Irish Acad. 1875; 25: 1–134.
- Macalister A. Observations on the mucular variations in the human anatomy. Third series with a catalogue of the principal muscular variations hitherto published. Trans Rov Irish Acad Sci. 1875; 25: 1–134.
- Meyer P, Lintingre PF, Pesquer L, et al. The median nerve at the carpal tunnel … and elsewhere. J Belg Soc Radiol. 2018; 102(1): 17.
- Moore K, Arthur F, Dalley I. Clinically Oriented Anatomy, 7th ed. Lippincott Williams&Wilkins 2013.
- Nayak SR, Prabhu LV, Sivanandan R. Third head of biceps brachii: A rare occurrence in the Indian population. Ann Anat. 2006; 188(2): 159–161.
- Olewnik Ł, Karauda P, Gonera B, et al. Impact of plantaris ligamentous tendon. Sci Rep. 2021; 11(1): 4550.
- Olewnik Ł, Kurtys K, Gonera B, et al. Proposal for a new classification of plantaris muscle origin and its potential effect on the knee joint. Ann Anat. 2020; 231: 151506.
- Olewnik Ł, Podgórski M, Polguj M, et al. Anatomical variations of the pronator teres muscle in a Central European population and its clinical significance. Anat Sci Int. 2018; 93(2): 299–306.
- Olewnik Ł, Zielinska N, Gołek Ł, et al. Is it the coracobrachialis superior muscle, or is it an unidentified rare variant of coracobrachialis muscle? Surg Radiol Anat. 2021; 43(10): 1581–1586.
- Olewnik Ł, Zielinska N, Karauda P, et al. The co-occurrence of a four-headed coracobrachialis muscle, split coracoid process and tunnel for the median and musculocutaneous nerves: the potential clinical relevance of a very rare variation. Surg Radiol Anat. 2021; 43(5): 661–669.
- Olewnik Ł, Paulsen F, Tubbs RS, et al. Potential compression of the musculocutaneous, median and ulnar nerves by a very rare variant of the coracobrachialis longus muscle. Folia Morphol. 2021; 80(3): 707–713.
- Podgórski M, Olewnik Ł, Rusinek M, et al. 'Superior biceps aponeurosis': Morphological characteristics of the origin of the short head of the biceps brachii muscle. Ann Anat. 2019; 223: 85–89.
- 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.
- Schwerdtfeger L, Pascoe M, Clapp T. High incidence of a third head of biceps brachii in females. Transl Res Anat. 2018; 12: 25–27.
- Snoeck O, Lefèvre P, Sprio E, et al. The lacertus fibrosus of the biceps brachii muscle: an anatomical study. Surg Radiol Anat. 2014; 36(7): 713–719.
- Testut L. Les anomalies musculaires chez l’homme: expliquées par l’anatomie comparée leur importance en anthropologie. G Masson, Paris 1884.
- Theile F. Traité de Myologie. Baillière, Paris 1843.
- Wood J. On human muscular variations and their relation to comperative anatomy. J Anat Physiol. 1867: 44–59.
- Yershov D, Hudák R. Unusual variation of the biceps brachii with possible median nerve entrapment. Prague Med Rep. 2015; 116(2): 167–172.
- Zhou M, Ishizawa A, Akashi H, et al. Bilateral accessory heads of biceps brachii muscle coexisting with brachioradial artery passing between two layers of atypical bicipital aponeurosis. Transl Res Anat. 2021; 25: 100134.
- Zielinska N, Olewnik Ł. Six-headed coracobrachialis muscle. Folia Morphol. 2022; 81(3): 809–813.
- Zielinska N, Olewnik Ł, Karauda P, et al. A very rare case of an accessory subscapularis muscle and its potential clinical significance. Surg Radiol Anat. 2021; 43(1): 19–25.
- Zielinska N, Tubbs RS, Podgórski M, et al. The subscapularis tendon: A proposed classification system. Ann Anat. 2021; 233: 151615.
- Żytkowski A, Tubbs R, Iwanaga J, et al. Anatomical normality and variability: Historical perspective and methodological considerations. Transl Res Anat. 2021; 23: 100105.
