IJAR.2017.532

Type of Article:  Original Research

Volume 6; Issue 1.3 (March 2018)

Page No.: 4987-4993

DOI: https://dx.doi.org/10.16965/ijar.2017.532

VARIANT PATTERNS OF BRACHIAL PLEXUS – A CADAVERIC STUDY IN NORTH INDIAN POPULATION

Rimple Bansal *1, Rajan Kumar Singla 2, Subhash Kaushal 3, Apurba Patra 4.

*1 Senior Resident, Department of Anatomy, GMC Patiala, Punjab, India.

2 Prof.& Head, Department of Anatomy, GMC Patiala, Punjab, India.

3 Professor, Department of Anatomy, GMC Patiala, Punjab, India.

4 Senior Resident, Department of Anatomy, GMC Patiala, Punjab, India.

Address for Correspondence: Dr. Rimple Bansal, Senior Resident, Department of Anatomy, GMC Patiala, Punjab, India.  E-Mail: rimpledr79@gmail.com

ABSTRACT:

Background: The brachial plexus is constituted by the ventral rami of C5-T1 spinal nerves. It forms a network of terminal nerves that innervate the upper limb. Variations of brachial plexus are common and  a better awareness of variations is very crucial to achieve successful results in its surgical procedures. The aim of present  study was  to find the variant patterns of brachial plexus and to discuss their developmental and clinical significance.

Materials and Method:  50 upper limbs belonging to 25 formalized and well preserved male cadavers obtained from the Department of Anatomy, constituted the material for the study. These were  dissected and roots, trunks, cords and terminal branches of brachial plexus were exposed. The variant patterns were noted and photographed.

Results: Out of 50 limbs, 5 limbs showed variations of brachial plexus at different levels.All the variations seen were unilateral. Out of 5 variant patterns seen, different types of communications between musculocutaneous and median nerve were observed in 4 limbs (8%).Out of 4, in 1 limb (2%) medial cord joined with lateral root of median nerve to form mediano-ulnar nerve which after a distance of 1cm bifurcated into median and ulnar nerve. In one limb (2%), there was no distinction between medial and lateral cord. Instead a single anterior cord was formed by union of anterior divisions of all the three trunks  anterior to axillary artery.

Conclusion: The variant patterns of brachial plexus  are usually more prone to accidental injuries and entrapment neuropathies. Knowledge of such variations may provide additional anatomical information for the clinicians during diagnosis of unusual clinical symptoms and also for surgeons during surgical exploration of axilla and arm to avoid damage to these nerves.

Key words: Brachial Plexus, anatomical Variations, Lateral Cord, Median Nerve, Two Cords.

REFERENCES

  1. Berry MM, Standring SM, Bannister LH. Nervous system. In: Gray’s Anatomy. Edrs.Williams PL, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE et al. 38th Edinburgh,Churchill Livingstone;1995. pp. 1266-74.
  2. Orebaugh SL, Williams BA. Brachial plexus anatomy: normal and variant. Sci World J.2009;9:300-12.
  3. Snell RS. Clinical Anatomy. 7th Philadelphia: Lippincott Williams and Wilkins; 2004.p. 477.
  4. Hollinshead W. General survey of the upper limb-the back and limbs. In: Anatomy for Surgeons. New York: Hoeber-Harper; 1958. pp. 225-8.
  5. Tountas CP, Bergman RA. Anatomical variations of the upper extremities. New York: Churchill Livingstone; 1993.
  6. Kerr AT. The brachial plexus of nerves in man, the variations in its formation and branches.Am J Anat.1918; 23(2): 285-395.
  7. Linell EA. The distribution of nerves in the upper limb, with reference to variabilities and their clinical significance.J Anat.1921; 55: 79-112.
  8. Nakatani T, Tanaka S. Absence of the musculocutaneous nerve with innervation of corocobrachialis, biceps brachii, brachialis and the lateral border of the forearm by branches from the lateral cord of the brachial plexus.J Anat.1997; 49: 459-60.
  9. Emamhadi M, Chabok S, Samini F, Alijani B, Behzadnia H, Firozabadi F et al. Anatomical Variations of Brachial Plexus  in Adult Cadavers; A Descriptive Study. Arch Bone Jt Surg. 2016; 4(3): 253-8.
  10. Romanes GJ. The pectoral region and axilla, the arm and the forearm and hand. In:Cunninghams Manual of practical Anatomy.vol 1.15th edn Edinburgh,London:The English Language Book Society and Oxford University Press. 1986: 28-89.
  11. Li Minor JM. A rare variant of median and musculocutaneous nerves in man.Arch Anat Histo Embryol. 1992; 73: 33-42.
  12. Rao PVVP, Chaudhary SC. Communication of the musculocutaneous nerve with the median nerve. East Afr Med J 2000;77(9):498-503.
  13. Rajashree B, Arati D, Mamata S, Chinmayi M, Charulata S. Absence of musculocutaneous nerve – a case report. J Anat Soc India 2003;52(1):94.
  14. Saritha S. Variations in the median and musculocutaneous nerves-A surgical prospective. J Anat Soc Ind 2004; 53(1):31-66.
  15. Chaudhary P, Kalsey G, Singla R, Arora K. Communication Between Musculocutaneous  and Median Nerve – Different  Types and their incidence  in North Indian Population. Ind J of Clin Pract. 2014;25(1):63-70.
  16. Venieratos D, Anagnostopoulou S. Classification of communications between the musculocutaneous and median nerves. Clin Anat.1998;11: 327-31.
  17. Kosugi K, Mortia T, Yamashita H. Branching pattern of musculocutaneous nerve – Cases possessing normal biceps brachii.Jikeikai Med J.1986;33: 63-71.
  18. Yang ZX, Pho RWH, Kour AK , Pereira BP . The musculocutaneous nerve and its branches to the biceps and brachialis muscle. J Hand Surg.1995; 20A(4): 671-5.
  19. Choi D, Niedenfu Venieratos.hr MR, Vazquez T, Parkin I , Sanudo JR . Patterns of connections between the muculocutaneous and median nerve in the axilla and arm.Clin Anat.2002; 15:11-7.
  20. Kaur N and Singla RK. Different types of communications between musculocutaneous nerve and median nerve- A Cadaveric Study in North Indian Population.Cibtech J 2013;2(1):21-8.
  21. Gopal K, Anurag, Singh O.  Anatomical variations of brachial plexus: anomalous branching pattern.Int J Res Med Sci.2016;4(8):3376-80.
  22. Sannes HD, Rey TA, Harris W. Axon growth and guidance.  New York: Academic Press; pp. 189–97.
  23. Rao PVVP, Chaudhary SC. Communication of the musculocutaneous nerve with the median nerve.East African Med J.2000;77(9): 498-503.
  24. Sisson S, Grossman JD .In: Anatomy of the domestic animals.4th edi London: Charles E. Tuttle;1961: 835-75. Cited by Rao PVVP, Chaudhary SC. Communication of the musculocutaneous nerve with the median nerve.East African Med J.2000;77(9): 498-503.
  25. Miller RA. Comparative studies upon the morphology and distribution of the brachial plexus. Am J Anat. 1934;54:143–75.
  26. Pick J. The autonomic nervous system.In: Morphological comparative, clinical and surgical alternate sympathetic pathways. Philadelphia, JB.Lippincott;1970.p

Cite this article: Rimple Bansal, Rajan Kumar Singla, Subhash Kaushal, Apurba Patra. VARIANT PATTERNS OF BRACHIAL PLEXUS – A CADAVERIC STUDY IN NORTH INDIAN POPULATION. Int J Anat Res 2018;6(1.3):4987-4993. DOI: 10.16965/ijar.2017.532