ABSTRACT
Median nerve is one of the commonly involved nerves in peripheral neuropathy of the upper limb. Peripheral neuropathies may occur due to various intrinsic (medical conditions like diabetes mellitus & Guillian Barre syndrome) and extrinsic (nerve entrapment) causes. This study reports an unusual course of median nerve which can be considered as cause of such entrapment neuropathy. During routine MBBS dissection on a 76 years old male cadaver unusual formation and variant course of median nerve was noted. In present study unusual relation of the medial root of median nerve with axillary artery was found at the origin and secondly the nerve was found coursing under the musculo-aponeurotic band located on the antero-medial side of lower one-third of the right arm. These observations are important as the aponeurotic band may compress the median nerve and may results in entrapment neuropathy. The comprehensive knowledge of possible variant anatomical relations of median nerve are of great importance to understand the cause of symptoms and to facilitate early diagnosis and prompt management of patient presenting with median nerve compression.
ABSTRACT
Background: The extensor musculature of the forearm and hand shows diverse variations. These can lead to various clinical conditions. Case Report: During routine cadaveric dissection, variations were observed in the muscles of extensor compartment of the forearm. Their anatomical relations were documented and the embryological basis and clinical importance was stressed upon. During routine cadaveric dissection in a formalin fixed 58 year old male cadaver, variations in the posterior compartment of the left forearmwere noted,measured and appropriately photographed. Observations: In the posterior compartment of the left forearm an accessorymusclewas found originating from the posterior surface of ulna, just distal to the origin of extensor indicis. It traversed along with the tendons of extensor digitorum and extensor indicis in a common compartment underneath the extensor retinaculum and inserted onto the dorsal surface of the base of the proximal phalanx lateral to the tendon of extensor digitorum for the middle finger. Also, the extensor digitorum muscle divided only into three tendons instead of four- one each for the index,middle and ring finger. The three tendons inserted normally via the dorsal digital expansion but, the tendon for the ring finger gave an additional slip on the ulnar aspect, which inserted separately onto the base of the proximal phalanx of the ring finger. Conclusion: Muscles in the extensor compartment of forearm may show diverse variations which have clinical relevance. Accessorymusclesmay be confused with soft tissue conditions like a ganglion. Supernumary tendons can be utilised for tendon transfers andmuscle grafts. These variationsmust be brought to the knowledge of the surgeons performing hand surgeries.
ABSTRACT
During routine dissection of upper extremity in a 55-year-old male cadaver we noted a rare variation in the branching pattern of the axillary artery on the left side. The second part of the axillary artery was the source of all the branches of the axillary artery which arise normally from second and third part. The third part of axillary artery was related to the branches of brachial plexus and without giving any branches continued as brachial artery at the lower border of teres major. This finding has an embryological basis and clinical relevance. These variations in the branching pattern of axillary artery may be due to deviation in the development of the vascular plexus of the limb bud. Awareness of variation of axillary artery may serve as a guide for both radiologists and vascular surgeons. During surgeries for lymph nodes in the axilla and pectoral region, presence of such variations must be kept in mind.
ABSTRACT
Anatomical variations in the region of axilla and pectoral region are very common. These variations need attention to avoid complications arising during surgeries and diagnostic and interventional invasive procedures in this region such as surgeries for breast carcinoma, venous access during central venous line, pacemaker and cardiac defibrillator implantation etc. During routine cadaveric dissection we had noticed a rare variation of axillary vein and artery. In this case axillary vein, just deep to the inferior border of pectoralis minor was pierced by the lateral thoracic artery, a branch of axillary artery. Perforation of the axillary vein by a branch of the axillary artery is extremely rare variation encountered till now. We report a variation wherein the lateral thoracic artery a branch of the second part of axillary artery was unusually long and perforated the axillary vein, just posterior to the inferior border of pectoralis minor muscle before supplying the structures in the anterolateral chest wall. Histological findings revealed duplication of lumen at the site of perforation through which the lateral thoracic artery was passing and the surrounding area was sealed by the connective tissue. Sound knowledge of anatomy of axillary and pectoral region may help in reducing complications while doing surgical and diagnostic procedure in these regions.
Las variaciones anatómicas en las regiones axilar y pectoral son muy comunes. Estas variaciones necesitan atención para evitar las complicaciones que surgen durante las cirugías y los procedimientos invasivos de diagnóstico e intervención en esta región, tales como cirugía de cáncer mamario, acceso venoso para una vía venosa central, implantación de marcapasos y desfibrilador, etc. Durante una disección de rutina se evidenció una variación poco frecuente de la vena axilar y arteria axilar. Se presenta una variación en que la arteria torácica lateral, rama de la segunda parte de la arteria axilar, inusualmente larga, perforaba la vena axilar, justo por detrás del margen inferior del músculo pectoral menor, antes de irrigar a las estructuras de la pared torácica anterolateral. La histológía reveló la duplicación del lumen en el sitio de perforación a través del cual pasa la arteria torácica lateral, que periféricamente fue sellada por tejido conectivo. La perforación de la vena axilar por una rama de la arteria axilar es una variación que raramente se observa, por eso un buen nivel de conocimientos de la anatomía de las regiones axilar y pectoral puede ayudar a reducir las complicaciones cuando se realizan procedimientos quirúrgicos y de diagnóstico en estas regiones.