Clinicoembryological Submission of Unusual Variation in Course and Branching Pattern of Lateral Cord of Brachial Plexus – A Case Report

Variations are commonly observed and being reported in the formation of lateral cord of brachial plexus and in the communicationof branches of lateral cord of brachial plexus, but formation of median nerve by lateral root of median nerve from lateral cord andmedial root of median nerve from medial cord at a substantially low level is quite unusual and the case reports regarding piercingof the coracobrachialis by lateral cord of brachial plexus are infrequent. The present case report describes an unusual unilateralcourse of lateral cord piercing the coracobrachialis and ensuing path followed by its various branches as well as unusuallylow-level formation of median nerve from lateral and medial roots coming from the lateral and medial cord of brachial plexus,respectively. This was witnessed in the infraclavicular part of the brachial plexus during the routine gross anatomy dissectionof the left upper extremity in a 35-year-old Indian male cadaver. Since axilla and upper half of the arm are challenging areasfor surgical procedures, so the unusual variations being reported in this case may help the surgeons of different specialties inexploration of neuronal tumor, shoulder reconstructive surgery shoulder arthroscopy, and using the coracobrachialis flap fordifferent surgical purposes.

What is wrong with the MCI.

n the wake of the Medical Council of India’s (MCI) take on the promotion of faculty recently, it is clear that the faculty of medical institutions across the country are in a state of alarm. A situation in which the whole onus of research is put on the faculty is quite quirky when there is no consideration of the fact that most medical colleges in India do not have a system of intramural funding, apt infrastructure and a pertinent environment for carrying out good research.

Classification and fascicular analysis of variant branching pattern of femoral nerve for microsurgical intervention: a series of thirteen cadavers / Clasificación y análisis fascicular de las variantes en el patrón de ramificación del nervio femoral en intervenciones microquirúrgicas: una serie de 13 cadáveres

Femoral neuropathy associated with lower limb is treated by surgical intervention through activation/regeneration/grafting of nerve fibers by a nerve cuff electrode implant or neuro-prosthesis. These procedures require detailed and precise knowledge of neuro-anatomical variants of the femoral nerve and its fascicular anatomy so that the nerve injury can be investigated and treated more efficiently. The aim of the study is to uncover the variations both in the femoral nerve and its branches, to classify them and to bring out corresponding fascicular anatomy using a hypothesis based on the principle of consistency, continuity and traceability of fascicles. The study was carried out in the Department of Anatomy AIIMS Rishikesh using 13 matched lower limbs (26 femoral nerves) from 13 cadavers. The femoral nerve was exposed in the femoral triangle and traced to the posterior abdominal wall. Variations in the shape, size and course of the femoral nerve and its branches were analyzed. The fascicular arrangement was also conceptualized based on the hypothesis. Seven classes, high division, trunk anomaly, semi-scattered, scattered branching pattern, pectocutaneous, lateral cutaneous nerve of thigh and nerve to sartorius anomalies were detected. The corresponding fascicular organizations were modeled. The seven classes along with corresponding fascicular pattern will be very useful for neurosurgeons, radiologists, anesthetists and anatomists in diagnosis and treatment of femoral neuropathy.

La neuropatía femoral asociada con el miembro inferior es tratada por intervención quirúrgica a través de activación, regeneración e injerto de fibras nerviosas mediante un implante de electrodo de manguito de nervios o neuro-prótesis. Estos procedimientos requieren un conocimiento detallado y preciso de las variantes neuro-anatómicas del nervio femoral y su anatomía fascicular de modo que la lesión del nervio pueda ser investigada y tratada de manera más eficiente. El objetivo del estudio fue descubrir las variaciones tanto en el nervio femoral y sus ramas y clasificarlos a partir de la anatomía fascicular utilizando una hipótesis basada en el principio de la continuidad y trazabilidad de los fascículos correspondientes. El estudio se llevó a cabo en el Departamento de Anatomía AIIMS Rishikesh utilizando 13 miembros inferiores pareados (26 nervios femorales) de 13 cadáveres. El nervio femoral se expuso en el triángulo femoral y fue trazado en la pared abdominal posterior. Se analizaron las variaciones en la forma, tamaño y trayecto del nervio femoral y sus ramas. El patrón fascicular fue conceptulizado de acuerdo a la hipótesis planteada. Se detectaron anomalías clasificadas en: siete clases, división alta, anomalías de tronco, semi-dispersos, patrón de ramificación dispersa, pectocutáneo, nervio cutáneo lateral y nervio del músculo sartorio. Las clasificaciones junto con el patrón fascicular correspondientes serán de gran utilidad para los neurocirujanos, radiólogos, anestesistas y anatomistas en el diagnóstico y tratamiento de la neuropatía femoral.