The Innervation Of Brachialis Muscle By Radial Nerve In Gujarat Region - A Human Cadaveric Study

Background: Though the supply to the human brachialis muscle by radial nerve has been investigated by manyauthors in past, but there is no consistency in these reports. The aim of the present study was to record theanatomical variations in radial nerve supply to the brachialis muscle.Materials and Methods: The material of the study consisted of 62 superior extremities obtained from dissectionlaboratory of department of anatomy, Medical College Baroda (Gujarat). All these extremities belonged to adultcadavers of known sex.Human brachialis muscle was identified with its proximal and distal attachment. The radial nerve branchinnervating to brachialis was identified and parameters like presence or absence of radial nerve branchinnervating to brachialis; number of branches; its length; site of emergence and its distance from lateral epicondyleand site of entry into brachialis were noted.Result: Brachialis muscle was innervated by a branch from radial nerve in 87.09% of cases. Varying number ofradial nerve branches (1 to 3) innervated the brachialis muscle. Most of these branches (91.93%) entered thelower one third of the muscle. The average length of these muscular branches was 9.17mm. The average distancefrom the site of emergence to the lateral epicondyle of humerus was 6.54 cm.Conclusion: Significant variations in supply of brachialis muscle were recorded. These variations are of clinicalimportance for surgeons, orthopaedicians and anaesthetists.

Study Of Brachialis Muscle: Additional Slip And Its Clinical Significance

Background: Brachialis is a muscle of anterior compartment of arm. It has two heads. Superficial head insertinginto ulnar tuberosity innervated by musculocutaneous nerve, the deep head inserts into coronoid process ofulna and supplied by radial nerve. Neuromuscular compression due to presence of additional slip of brachialisforms the basis of this study.Materials and methods: Study was done in 60 adult human cadaveric upper limbs of both the sides irrespectiveof sex in the Department of Anatomy, Kempegowda institute of medical sciences (KIMS), Bangalore and othermedical colleges nearby. Presence of additional slips of brachialis with important and interesting relations wasfound which were comparable with previous studies. As qualitative method was done, Descriptive statisticswere utilized.Results: Additional slips were present in 21.6%. It was found mainly in the left upper limbs in 69.2% and rest30.7% are present in right side limbs. Among 13 specimens, additional slips originated mainly from theanteromedial aspect in 84.6% and in 15.3% it originated from the anterolateral aspect of main brachialis.Additional slips were innervated mostly by the musculocutaneous nerve in 69.2%, median nerve in 15.3% andradial nerve in 7.6%. No innervation was observed in one specimen.Conclusion: Knowledge of additional slips and its origin and course is very important for identifying the causefor neurovascular symptoms due to compression of neurovascular structures

Accessory Branch Of Median Nerve: An Anatomical Variation In The Innervation Of Brachialis Muscle With Its Clinical Implications

The median nerve (MN) is widely known among Anatomists to innervate the forearm. It usually gives out a branchto the Pronator Teres muscle as it enters the arm, while the muscles of the anterior compartment of the arm aremajorly innervated by the musculocutaneous nerve (MCN). An accessory branch of MN was noticed in the leftarm during student’s dissection of a male cadaver to innervate the lower part of the Brachialis muscle (BM). Thebranch was given out at the infero-lateral side of the nerve and it coursed lateral to the lateral brachial vein andafter small distance it disappeared into the Brachialis muscle to supply it. It is in view of the above that we areadvocating that surgeons, neurologists and anaesthists should also be conscious of these variations and bemeticulous in their efforts to interpret some of the symptoms induced by nerve lesion. This branch could be vitalin reduce Brachialis muscle palsy in event of damage to MCN.

Variant Formation And Distribution Of Median Nerve

During routine cadaveric dissection while teaching undergraduate medical students, the median nerve on theleft upper limb of a 60 year old female cadaver showed presence of an accessory lateral root arising from lateralcord of brachial plexus.It also pierced brachialis muscle in the arm before reaching cubital fossa. Knowledge ofthese variations is helpful in evaluating nerve injury and preventing complications during anaesthetic andsurgical procedures in the axilla.

Bilateral Absence Of Musculocutaneous Nerve: Report Of Two Cases

Anatomical variations involving the brachial plexus are not uncommon. Abnormal communications among thebranches of musculocutaneous nerve especially those involving the posterior division are widely reported dueto their significance in various surgical procedures performed in this region. During the routine gross anatomicaldissection, we observed the bilateral absence of musculocutaneous nerve in two male cadavers aged 60 and 65years and the muscles of anterior compartment of arm were innervated by the braches from the Median nerve. Incase 1, it was observed that in the right and left arm, branches from the median nerve supplied the muscles of theanterior compartment namely the coracobrachialis, biceps brachii and brachialis. The branch which innervatedthe brachialis muscle later continued as lateral cutaneous nerve of forearm. In case 2, Absence of MCN observedbilaterally wherein right arm, wherein, a single branch from median nerve supplied the coracobrachialis muscle.Another branch from the median nerve, after passing through the lower end of coracobrachialis, divided into anoblique and a vertical branch which supplied the biceps brachii and brachialis respectively. These anatomicalvariations in the course of musculocutaneous and median nerve should be considered during surgical proceduresand while performing nerve conduction studies.

Clinical and radiological characteristics of hemiplegic arm raising related to yawning in stroke patient / 解放军医学杂志

Objective To investigate the clinical and radiological characteristics of parakinesia brachialis oscitans (PBD) related to yawning in stroke patient and its mechanism.Methods We reported 4 patients with involuntary raising of the paralyzed limbs when yawning in neurological unit of Hainan Branch of Chinese PLA General Hospital,and analyzed their clinical characteristics together with published cases in literatures.Results In this group of stroke patients,when they yawned,their paralyzed upper limb could lift upward involuntarily.Totally 22 patients with ischemic (n=20) and hemorrhagic (n=2) stroke were enrolled.Brain imaging showed infarcts in the middle cerebral artery (MCA) in 17 patients and in the brain stem in 5 patients.This phenomenon occurred 4 hours to 4 months (14.57 ± 31.66d) after stroke onset,and lasted from 1 week to 3 years (6.70 ± 11.66 months).Corticobulbar tract and pyramidal tract were both damaged in these 22 patients.The mechanism might be that after corticobulbar tract and pyramidal tract damaged,their dominant role in the cranial nerve nuclei of the brainstem and the anterior horn cells of the spinal cord disappeared,and the projection of oxytocinergic neurons from paraventricular nucleus functions,thus causing yawning and muscle contraction.Conclusion PBO may be a rare phenomenon of abnormal movement after stroke.This phenomenon indicates damaging of pyramidal tract,and PBO disappears gradually with the recovery of pyramidal tract function.

Two unreported cartilagines sesamoidea in the elbow of the dog / Dos cartílagos sesamoideos no reportados en el codo del perro

Two unreported sesamoid cartilages were found inside tendon of insertion of both muscle biceps brachii and muscle brachialis in the dog. This find adds remarkable facts envolving Anatomy, Comparative Anatomy and Clinic and Biomechanics of the elbow joint in the dog. Statistics also emphasize the importance of traumatological incidences on elbow joint in veterinary.

Dos cartílagos sesamoideos no reportados se encontraron en el interior del tendón de inserción de los músculos bíceps braquial (M. Biceps brachii) y Braquial (M. Brachialis) en el perro. Este hallazgo se suma a importantes hechos que comprometen la Anatomía, Anatomía Comparada, Clínica y Biomecánica de la articulación del codo en el perro. Además, la casuística veterinaria también hace hincapié en importantes incidencias traumatológicas en dicha articulación.

Neurotization of free gracilis transfer with the brachialis branch of the musculocutaneous nerve to restore finger and thumb flexion in lower trunk brachial plexus injury: an anatomical study and case report

OBJECTIVE: To investigate the feasibility of using free gracilis muscle transfer along with the brachialis muscle branch of the musculocutaneous nerve to restore finger and thumb flexion in lower trunk brachial plexus injury according to an anatomical study and a case report. METHODS: Thirty formalin-fixed upper extremities from 15 adult cadavers were used in this study. The distance from the point at which the brachialis muscle branch of the musculocutaneous nerve originates to the midpoint of the humeral condylar was measured, as well as the length, diameter, course and branch type of the brachialis muscle branch of the musculocutaneous nerve. An 18-year-old male who sustained an injury to the left brachial plexus underwent free gracilis transfer using the brachialis muscle branch of the musculocutaneous nerve as the donor nerve to restore finger and thumb flexion. Elbow flexion power and hand grip strength were recorded according to British Medical Research Council standards. Postoperative measures of the total active motion of the fingers were obtained monthly. RESULTS: The mean length and diameter of the brachialis muscle branch of the musculocutaneous nerve were 52.66±6.45 and 1.39±0.09 mm, respectively, and three branching types were observed. For the patient, the first gracilis contraction occurred during the 4th month. A noticeable improvement was observed in digit flexion one year later; the muscle power was M4, and the total active motion of the fingers was 209°. CONCLUSIONS: Repairing injury to the lower trunk of the brachial plexus by transferring the brachialis muscle branch of the musculocutaneous nerve to the anterior branch of the obturator nerve using a tension-free direct suture is technically feasible, and the clinical outcome was satisfactory in a single surgical patient.

Topographic and biometric study of radial nerve branches to the muscles of the anterior compartment of the arm / Estudio topográfico y biométrico de los ramos del nervio radial para los músculos del compartimiento anterior del brazo

The radial nerve is a terminal branch of the brachial plexus that innervates the entire posterior compartment of the upper limb. Researches have shown that the branches can contribute to innervation of the muscles from the anterior compartment of the arm. This study sought to identify branches of radial nerve for brachialis and coracobrachialis muscles and its clinical value during surgery. Dissection was performed in 60 arms, from 30 corpses selected from the Human Anatomy Laboratories of Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL). In each arm, three segments of the same proportion were considered (proximal, middle and distal) in order to observe the number of radial nerve branches to brachialis and coracobrachialis muscles. Branches were identified in 4 of the 60 upper limb (6.66%) with the following distribution: nerve with 1 branch to the brachialis muscle in the distal third (1.66%); with 1 branch to the middle third of the coracobrachialis (1.66%) and 5 branches to the coracobrachialis muscle in the proximal third; 1 branch being found in an upper limb (1.66 %) and 4 branches in the other upper limb (1.66 %). The event was not bilaterally in the same body, and in four cases there was no branching, but only communication with other terminal nerves of the brachial plexus. In conclusion, although most authors do not describe the possibility of the occurrence of radial nerve branches to the muscles of the anterior compartment of the arm, this condition exists as an anatomical variation.

El nervio radial es un ramo terminal del plexo braquial que inerva el compartimiento posterior del miembro superior. Diversos estudios han mostrado que sus ramos pueden contribuir a la inervación de los músculos del compartimiento anterior del brazo. El presente estudio tuvo como objetivo identificar ramos del nervio radial dirigidos a los músculos braquial y coracobraquial y su importancia clínica durante las cirugías. Para ello, se disecaron 60 brazos de 30 cuerpos formolizados en los Laboratorios de Anatomía Humana de la Universidad Estadual de Ciencias de la Salud de Alagoas, Brasil (UNCISAL). En cada brazo, se consideraron tres partes de similares proporciones (proximal, medio y distal) para localizar los ramos dirigidos a los músculos mencionados. En 4 de los 60 brazos (6,66%) se identificaron ramos con la siguiente distribución: un ramo para el músculo braquial en el tercio distal (1,66%); un ramo para el tercio medio del músculo coracobraquial (1,66%) y cinco ramos para este mismo músculo en su tercio proximal; en otro miembro (1,66%)se encontró solo un ramo y en la otra muestra (1,66%) se encontraron cuatro ramos. Ninguno de los casos fue bilateral y en los cuatro casos no había ninguna ramificación. No hubo comunicación con el nervio musculocutáneo pero si con otros ramos del plexo braquial. Aunque la mayoría de los autores no describe la posibilidad de que el nervio radial inerve a los músculos anteriores del brazo, esta disposición existe como una variación anatómica.

Anomalous Branches of Median Nerve In The Arm.

Background: Dissection of right and left upper limbs and demonstration of the origin and the course ofmedian nerve. Result: Median nerve in the right upper limb is formed normally but it supplies brachialis muscle and both head of the biceps in the armwhich is anomalous. In the left arm of the patient the course and supply of median nerve is normal. Conclusion: The patient has unilateral anomalous supply of median nerve in the arm – this can result in trauma to this nerve while undergoing any surgery in right arm.

Morphology of Brachialis Muscle: Variations and Clinical Significance.

Background: Though rare but variations of brachialis muscle insertion have been reported. Material and Methods: The study was conducted on 115 upper limbs over a period of 4 years. The dissection of arm and forearm was done carefully to preserve all minute details ,observing the morphology of insertion pattern and nerve supply. Observation: Out of 115 specimens, 2 specimens showed insertion of brachialis into bicipital aponeuroses. Accessory slips were seen in 4 specimens which are mixed with main fibers at insertion point. Rarest of all was insertion of an accessory brachialis muscle on radial tuberosity in 2 specimens. The muscle originated from lateral border of shaft of humerus and shared a few fibers with main Brachialis muscle. The muscle was inserted into radius just below the radial tuberosity. Conclusion: The identification of an inter-nervous plane may allow for improvement in the current anterior and anterolateral surgical approaches to the humerus. This could be one of a possible etiology of Radial tunnel syndrome.

Acute Brachialis Tear and Hematoma Caused by Closed Acute Elbow Posterior Dislocation / 대한스포츠의학회지

This report was designed to investigate a rare case that brachialis tear and hematoma caused by acute elbow posterior dislocation. We studied a 20-year-old male patient with right elbow joint pain after outstretched injury. Physical examination showed instability of hright elbow joint and simple radiography indicated a posterolateral dislocation of right elbow joint. Computed tomography taken after closed reduction using Parvin technique revealed a few small bone fragment located on posterior humerus capitulum. Magnetic resonance imaging showed complete tear of brachialis and anterior articular capsule with hematoma. The patient was managed with long arm splint and hinge brace for an elbow dislocation with brachialis rupture and hematoma. The elbow joint range of motion was recovered to be in a normal range, and pain was diminished. There are few reported cases of acute elbow posterior dislocation combined with brachialis rupture and hematoma. The patient showed good clinical outcome after conservative treatment.

Clinical and functional significance of accessory brachialis muscle: an unique anatomical variant / Significado clínico y funcional del músculo braquial accesorio: una variante anatómica única

A thorough knowledge of the variations in the patterns of muscle insertion and the consequent neurovascular entrapment due to them is important for orthopedic and plastic surgeons. During routine dissection, we encountered a unique occurrence of an accessory brachialis muscle (acBr) blending with the medial aspect of bicipital aponeurosis in the cubital fossa. It also entrapped the median nerve and brachial artery due to its superficial position. The abnormality reported here might result in neurovascular compression symptoms in the upper limb and possible mechanical advantages or disadvantage in the flexion of elbow joint. To the best of our knowledge, the brachialis variant insertion we present here is rare in the list of its anomalies. We also discuss in this report the embryological background and the clinical application of the variation that can abet clinicians in evaluating symptoms involving the upper limb.

Es importante para los cirujanos ortopédicos y plásticos, el conocimiento integral de las variaciones en los patrones de inserción de los músculos y el consiguiente atrapamiento neurovascular. Durante una disección de rutina, encontramos un caso único de un músculo accesorio braquial con aponeurosis bicipital en el lado medial de la fosa cubital. También cubre la arteria braquial y nervio mediano debido a su posición superficial. La anomalía informada aquí podría resultar en síntomas de compresión neurovascular en el miembro superior y las posibles ventajas o desventajas mecánicas de flexión de la articulación del codo. De acuerdo a lo estudiado, la inserción variante braquial que presentamos aquí es un caso raro dentro de la lista de sus variaciones. También se discuten en este informe la base embriológica y la aplicación clínica de la variación que puede ser útil para los clínicos en la evaluación de los síntomas relacionados con el miembro superior.

Sub-Brachialis Course of the Median Nerve in the Arm and its Possible Clinical Complications: A Case Report

The median nerve in its normal course in the arm crosses the brachial artery from lateral to medial side. It then passes superficial to the brachialis muscle and then enters the cubital fossa. During routine cadaveric dissection of the right upper limb, an unusual variation in the course of the median nerve was observed. The median nerve in the arm crossed the brachial artery from medial to lateral side and passed deep to the brachialis muscle. It then emerged from beneath the brachialis muscle and entered the cubital fossa. In the cubital fossa, it ran medial to the brachial artery as the normal course of the nerve. Further distribution of median nerve in the forearm and hand was observed to be normal. The anomaly reported here may result in the compression of the median nerve deep to the brachialis and hence resulting in mechanical disadvantages in the flexion at the wrist joint.

Doble inervación del músculo braquial en la población chilena / Dual innervation of the brachialis muscle in the Chilean population

La doble inervación del músculo braquial está dada por el nervio musculocutáneo y por ramos provenientes del nervio radial según lo describen algunos textos anatómicos y numerosos trabajos científicos. Sin embargo, no existe consenso en la frecuencia con la que ésta se presenta. El objetivo de este estudio es verificar la presencia y determinar la frecuencia de la contribución del nervio radial en la inervación del músculo braquial. En el presente trabajo se utilizaron 30 miembros superiores previamente fijados con solución fijadora y conservadora. Se realizó disección de la región braquial para determinar la presencia de ramos del nervio radial inervando al músculo braquial, verificando la presencia de ramos que penetraban en el músculo y tomando muestras de estos ramos en el sitio donde perforaban al músculo para su estudio histológico. Fue posible observar la presencia de ramos del nervio radial que penetraban en el músculo braquial en un 90 porciento de los casos; en ellos el punto motor de estos ramos se ubicó siempre en el tercio distal del músculo. De acuerdo a los resultados obtenidos en el presente trabajo, la doble inervación del músculo braquial observada por autores clásicos y reportada en estudios en diversas poblaciones, está presente en alto porcentaje de la muestra. Estos hallazgos pueden servir de referencia para procedimientos quirúrgicos, estudios electromiográficos y sonográficos.

The dual innervation of the brachialis muscle by the musculocutaneos nerve and branches from the radial nerve has been described by some anatomical texts and several scientific papers; however, there is no consensus about the frequency with which this occurs. In this study we proposed to check the presence and determine the frequency of the contribution of radial nerve in the innervations of the brachialis muscle. In this study we used 30 upper limbs fixed in fixative and conservative solution. Dissection of the brachial region was carried out, checking the branches that penetrated the muscle and taking samples of these branches to histological study. It was possible to observe the presence of branches of the radial nerve innervating the brachialis muscle in a 90 percent of the sample used in this study; the motor point of these branches was always located in the distal third of this muscle. According with the results of this study, the dual innervations of the brachial muscles observed by classical authors and reported by several investigations is also present in a high percentage of the sample. These findings can serve as reference for surgical procedures, electromyographic and ultrasound studies.

Median Nerve Branch Innervating the Brachialis Muscle: A Case Report / 체질인류학회지

We observed a slender nerve branch of the lateral root of the median nerve innervating the brachialis muscle, which is normally innervated by the musculocutaneous nerve, at the left arm of a Korean male (age, 74 years). The present nerve branch was accompanied with the communicating branch between the median and musculocutaneous nerves and supplied to the medial inferior portion of the brachialis muscle. The spinal root origins of this branch were C5 and C6. The nerve fiber number of the nerve branch innervating the brachialis muscle was 328. This variation may be very rare case and was different from previous observation.

Ruptura bilateral do tendão proximal do músculo bíceps braquial e distal de único tendão do mesmo músculo em atleta: relato de caso e revisão de literatura / Bilateral rupture of the proximal tendon of the biceps brachii muscle and distal tendon of the same single muscle in athletes

Os autores apresentam um caso raro de ruptura do tendão proximal e distal do bíceps braquial em atleta que fez uso da esteroide anabolizante por um determinado período de tempo e comentam os aspectos relacionados com quadro clínico, diagnóstico e tratamento destas lesões.

Anatomical Locations of the Motor Points of the Biceps Brachii and Brachialis Muscles

OBJECTIVE: To identify the range of the precise locations of the motor points of biceps brachii and brachialis muscles in relation to bony landmarks. METHOD: Nine upper limbs of five male cadavers were dissected. The number and location of the motor points from the musculocutaneous nerve to biceps brachii and brachialis muscles were identified in relation to the bony landmarks. Bony landmarks were coracoid process and lateral epicondyle of the humerus. The length of the arm was defined as the distance from the apex of the coracoid process to the lateral epicondyle of humerus. The locations of the motor points were expressed as the percentage ratio of the length from the coracoid process to the motor points in relation to the length of the arm. RESULTS: First proximal motor points of the long head, short head of biceps brachii, and brachialis were located in 47.5 5.6%, 53.0 4.6%, 64.3 3.4% and second proximal points of them were 51.8 2.9%, 57.7 3.5%, 68.5 4.4% respectively. CONCLUSION: The identification of the locations of motor points related to the bony landmarks would increase the accuracy and ease of the motor point blocks to elbow flexors such as biceps brachii and brachialis muscles.

The Muscular Branch of the Radial Nerve to the Brachialis Muscle in Korean / 체질인류학회지

Most textbooks describe the brachialis muscle is innervated by the musculocutaneous and radial nerves. This study was performed to clarify the incidence and morphology of the branch of the radial nerve to the brachialis muscle. Eighty sides of 40 adult Korean cadavers were used in this study. The incidence of the radial nerve to the brachialis muscle was 75% of 80 sides and the radial nerve was innervated bilaterally in 65% (26 sides). The number of the branch arising from the radial nerve was one (65%), two (31.7%) or three (3.3%). The average distance from the lateral epicondyle to the branch arising from the radial nerve was 68.5 mm (range: 4 ~126 mm). The brachialis muscle received a branch from radial nerve, through a descending branch (58.5%), a transverse branch (26.8%) or an ascending branch (14.6%). A branch of the radial nerve was usually divided into one or two branches (79.3%) before piecing the brachialis muscle. The average distance from the lateral epicondyle to the perforating point of the branch was 52.4 mm (range: 3 ~123 mm). The branch of the radial nerve penetrated inferior and middle third of the brachialis muscle in 44.2% and 53.2% respectively.