Three headed Biceps brachii with variant communication between median and musculocutaneous nerve.pdf (original) (raw)
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Unusual Variation of the Biceps Brachii with Possible Median Nerve Entrapment
Prague Medical Report, 2015
The biceps brachii is one of three muscles of the anterior compartment of arm. Variations of the biceps brachii are not rare. The most frequent is the existence of a third head called the humeral head by Le Double (1897) (Rodríguez-Vázquez et al., 1999). Our article is based on the unexpected result of a routine dissection class held for medical students. Dissection was performed according to the guidelines accepted by the anatomy department (Seichert, 1999). We describe a third (accessory) head of the biceps brachii. In addition of two regular heads, the third head originated together with the short head from the coracoid process and had three insertions on the humerus after enfolding the median nerve and the brachial artery. This particular variation is important from a clinical perspective as the third head may cause entrapment syndrome of the median nerve and hypoperfusion of the upper limb due to compression of the brachial artery.
Surgical and Radiologic Anatomy, 2010
A three-headed biceps brachii muscle was found in one male cadaver out of 118 (0.85%) studied, both for educational and research purposes. The supernumerary head of the biceps brachii muscle was located superficially to the normal heads. It was originated from the insertion of the pectoralis major tendon at humerus. At the lower third of the arm, it was merging with the normal biceps brachii muscle and as a conjoint tendon was inserted at the radial tuberosity. The significance of our finding lies on the fact that the location of the supernumerary head was superficial to the other two heads, in contrast to previous reports in the literature. Surgeons and especially orthopaedic surgeons should bear in mind muscular variations like the one reported in the present study.
Journal of Morphological Sciences, 2019
Many authors have reported and classified several anatomical variations between the musculocutaneous (Mc) and median (Me) nerves, regarding their origin, number, and proximity with the coracobrachialis muscle. There also are, in the scientific community, records classifying the origin of supernumerary heads of the biceps brachii muscle. However, the occurrence of both aforementioned variations in the same arm is very uncommon. During a routine dissection of the right upper limb of a male cadaver, a third head of the biceps brachii was found originating from the fibers of the brachialis muscle, as well as a communicating branch between the Mc and the Me nerves, in the same limb. The objective of the present case report is to describe these multiple variations found, relating them and discussing their relevant clinical implications.
Academia Anatomica International, 2019
Introduction: To determine the incidence and gross morphology of additional head of biceps brachii in the Indian population, and to note concurrent musculocutaneous nerve variations. Subjects and Methods: One hundred and twenty upper limbs (males-100, females-20) from 60 formalin-embalmed cadavers were utilized for the study. Results: The additional heads were found in 11 cadavers. Third head was present in 16.6% and fourth head in 1.7%. The variation was unilateral in 72.7% and bilateral in 27.3% cadavers. Out of 120 limbs, 14 had additional head, and 71.4% of these were left-sided. In 73.3%, additional head joined with tendon and with the belly of BB in 26.7%. Three types of origin: anterolateral, posteromedial and high humeral were observed in 60%, 26.7% and 13.3%, respectively. The additional muscle was 11.7 ± 3.9 cm in length. The mean length on the right and left sides was 9.8 ± 3.3 cm and 12.4 ± 3.9 cm, respectively. Incidence of concurrent additional head and musculocutaneous variations was 42.8%. The nerve variations were unilateral with 80% on the left, and ipsilateral to additional muscle. Conclusion: The incidence of additional head in biceps brachii is 18.3% in the Indian population. Most common presentation is of a left-sided third head, and musculocutaneous variants occur on the same side as additional muscle. Presence of extra head should be considered during the analysis of the diagnostic scans, and awareness of the associated musculocutaneous nerve variations would be helpful in avoiding complications during surgical interventions.
International Journal of Morphology, 2006
RESUMEN: Durante una disección de rutina de la región anterior del brazo, se observó una relación anormal del nervio mediano con una cabeza accesoria del músculo bíceps braquial, en un miembro superior derecho de un cadáver masculino. Mientras que las cabezas larga y corta tuvieron un origen normal, una tercera cabeza se originó de la superficie anteromedial de la parte superior del cuerpo humeral. Algunas fibras de esta cabeza accesorias, se originaron del lado medial de la fascia profunda que rodea al músculo braquial. Las fibras cruzaban al nervio mediano superficialmente, antes de unirse a la tercera cabeza, la cual se insertó a través de un tendón común con las cabezas larga y corta. El conocimiento de tales variaciones es de importancia tanto para anatomistas o clínicos, así como esencialmente para cirujanos plásticos en las cirugías, que se usan colgajos.
2007
Communication between different branches of the brachial plexus is a common phenomenon that has several clinical and surgical implications. Forty-eight upper extremities were dissected to investigate the communication between median and musculocutaneous nerves. The cadavers were fixed in a mixture of four fixatives through femoral canulation. Communications were observed in two of the left arms. Their points of origin and course were evaluated. One of the biceps brachii muscles possessed an accessory head originating from the anterior surface of the left humerus. These anatomical variations are of crucial importance in brachial plexus block in the upper arm.
Surgical and Radiologic Anatomy, 2011
Unusual neural and muscular variations in the right upper limb were noted during anatomical dissection of a 54-year-old male cadaver. The absence of the musculocutaneous nerve was correlated with a three-headed biceps brachii muscle. The distribution of muscular branches innervating the anterior compartment of the muscles of the arm was diVerent to the cases described in literature hitherto. This report contains a comparison of various instances where the musculocutaneous nerve is absent. We discuss the embryological explanation for this anomaly and its clinical results. It is important to be aware of such possible anatomical variations during clinical practice.
Three-headed biceps brachii muscle associated with duplicated musculocutaneous nerve
Clinical Anatomy, 2005
A unilateral three-headed biceps brachii muscle coinciding with an unusual variant of the musculocutaneous nerve was found during routine dissection of a 79-year-old male cadaver. The supernumerary bicipital head originated from the antero-medial surface of the humerus just beyond the insertion of the coracobrachialis, and inserted into the conjoined tendon of biceps brachii. Associated with this muscular variant was a duplicated musculocutaneous nerve. The proximal musculocutaneous nerve conformed to the normal pattern only in its proximal part, and terminated after innervating the coracobrachialis and biceps brachii muscles. The distal musculocutaneous nerve arose from the median nerve in the lower arm, then passed laterally between the supernumerary bicipital head and the brachialis muscles, supplying both and terminating as the lateral cutaneous nerve of the forearm. The supernumerary bicipital head and the accompanying anomaly of the musculocutaneous nerve seem to be unique in literature.
An anatomical study of the third head of biceps brachii muscle and its innervations
Introduction: Biceps brachii muscle is the double headed flexor muscle of anterior compartment of arm, showing most common anatomical variation. Objective: To study the morphological variation of biceps brachii muscle along with its innervations. Method: 42 upper extremities of 21 formalin fixed cadavers used during routine dissection in anatomy department of LMC were studied. Biceps brachii muscles were examined for their attachments, number of heads of origin, level of fusion of muscle bellies and innervations. Appropriate photographs were taken. Result: Out of 42 upper extremities of 21 cadavers third head of biceps brachii muscle was found in two right upper extremities (9.52%). One of the specimens had dual nerve supply from musculocutaneous and median nerve where as in another specimen third head was innervated only by musculocutaneous nerve. Conclusion: Knowledge of additional head of biceps brachii is important for surgery of the fracture of shaft of humerus. Keywords: biceps brachii, third head of biceps brachii, musculocutaneous nerve, median nerve.