Median Nerve Compression Caused by Brachial Pseudoaneurysm: Report of Two Cases and Review of the Literature (original) (raw)
Brachial artery pseudoaneurysm
BMJ case reports, 2014
We describe a case of an elderly man who presented with an upper arm swelling that had developed following a humeral fracture 8 months previously. The swelling was painless but associated with significantly diminished motor function of his right hand and concurrent paraesthaesia. On examination, a large pulsatile mass was identified and CT angiography confirmed the presence of an 11×7 cm brachial artery pseudoaneurysm. The patient underwent surgical repair in which a fragment of the humerus was found to have punctured the brachial artery resulting in a pseudoaneurysm. The patient had an uncomplicated postoperative period and was discharged 2 days later having regained some motor function in his right hand.
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.
Entrapment of Median Nerve by a muscular Branch of Brachial Artery: A Case Report
Variations in the arterial pattern of the upper limbs are commonly encountered in routine dissection. In-depth information of the vascular structure of the upper extremities is not only important for diagnostic interventions and surgical approaches, but has medico-legal implications. We report the unusual variation of an additional muscular branch of the brachial artery entrapping the median nerve in the middle of the arm. This anomaly was present in both upper extremities of an adult male Indo-Malaysian cadaver. The abnormality reported here might result in neurovascular compression symptoms in the upper limbs. Knowledge of the vascular dissimilarity of the brachial artery and its division, and possible neurovascular entrapment is important to surgeons and medical practitioners for anticipating nerve compression and for confirmation via motor and sensory examination.
Entrapment of the Median Nerve by a Muscular Branch of the Brachial Artery: A Case Report
Forensic Medicine and Anatomy Research, 2014
Variations in the arterial pattern of the upper limbs are commonly encountered in routine dissection. In-depth information of the vascular structure of the upper extremities is not only important for diagnostic interventions and surgical approaches, but has medico-legal implications. We report the unusual variation of an additional muscular branch of the brachial artery entrapping the median nerve in the middle of the arm. This anomaly was present in both upper extremities of an adult male Indo-Malaysian cadaver. The abnormality reported here might result in neurovascular compression symptoms in the upper limbs. Knowledge of the vascular dissimilarity of the brachial artery and its division, and possible neurovascular entrapment is important to surgeons and medical practitioners for anticipating nerve compression and for confirmation via motor and sensory examination.
Entrapment of Brachial Artery and Median Nerve within the Brachialis Muscle – A Case Report
Brachial artery and median nerve is the main neurovascular bundle of the arm. They have close relationship throughout the arm. Their entrapment may result in neurovascular symptoms in the distal part of the upper limb. We report a rare entrapment of these structures in the arm within the brachialis muscle. The brachial artery and median nerve entered the substance of brachialis at the junction of upper and middle thirds of the arm(after a course of about 8 cm). They came out through the tendon of brachialis in the cubital fossa.They coursed within the brachialis muscle for about 10 cm. There were no other variations in the arm. Knowledge of this entrapment may be useful for the orthopedic surgeons since there is a high chance of involvement of the artery and the nerve in the supracondylar fractures of the humerus.
Brachial artery pseudoaneurysm secondary to inadvertent arterial puncture
Revista argentina de cirugía, 2021
Brachial artery pseudoaneurysm secondary to inadvertent arterial puncture Los pseudoaneurismas de la arteria humeral son infrecuentes, pero pueden asociarse a complicaciones de alta morbilidad como la isquemia de miembro superior. Comunicamos un caso de pseudoaneurisma humeral en el pliegue del codo, que se presentó como tumor pulsátil con leve disminución de la temperatura y parestesias en la mano homolateral de un año de evolución, debido a una punción arterial inadvertida durante la venopunción para extracción de sangre. Se trató con éxito mediante resección quirúrgica más reconstrucción vascular con bypass húmero-cubital y bypass húmeroradial ambos con vena safena. Se discuten las diversas opciones terapéuticas disponibles para los pseudoaneurismas humerales considerando las características anatómicas y la sintomatología del paciente.
Delayed presentation of a traumatic brachial artery pseudoaneurysm
2009
Brakiyel arter psödoanevrizmasının penetran travma sonrası geç başvurusu nadiren bildirilmiştir. Bu yazıda, antekübital fossa bölgesine nafiz penetran bir travma ve arkasından da dirseğinde ani bir şişlik ve duyarlılık oluşmasından üç ay sonra başvuran 23 yaşında bir erkek olgu sunuldu. Doppler ultrasonografi ve bilgisayarlı tomografi anjiyografisi büyük bir psödoanevrizma varlığını doğruladı. Normal arteriyel dolaşımı sağlayacak şekilde araya yerleştirilen bir safen ven interpozisyon greftiyle cerrahi rekonstrüksiyon gerçekleştirildi. Anahtar Sözcükler: Brakiyel arter; gecikmiş başvuru; sahte anevrizma; penetran travma; psödoanevrizma; üst ekstremite. Delayed presentation of a brachial artery pseudoaneurysm following penetrating trauma is infrequently reported. We report the case of a 23-year-old male who presented three months following a penetrating trauma to his antecubital fossa with a sudden exacerbation of swelling and tenderness of his elbow. Doppler ultrasound and computed tomography arteriography confirmed the presence of a large pseudoaneurysm. Surgical reconstruction was performed using the long saphenous vein as an interposition vein graft, restoring normal arterial circulation.
Superficial brachial artery: a possible cause for idiopathic median nerve entrapment neuropathy
Folia Morphologica, 2017
Nerve entrapment syndromes occur because of anatomic constraints at specific locations in both upper and lower limbs. Anatomical locations prone to nerve entrapment syndromes include sites where a nerve courses through fibro-osseous or fibromuscular tunnels or penetrates a muscle. The median nerve (MN) can be entrapped by the ligament of Struthers; thickened biceps aponeurosis; between the superficial and deep heads of the pronator teres muscle and by a thickened proximal edge of flexor digitorum superficialis muscle. A few cases of MN neuropathies encountered are reported to be idiopathic. The superficial branchial artery (SBA) is defined as the artery running superficial to MN or its roots. This divergence from normal anatomy may be the possible explanation for idiopathic MN entrapment neuropathy. This study presents three cases with unilateral presence of the SBA encountered during routine undergraduate dissection at the University of Johannesburg. Case 1-SBA divided into radial and ulnar arteries. Brachial artery (BA) terminated as deep brachial artery. Case 2-SBA continued as radial artery (RA). BA terminated as ulnar artery (UA), anterior and posterior interosseous arteries. Case 3-SBA continued as UA. BA divided into radial and common interosseous arteries. Arteries that take an unusual course are more vulnerable to iatrogenic injury during surgical procedures and may disturb the evaluation of angiographic images during diagnosis. In particular, the presence of SBA may be a course of idiopathic neuropathies.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], 2016
Poor positioning of patients can result in devastating permanent neurologic deficits. We describe a previously unreported cause of median nerve compression that we have termed the brachialis syndrome, associated with patient positioning that results in permanent median nerve damage. We identified this condition affecting 6 median nerves. All patients underwent surgical decompression of the proximal median nerve at the level of the antecubital fossa. Five patients presented with symptoms of median nerve compression; 6 affected median nerves manifested brachialis syndrome after a lengthy index surgery. Every patient had a similar presentation characterized by a mixed sensory and motor deficit. Average time to symptom presentation postoperatively was 1 hour. Two patients had delayed time to decompression, one of 25 days and one of 92 days. In the additional patients, the average time to decompression was 19.7 hours. At median nerve decompression, the brachialis was found to have varyin...
An Entrapment of Median Nerve and Brachial Artery in the Arm
2017
During routine dissection for First MBBS students on a 65 years donated embalmed male cadaver in the Department of Anatomy, K. J. Somaiya Medical College, we observed that the median nerve and the brachial artery passed through the coracobrachialis muscle in the right arm. The superficial fibres of the coracobrachialis muscle were normal in their insertion i.e. on the middle 5 cm of the medial border of the shaft of the humerus. We also encountered an accessory slip of the brachialis muscle originated from anteromedial surface of the shaft of humerus and got inserted into the medial epicondyle of the humerus. The accessory slip of the brachialis muscle passed over the brachial artery and the median nerve. This may result in neurovascular compression and it may have some mechanical advantages and disadvantages during the movement of elbow joint. The knowledge of such variations were important for medical fraternity such as surgeons, orthopaedicians, neurologists, radiologists and phy...