Variations of spinal nerue compositions, which giue rise to the variable motor and sensory component, occured at the terminal branches of brachial plexus. This study performed to investigate the spinal nerve compositions of the main terminal branches of the brachial plexus in 32 sides of Korean adults. The main terminal branches contained the musculocutaneous, median, ulnar, radial and axillary nerves. The obtained results were as follows. The spinal nerve compositions of musculocutaneous nerve appeared as two types. The most frequent type was composed of C5, C6 and C7 at 75.0%. The mean diameter of C5 and C6 was 1.68+/-0.21 mm and 1.66+/-0.40 mm, respectively. The median nerve appeared as two types. The most frequent type was composed of C6, C7, C8, T1 components at 87.5%. The mean diameter of C7 was the thickest at 2.64+/-0.48 mm and C5 was most thin at 0.28+/-0.04 mm. The ulnar nerve appeared as four types. The most frequent type was comprised with C7, C8 and T1 at 75.0%. In the mean diameter, C8 was the thickest with 2.64+/-0.57mm and T1 was most thin with 0.06+/-0.56 mm. The radial nerve appeared as four types. The most frequent type was comprised from C5 to T1 at 43.7%. In the mean diameter, C7 was the thickest at 2.70+/-0.52 mm. The axillary nerve appeared as two types. The frequentest type was comprised with C5, C6 and C7 at 56.2%. In the mean diameter, C6 was the thickest at 1.73+/-0.56 mm. From the obtained results, spinal nerve compositions of the main terminal branches of the brachial plexus were more variable than the description of the anatomic textbook.
Adult ; Brachial Plexus* ; Humans ; Median Nerve ; Musculocutaneous Nerve ; Radial Nerve ; Spinal Nerves ; Ulnar Nerve

This study was carried out to evaluate the quantity of the nerve fiber of the terminal branches of the typical brachial plexus in the 6 sides of the Korean adults. The dorsal scapular nerve, which is derived from ramus of the brachial plexus, was comprised of C5 and participating nerve fiber was 355+/-180. The long thoracic nerve was composed of C5, C6 and C7, and was mainly originated from C6, and participating nerve fiber was 743+/-346. The nerves, which are branched out from trunk, nerve to subclavius muscle was composed of C5 and participating quantity was 242+/-71. The suprascapular nerve was comprised of C5 and C6, and the nerve fiber was mainly derived from C5 (1,942+/-505). The nerve, which is originated from proximal portion of the cord, the lateral pectoral nerve was constituted of C5, C6 and C7. The main component was C7 as the 2,917+/-785 nerve fiber. The medial pectoral nerve was made with C8 and T1. The main component was C8 as the 964+/-430 nerve fiber. The upper subscapular nerve was derived from C5 and C6. The nerve fiber was 1,179+/-92 in C5, mainly participated. The Lower subscapular nerve was constituted of C5, C6 and C7. C6 was the main component and contributing nerve fiber was 1,070+/-390 in C6, principal component. The thoracodorsal nerve was formed by C6, C7 and C8. The chief component was C7, contributed of 2,335+/-324. The nerves, which are came out from the distal portion of the cord, musculocutaneous nerve was derived from the C5, C6 and C7. The C6 was principal component, and was joined with 4,009+/-1,883. The median nerve was contributed from C5 to T1. The chief component was C7 added with 9,651+/-2,663. The ulnar nerve was composed of C7, C8 and T1. The C8 was the main component comprised of 10,075+/-1,473. The medial brachial and antebrachial cutaneous nerves was constituted of C8 and T1. In the both nerves, the main component was T1 participated with 1,752+/-390, 3,080+/-1,140 respectively. The radial nerve was composed of C5 to T1. The C7 was principal component added with 7,958+/-2,333. The axillary nerve was made up C5 and C6. In the nerve, the both spinal segments were similarly participated to the nerve. This results could be applied for the injuries and neurotization procedure of the terminal nerves of the brachial plexus.
Brachial Plexus ; Median Nerve ; Muscles ; Musculocutaneous Nerve ; Nerve Fibers ; Nerve Transfer ; Porphyrins ; Radial Nerve ; Spinal Nerves ; Thoracic Nerves ; Ulnar Nerve

OBJECTIVE: The purpose of this study was to determine the normal morphometric landmarks of the uniting and dividing points of the brachial plexus (BP) in the periclavicular region to provide useful guidance in surgery of BP injuries. METHODS: A total of 20 brachial plexuses were obtained from 10 adult, formalin-fixed cadavers. Distances were measured on the basis of the Chassaignac tubercle (CT), and the most lateral margin of the BP (LMBP) crossing the superior and inferior edge of the clavicle. RESULTS: LMBP was located within 25 mm medially from the midpoint in all subjects. In the supraclavicular region, the upper trunk uniting at 21 +/- 7 mm from the CT, separating into divisions at 42 +/- 5 mm from the CT, and dividing at 19 +/- 4 mm from the LMBP crossing the superior edge of the clavicle. In the infraclavicular region, the distance from the inferior edge of the clavicle to the musculocutaneous nerve (MCN) origin was 49 +/- 1 mm, to the median nerve origin 57 +/- 7 mm, and the ulnar nerve origin 48 +/- 6 mm. From the lateral margin of the pectoralis minor to the MCN origin the distance averaged 3.3 +/- 10 mm. Mean diameter of the MCN was 4.3 +/- 1.1 mm (range, 2.5-6.0) in males (n = 6), and 3.1 +/- 1.5 mm (range, 1.6-4.0) in females (n = 4). CONCLUSION: We hope these data will aid in understanding the anatomy of the BP and in planning surgical treatment in BP injuries.
Adult ; Brachial Plexus ; Cadaver ; Clavicle ; Female ; Humans ; Male ; Median Nerve ; Musculocutaneous Nerve ; Pectoralis Muscles ; Ulnar Nerve

OBJECTIVES: The primary objective of this study was to define the anatomy of the musculocutaneous nerve as it innervates the biceps and brachialis muscles in relation to nerve transfer surgery in brachial plexus injury.

METHODS: Surgical dissection of the musculocutaneous nerve of both upper extremities of 34 embalmed cadavers was performed to define the anatomy of the musculocutaneous nerve as it supplies the biceps and the brachial muscles. Among the data that we noted were the distance where the branch of the biceps and branchialis took off from the musculocutaneous nerve from the coracoids, which was the bony landmark.

RESULTS: There were 17 males and 17 females with a total of 65 musculocutaneous nerve to biceps muscle had an average distance of 10.9cm and a median of 11.0cm±1.83cm (range, 6.5-14.2 cm) from the coracoid. The branching of musculocutaneous nerve to the brachialis had an average distance of 15.1 cm and a median 15.5cm±1.72cm (range, 12.7-21.0cm) from the coracoid. Transferring the fascicles of the ulnar nerve to the biceps branch and a fascicle of the median nerve to the brachialis branch is fairly easy since both nerves are within the vicinity of respective recipient site.

CONCLUSION: The anatomy of the musculocutaneous nerve as it supplies the elbow flexors is fairly consistent and there is little discrepancy between cadaveric specimens. Human ; Male ; Female ; Musculocutaneous Nerve ; Ulnar Nerve ; Median Nerve ; Elbow ; Nerve Transfer ; Elbow Joint ; Brachial Plexus ; Embalming ; Cadaver

During the routine gross anatomical dissection, bilateral absence of the musculocutaneous nerve and unilateral brachioradial artery were found in a 76-year-old Korean male cadaver. At the apex of the axilla, the lateral cord of the brachial plexus united into the median nerve without branching off the musculocutaneous nerve. The flexor arm musculatures, normally innervated by the musculocutaneous nerve, were innervated by two separate branches from the median nerve. The distal one continued as the lateral antebrachial cutaneous nerve. In addition, the radial artery of the left arm was originated from the middle one-third of the brachial artery. At bifurcation, it lay deep to the median nerve and crossed it medially. However, at the elbow, it crossed again the median nerve anterolaterally. Just above the cubital fossa, it anastomosed with the brachial artery. The arterial distribution of the right arm was normal. The separate reports which described the absence of the musculocutaneous nerve or brachioradial artery have been reported. However, this combined variation has not been documented until now.
Aged ; Arm ; Arteries ; Axilla ; Brachial Artery ; Brachial Plexus ; Cadaver ; Elbow ; Humans ; Male ; Median Nerve ; Musculocutaneous Nerve ; Radial Artery

Comparison of the perivascular and paresthetic techniques of axillary brachial plexus block was made in two groups of 40 patients undergiong elective upper limb surgery. The results were as follows. Complete block were 16 cases(80%) in perivascular group, 17 cases(85%) in paresthetic group and total failure was abscent. Among incomplete block, radial nerve were 6 cases, ulnar never 2 cases and median nerve 1 case. There is no statistical difference between the two techniques. It is suggested that the axillary brachial plexus block is best suited for surgery of the forearm and hand, especially when surgery is in the area innervated by the median and ulnar nerves.
Brachial Plexus* ; Forearm ; Hand ; Humans ; Median Nerve ; Radial Nerve ; Ulnar Nerve ; Upper Extremity

A 43-year-old female cadaver showed a complete bilateral absence of the musculocutaneous nerve. The anterior compartment muscles of both arms were supplied by median nerve excepting the coracobrachialis which was innervated by a direct branch from the lateral cord of brachial plexus. The median nerve, after supplying the biceps and brachialis muscles, gave onto the lateral cutaneous nerve of the forearm. The median nerve also showed variation on the left side where it was formed by two lateral roots and one medial root. Variations of the brachial plexus are of great interest to anatomists, clinicians and surgeons, in that they may be incorporated in their day to day practice. Our present case may be noted for its clinical and surgical significance in the variations of brachial plexus which can be useful for diagnostic purposes.
Adult ; Anatomists ; Arm ; Brachial Plexus ; Cadaver ; Female ; Forearm ; Humans ; Median Nerve ; Muscles ; Musculocutaneous Nerve

During routine dissection of the upper extremity of an adult male cadaver, multiple variations in branches of medial and lateral cords of brachial plexus were encountered. Three unique findings were observed. First, intercordal neural communications between the lateral and medial cords were observed. Second, two lateral pectoral nerves and one medial pectoral nerve were seen to arise from the lateral and medial cord respectively. The musculocutaneous nerve did not pierce the coracobrachialis. Finally, the ulnar nerve arose by two roots from the medial cord. Knowledge of such variations is of interest to anatomists, radiologists, neurologists, anesthesiologists, and surgeons. The aim of our study is to provide additional information about abnormal brachial plexus and its clinical implications.
Adult ; Anatomists ; Brachial Plexus* ; Cadaver ; Humans ; Male ; Musculocutaneous Nerve ; Thoracic Nerves ; Ulnar Nerve ; Upper Extremity

BACKGROUND: The authors sought to determine whether a shallow needle approach to the axillary artery would improve complete sensory blocks of median, radial, and ulnar nerves as compared with a perpendicular approach when transarterial axillary block is performed using a scalp vein needle (23G, 3/4'). METHODS: Fifty-four patients were allocated equally to a perpendicular group (the PA group) or a shallow approach group (SA group). Sensory and motor scores were evaluated and compared in the two groups at 5-minute intervals for 20 minutes after block. The main outcome variables were rates of blockage of median, radial, and ulnar nerves. RESULTS: Excellent block rates (defined as completion of surgery using brachial plexus block alone) were obtained in both groups (SA group 77.8% vs. PA group 70.3%, P = 0.755). However, the rate of blockage of all three nerves was significantly higher in the SA group (74% vs. 40.7%, P = 0.013). Furthermore, the rate of complete sensory block of the radial nerve at 20 minutes was significantly greater in the SA group (85.2% vs. 59.3%, P = 0.033). CONCLUSIONS: A shallow needle approach to the axillary artery resulted in a significantly higher median, radial, and ulnar nerve block rate at 20 minutes after LA injection than a perpendicular approach.
Axillary Artery* ; Brachial Plexus Block* ; Brachial Plexus* ; Humans ; Needles* ; Radial Nerve ; Scalp ; Ulnar Nerve ; Veins

BACKGROUND: The authors sought to determine whether a shallow needle approach to the axillary artery would improve complete sensory blocks of median, radial, and ulnar nerves as compared with a perpendicular approach when transarterial axillary block is performed using a scalp vein needle (23G, 3/4'). METHODS: Fifty-four patients were allocated equally to a perpendicular group (the PA group) or a shallow approach group (SA group). Sensory and motor scores were evaluated and compared in the two groups at 5-minute intervals for 20 minutes after block. The main outcome variables were rates of blockage of median, radial, and ulnar nerves. RESULTS: Excellent block rates (defined as completion of surgery using brachial plexus block alone) were obtained in both groups (SA group 77.8% vs. PA group 70.3%, P = 0.755). However, the rate of blockage of all three nerves was significantly higher in the SA group (74% vs. 40.7%, P = 0.013). Furthermore, the rate of complete sensory block of the radial nerve at 20 minutes was significantly greater in the SA group (85.2% vs. 59.3%, P = 0.033). CONCLUSIONS: A shallow needle approach to the axillary artery resulted in a significantly higher median, radial, and ulnar nerve block rate at 20 minutes after LA injection than a perpendicular approach.
Axillary Artery* ; Brachial Plexus Block* ; Brachial Plexus* ; Humans ; Needles* ; Radial Nerve ; Scalp ; Ulnar Nerve ; Veins