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An evaluation of the system of classifications of the median and musculocutaneous nerves: A study in West Bengal population

Journal Name:

  • Indian Journal of Basic & Applied Medical Research

Publication Year:

  • 2013

Key Words:

Author Name
Abstract (2. Language): 
Introduction: Anomalies of the brachial plexus are of interest to academicians and clinicians. The present study provides an assessment concerning the present classification criteria of median & musculocutaneous nerve among the Eastern Indian population. The related causative factors, developmental background and clinical relevance have also been elaborated. Methods: Meticulous dissection of brachial plexus was performed bilaterally on 54 embalmed adult human cadavers in selected Medical colleges in West Bengal as a part of the undergraduate medical curriculum. Results: Among 41male cadavers (75.93%), 6 cases (14.63%) were found on the right side and 3 cases (7.32%) on the left side. Among the females, only 1 case (7.69%) was found on the right side. The average distances (±Standard Deviation) of formation of median and musculocutaneous nerves and nerve to coracobrachialis, biceps brachii, brachialis from tip of coracoid process were 2.83(±0.65)cm, 4.55(±1.41)cm, 4.27(±0.42)cm, 7.65(±0.43)cm and16.04(±1.04)cm respectively. Arterial relations as well as side and gender predisposition of the anomalies were also tabulated. Conclusion: The median & musculocutaneous nerves as well as their different muscular branches in the arm vary considerably in levels of origin, location and course which have paramount clinical significance. The prevalent classification system may be revised in the background of distinctive new pattern of anomalies.
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REFERENCES

References: 

1. Standring S, Newell RLM, Collins P, Healy JC, Mahadevan V, eds. In Pectoral girdle, shoulder region &
axilla, Development of nervous system. In: Gray’s Anatomy, The Anatomical Basis of Clinical Practice.
40th ed. Spain: Churchill Livingstone, 2008; 818-22, 369-70.
2. Hollinshead WH. Functional anatomy of the limbs and back. In: Anatomy for Surgeon. Vol-3, 2nd ed.
Maryland: Harper & Row, 1969; 134-40.
3. Malukar O, Rathva A. A Study of 100 Cases of Brachial Plexus. National Journal of Community Medicine
2011; 2(1):166-70.
Fig 14: Column diagram shows gender and side distribution of the study population
according to the formation of median nerve in relation to axillary artery.
Fig-15: shows Le Minor Type I variation.
Fig-16: shows Le Minor Type III variation.
Fig-17: shows Le Minor Type V variation.
Fig-18: shows Venieratos and
Anangnostopoulou Type III variation.
Indian Journal of Basic & Applied Medical Research; September 2013: Issue-8, Vol.-2, P. 841-853
852
www.ijbamr.com
4. Nakatani T, Tanaka S, Mizukami S. Two rare anomalies of the brachial plexus. J Anat. 1998; 192(2): 303–
4.
5. Anyanwu GE, Obikili EN, Esom AE, Ozoemana FN. Prevalence and pattern of communication of median
and musculocutaneous nerves within the black population: Nigeria - a case study. International Journal of
Biomedical and Health Sciences 2009; 5(2):87-94.
6. Choi D, Rodriguez-Niedenfuhr M, Vazquez T, Parkin I, Sanudo JR. Patterns of connection between the
musculocutaneous and median nerves in the axilla and arm. Clin Anat 2002; 15:11-7.
7. Le Minor JM. A rare variation of the median and musculocutaneous nerves in man. Arch Anat Histol
Embryol 1990; 73:33– 42.
8. Venieratos D, Anagnostopoulou S. Classification of communications between the musculocutaneous and
median nerves. Clin Anat 1998; 11:327–31.
9. Chouhan R, Roy TS. Communication between the median nerve and musculocutaneous nerve-A Case
Report. Journal of the Anatomical Society of India 2002; 51(1):72-5.
10. Miller RA. Comparative studies upon the morphology and distribution of the brachial plexus. Am J Anat
1934; 54: 143–75.
11. Kosugi K, Morita T, Koda M, Yamashita H. Branching pattern of musculocutaneous nerve. 1. Case
possessing normal biceps brachii. Jikeikai Med J 1986; 33:63–71.
12. Larsen WJ. Development of limbs In: Human Embryology.4th ed. Edinburgh: Churchill Livingstone, 2009:
640-3.
13. Sannes HD, Reh TA, Harris WA. Development of the nervous system In: Axon growth and guidance. New
York: Academic Press, 2000:189-97.
14. Brown MC, Hopkins WG, Keynes RJ. Axon guidance and target recognition. In: Essentials of neural
development. Cambridge: Cambridge University Press, 1991:46-66.
15. Leffert RD. Anatomy of brachial plexus In: Brachial Plexus injuries. New York: Churchill Livingstone,
1985: 384.
16. Sunderland S. Nerves and Nerve Injury In: The median nerve: Anatomical and Physiological features. 2nd
ed. Edinburgh: Churchill Livingstone, 1978: 672-7, 691-727.
17. Standring S, Newell RLM, Collins P, Healy JC, Mahadevan V, eds. In Pectoral girdle, shoulder region &
axilla, Development of nervous system. In: Gray’s Anatomy, The Anatomical Basis of Clinical Practice.
40th ed. Spain: Churchill Livingstone, 2008; 818-22, 369-70.
18. Hollinshead WH. Functional anatomy of the limbs and back. In: Anatomy for Surgeon. Vol-3, 2nd ed.
Maryland: Harper & Row, 1969; 134-40.
19. Malukar O, Rathva A. A Study of 100 Cases of Brachial Plexus. National Journal of Community Medicine
2011; 2(1):166-70.
20. Nakatani T, Tanaka S, Mizukami S. Two rare anomalies of the brachial plexus. J Anat. 1998; 192(2): 303–
4.
Indian Journal of Basic & Applied Medical Research; September 2013: Issue-8, Vol.-2, P. 841-853
853
www.ijbamr.com
21. Anyanwu GE, Obikili EN, Esom AE, Ozoemana FN. Prevalence and pattern of communication of median
and musculocutaneous nerves within the black population: Nigeria - a case study. International Journal of
Biomedical and Health Sciences 2009; 5(2):87-94.
22. Choi D, Rodriguez-Niedenfuhr M, Vazquez T, Parkin I, Sanudo JR. Patterns of connection between the
musculocutaneous and median nerves in the axilla and arm. Clin Anat 2002; 15:11-7.
23. Le Minor JM. A rare variation of the median and musculocutaneous nerves in man. Arch Anat Histol
Embryol 1990; 73:33– 42.
24. Venieratos D, Anagnostopoulou S. Classification of communications between the musculocutaneous and
median nerves. Clin Anat 1998; 11:327–31.
25. Chouhan R, Roy TS. Communication between the median nerve and musculocutaneous nerve-A Case
Report. Journal of the Anatomical Society of India 2002; 51(1):72-5.
26. Miller RA. Comparative studies upon the morphology and distribution of the brachial plexus. Am J Anat
1934; 54: 143–75.
27. Kosugi K, Morita T, Koda M, Yamashita H. Branching pattern of musculocutaneous nerve. 1. Case
possessing normal biceps brachii. Jikeikai Med J 1986; 33:63–71.
28. Larsen WJ. Development of limbs In: Human Embryology.4th ed. Edinburgh: Churchill Livingstone, 2009:
640-3.
29. Sannes HD, Reh TA, Harris WA. Development of the nervous system In: Axon growth and guidance. New
York: Academic Press, 2000:189-97.
30. Brown MC, Hopkins WG, Keynes RJ. Axon guidance and target recognition. In: Essentials of neural
development. Cambridge: Cambridge University Press, 1991:46-66.
31. Leffert RD. Anatomy of brachial plexus In: Brachial Plexus injuries. New York: Churchill Livingstone,
1985: 384.
32. Sunderland S. Nerves and Nerve Injury In: The median nerve: Anatomical and Physiological features. 2nd
ed. Edinburgh: Churchill Livingstone, 1978: 672-7, 691-727.

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