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01-12-2012 | Original article

Brachial plexus variations during the fetal period

Authors: Jowita Woźniak, Alicja Kędzia, Krzysztof Dudek

Published in: Anatomical Science International | Issue 4/2012

Abstract

The brachial plexus is an important nervous system structure. It can be injured during the perinatal period and by postnatal damage. The goal of this study was to assess human fetal brachial plexus variability. A total of 220 brachial plexuses were surgically prepared from 110 human fetuses aged 14–32 weeks of fetal life (50 females and 60 males) ranging in CRL from 80 to 233 mm. The study incorporated the following methods: dissectional and anthropological, digital image acquisition, digital image processing using Image J and GIMP software, and statistical methods (Statistica 9.0). Symmetry and sexual dimorphism were examined. Anomalies of the brachial plexuses were observed in 117 (53.18 %) cases. No sexual dimorphism was found. It was observed that cord variations occurred more often on the left side. Division variants (33.64 %) occurred most often, but also cords (18.18 %) as well as root nerves and terminal ramifications (15.90 %) were found. Trunk anomalies were rare and occurred in only 5.45 % of plexuses. Three height types of median nerve roots in combination with the nerve were distinguished. In one-third of cases, median nerve root connections were found below the axillary fossa and even half in the proximal part of the humerus. In conclusion, the brachial plexus was characterized for anatomical structural variability. Most often division and cord variations were observed. Anomalies occurred regardless of sex or body side except for cord variants. Brachial plexus variation recognition is significant from the neurosurgical and traumatological point of view.

Adebisi A, Singh SP (2002) Anomalous patterns of formation and distribution of the brachial plexus in Nigerians and the implication for brachial plexus block. Niger J Surg Res 4:103–106

Aktan ZA, Ozturg L, Bilge O, Ozer MA, Pinar YA (2001) A cadaveric study of the anatomic variations of the brachial plexus nerves in the axillary region and arm. Turk J Med Sci 31:147–150

Badawoud M (2003) A study of anatomical variations of median nerve formation. Bahrain Med Bull 25(4):1–9

Bhat KMR, Girijavallabhan V (2008) Variation in the branching pattern of posterior cord of brachial plexus. Neuroanatomy 7:10–11

Carlson BM (1999) Human embryology and developmental biology. Mosby, St Louis, p 450

Castellana C, Kosa F (1999) Morphology of the cervical vertebrae in fetal-neonatal human skeleton. J Anat 194:147–152PubMedCrossRef

Gu Y (2007) Contralateral C7 root transfer over the last 20 year in China. Chin Med J 120(3):113–1126

Jahanshahi M, Moharreri AR, Golalipour MJ (2003) A variation of brachial plexus: absence of musculocutaneous nerve. MJIH 6(1):87–88

Kaus M, Wójtowicz Z (1995) Communicating branch between the musculocutaneous and median nerves in human. Folia Morphol 54(4):273–277

Kerr AT (1918) The brachial plexus of nerves in man, the variation and branches. Am J Anat 23:285–395CrossRef

Kocabiyik N, Palcin B, Yazar F, Ozan H (2005) An accessory branch of musculocutaneous nerve joining median nerve. Neuroanatomy 4:13–15

Lee HY, Chung IH, Sir WS, Kang HS, Lee HS, Ko JS, Lee MS, Park AS (1992) Variations of ventral rami of the brachial plexus. Korean Med Sci 7(1):19–24

Lewis WH (1902) The development of the arm in man. Am J Anat 1(2):145–183CrossRef

Loukas M, Aqueelah H (2005) Musculocutaneus and median nerve connections within, proximal and distal part to the coracobrachialis muscle. Folia Morphol 64(2):101–108

Matejcik V (2003) Aberrant formation and clinical picture of brachial plexus from the point of view of a neurosurgeon. Bratisl Lek Listy 104(10):291–299PubMed

Matejcik V (2005) Variations of nerve root of the brachial plexus. Bratisl Lek Listy 106(1):34–38PubMed

Nayak S, Somayaji N, Vollala VR, Reghunthan D, Rodrigues V (2005) A rare variation in the formation of upper trunk of the brachial plexus—a case report. Neuroanatomy 4:37–38

Oliveira-Filho J, Araujo VF, Queiroz RS, Nunes LS, Masuko TS (2009) Brachial plexus variations: an anatomic study. R Ci Med Biol Salvador 8(2):142–145

O’Rahilly R, Müller F, Meyer DB (1990a) The human vertebral column at the end of the embryonic period proper. 3. The thoracicolumbar region. J Anat 168:81–93PubMed

O’Rahilly R, Müller F, Meyer DB (1990b) The human vertebral column at the end of the embryonic period proper. 4. The sacrococcygeal region. J Anat 168:95–111PubMed

Ozguner G, Desdicioglu K, Albay S (2010) Connection between radial and ulnar nerves at high humeral level. Int J Anat Var 3:49–50

Pandey SK, Shukla VK (2007) Anatomical variations of the cords of brachial plexus and median nerve. Clin Anat 20:150–156PubMedCrossRef

Poornima GC, Satyaprasad V (2006) Variant innervation of flexors of the arm associated with additional head of biceps brachii. Neuroanatomy 5:24–26

Rodriguez-Niedenführ M, Burton GJ, Deu J, Sañudo JR (2001) Development of the arterial pattern in the upper limb of staged human embryos: normal development and anatomic variations. J Anat 199:407–417PubMedCrossRef

Rodriguez-Niedenführ M, Vazquez T, Parkin I, Sañudo JR (2003) Arterial patterns of the human upper limbs: update of anatomical variations and embryological development. Eur J Anat suppl 1:21–28

Satyanarayana N, Vishwakarma N, Kumar GP, Guha R, Datta AK, Sunitha P (2009) Variation in relation of cords of brachial plexus and their branches with axillary and brachial arteries—a case report. Nepal Med Coll J 11(1):69–72PubMed

Shinohara H, Naora H, Hashimoto R, Hatta T, Tanaka O (1990) Development of the innervation pattern in the upper limb staged human embryos. Acta Anat 138:265–269PubMedCrossRef

Singhal S, Rao VV, Ravindranath R (2007) Variations in brachial plexus and the relationship of median nerve with the axillary artery: a case report. J Brachial Plex Peripher Nerve Inj 2:21PubMedCrossRef

Şişu AM, Petrescu CI, Cebzan CC, Niculescu MC, Niculescu V (2007) Study of celiac ganglia development. Rom J Morphol Embryol 48(1):55–58PubMed

Tatar I, Brohi R, Sen F, Tonak A, Celik H (2004) Innervation of the coracobrachialis muscle by a branch from the lateral root of the median nerve. Folia Morphol 63(4):503–506

Uysal II, Seker M, Karabulut AK, Büyükmumcu M, Ziylan T (2003) Brachial plexus variations in human fetuses. Neurosurgery 53(3):676–684PubMedCrossRef

Uzmansel D, Kortoğlu Z, Kara A, Öztürk NC (2010) Frequency, anatomical properties and innervation of axillary arch and its relation to the brachial plexus in human fetuses. Surg Radiol Anat 32(9):859–863PubMedCrossRef

Uzun A, Bilgic S (1999) Some variations in the formation of the brachial plexus in infants. Turk J Med Sci 29:573–577

Uzun A, Seelig LL Jr (2001) A variation in the formation of the median nerve: communication branch between the musculocutaneous and median nerves in man. Folia Morphol 60(2):99–101

Villamare J, Goodwin S, Hincke M, Jalali A (2009) A brachial plexus variation characterized by the absence of the superior trunk. Neuroanatomy 8:4–6

Yogesh AS, Joshi M, Chimurkar VK, Marathe RR (2010) Unilateral variant motor innervations of flexure muscles of arm. J Neurosci Rural Pract 1(1):51–53PubMedCrossRef

Title: Brachial plexus variations during the fetal period
Authors: Jowita Woźniak
Alicja Kędzia
Krzysztof Dudek
Publication date: 01-12-2012
Publisher: Springer Japan
Published in: Anatomical Science International / Issue 4/2012
Print ISSN: 1447-6959
Electronic ISSN: 1447-073X
DOI: https://doi.org/10.1007/s12565-012-0150-1

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Brachial plexus variations during the fetal period

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