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Abstract

The absence of the musculocutaneous nerve represents a failure of the nerve to depart from the median nerve during early development. During a routine dissection of a 66-year-old white female cadaver, a bilateral absence of the musculocutaneous nerve was observed in the upper limbs. Muscles of the anterior flexor compartments of the arms including biceps brachii and brachialis were supplied by branches of the median nerve. The lateral cutaneous nerve of the forearm also branched from the median nerve. In a clinical case of a particularly high median nerve injury, a variation of an absent musculocutaneous nerve may not only result in typical median nerve palsy of the forearm and hand, but palsy in the arm that would manifest as deficiencies in both shoulder and elbow flexion as well as cutaneous sensory loss from the lateral forearm.
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Authors and Affiliations

Dawn D. Hunter
1
Janusz Skrzat
2
Matthew J. Zdilla

  1. Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, West Virginia, USA
  2. Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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Abstract

The musculocutaneous nerve (C5–C7) is a terminal branch of the lateral cord of the brachial plexus and provides motor innervation to the anterior compartment of arm muscles. Both the musculocutaneous and median nerve may show numerous anatomical variations. Keeping in mind possible aberrations in the course of the upper limb nerves may increase the safety and success rate of surgical procedures. The presented report is a detailed anatomical study of the fusion between the median and musculocutaneous nerve, supplemented by intraneural fascicular dissection. In the presented case, the musculocutaneous nerve was not found in its typical location in the axillary cavity and upper arm during the preliminary assessment. However, a careful intraneural fascicular dissection revealed that musculocutaneous nerve was fused with the median nerve and with its lateral root; Those nerves were surrounded by a common epineurium, however they were separable. The muscular branch to the biceps brachii muscle arose from the trunk ( fascicular bundle) dissected out from the median nerve and corresponding to the musculocutaneous nerve. Such variation may be of utmost clinical importance, especially during reconstructions of the brachial plexus or its branches.

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Authors and Affiliations

Edward Clarke
Grzegorz Wysiadecki
Robert Haładaj
Janusz Skrzat
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Abstract

Th e forearm is a body region of numerous anatomical variations. Due to its favorable anatomy fl exor digitorum superfi cialis muscle (FDS) is commonly used in tendon transfer surgeries. In this study a unique combination of abnormalities was found in a single forearm: the fl exor digitorum superfi cialis muscle penetrated by the median nerve, one of the fl exor digitorum superfi cialis tendons early division and absence of the palmaris longus muscle. Described variation potentially may lead to the clinical manifestation of the median nerve compression and should be also considered during FDS surgery.
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Authors and Affiliations

Maciej Lis
Bernard Solewski
Mateusz Koziej
Ewa Walocha
Jerzy A. Walocha
Wiesława Klimek-Piotrowska

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