International Journal of Current Research and Review
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IJCRR - Vol 07 Issue 02, January, 2015

Pages: 66-68

Date of Publication: 30-Nov--0001


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BILATERAL OCCURENCE OF THIRD HEAD OF BICEPS BRACHII ASSOCIATED WITH UNILATERAL VARIATION IN THE COURSE OF MUSCULOCUTANEOUS NERVE - A CASE REPORT

Author: Shastrakar Rupali Sureshrao, Sawant V. G.

Category: Healthcare

Abstract:It is very common to see variations in the course of nerves and muscles of the arm. We observed one bilateral concurrent variation in the course of musculocutaneous nerve and origin of biceps brachii muscle. Musculocutaneous nerve, after piercing the coracobrachialis muscle gives one communicating branch to the median nerve and then supply the third head of biceps brachii and brachialis muscle in the right upper limb. After that it continues as the lateral cutaneous nerve of forearm.In the left upper limb musculocutaneous nerve is not piercing the coracobrachialis muscle but otherwise following the normal course.

Keywords: Nerve, Musculocutaneous, Median, Biceps brachii, Third head of biceps brachii

Full Text:

INTRODUCTION

Brachial plexus is formed by the anterior primary rami of spinal nerves C5, C6, C7, C8 and T1. The plexus is said to be prefixed when the branches of fourth cervical fibers join the plexus and postfixed when joined by branches from second thoracic nerves. C5 and C6 roots join to form upper trunk. C7 root forms the middle trunk. C8 and T1 roots join to form lower trunk. Each trunk divides into ventral and dorsal divisions. Ventral division of the lower trunk forms medial cord. Dorsal divisions of all the three trunks join to forms posterior cord. Ventral divisions of upper and middle trunk joint to forms lateral cord. Musculocutaneous nerve (MCN) is the branch from the lateral cord of the brachial plexus. The nerve initially accompanies the axillary artery, pierces the coracobrachialis muscle, and then passes downwards between the biceps brachii and brachialis. It supplies coracobrachialis, biceps brachii and medial part of brachialis muscles. Below the elbow joint the nerve is continuous as the lateral cutaneous nerve of the forearm. It should be noted that the brachial plexus is the most variable part of the peripheral nervous system [1]. The prevalence of variations ranges from 12.8 up to 53% [1, 2].Variations of the musculocutaneous nerve may occur in 6.25% of cases [3]

CASE REPORT

During routine dissection for medical undergraduates ,in a middle aged Indian cadaver we observed a variation in the course of musculocutaneous nerve associated with third head of biceps brachii muscle . In the right upper limb , musculocutaneous nerve after piercing the coracobrachialis muscle gives one communicating branch to the median nerve to supply the third head of biceps brachii and brachialis muscle . In the left upper limb ,third head of biceps brachii associated with normal course of musculocutaneous nerve except that it is not piercing the corachobrachialis . After that it continues as lateral cutaneous nerve of forearm in the right and the left upper limb.

DISCUSSION

Variations in the course and termination of musculocutaneous nerve are common . As reported by Venieratos D. and Anagnostopoulou S. [4],there are three types of communications between musculocutaneous and median nerve with reference to coracobrachialis muscle. In one type ,communication was proximal to entry of musculocutaneous nerve into coracobrachialis. In second type communication was distal to entry of musculocutaneous nerve into coracobrachialis. In third type nerve and communicating branch did not pierce the coracobrachialis muscle. According to Loukas M. and Aqueelah H. four different patterns of communication exist between musculocutaneous and median nerve.Type I (54 communications , 45%).The communications were proximal to the point of entry of musculocutaneous nerve into coracobrachialis. Type II (42, communications, 35%) the communications were distal to the point of entry of the MCN into the coracobrachialis; type III (11 communications, 9%): the MCN did not pierce the coracobrachialis; and Type IV (9 communications, 8%) : the communications were proximal to the point of entry of the MCN into the coracobrachialis and additional communication took place distally. [5] In this case report the findings coinside with second type of communication mentioned by Venieratos D. and Anagnostopoulou S. and Type II by Loukas M .and Aqueelah H., in the right upper limb. The lateral root of the MN carries fibres that may pass through the MCN, and a communicating branch from the later usually joins the MN in the lower third of arm[13].In the left upper limb it coinside with Type III by Loukas M .and Aqueelah H. A supernumerary head of biceps brachii is the most frequently occurring muscular variation in the upper limb, prevalence is upto 22.9%.[6] Variations include bifurcate origin of long head[7], occurrence of third head [8-9] and occurrence of four heads[10-11].Greig, Anson and Budinger found one or more accessory heads of biceps brachii in 28 (21.5 %) of 130 muscle studied. In most of them extra head was arising from middle third of humerus. In another two it arose from intertubercular groove and in other five from the pectoralis major. In this case the third head is arising from the middle of the shaft of humerus. The clinical relevance of such variations might also be correlated to entrapment syndromes. Entrapment of MCN is rare and has its origin either in physical activity according to Falsenthal et al., 1984[14] or in violent passive movements of arm and forearm according to Kim and Goodrich, 1984[15 ]. This knowledge may prove useful for clinicians in order to avoid an unnecessary Carpal tunnel release [4]. Knowledge of these variations is important in traumatology and in plastic and reconstructive surgeries.

References:

1. Johnson E, Vekris M, Demesticha T, Soucacos P (2010) Neuroanatomy of the brachial plexus: normal and variant anatomy of its formation. Surg Radiol Anat 32:291–29

 2. Pandey SK, Shukla VK (2007) Anatomical variations of the cords of brachial plexus and the median nerve. Clin Anat 20(2):150–156

3. Bhattarai C, Poudel PP (2009) Unusual variation in musculocutaneous nerves. Kathmandu Univ Med J 7:408–410

4. Venieratos D, Anagnostopoulou S. Classification of communications between the musculocutaneous and median nerves. Clin Anat 1998; 11: 327–331.

5. Loukas M, Aqueelah H. Musculocutaneous and median nerve connections within, proximal and distal to the coracobrachialis muscle. Folia Morphol (Warsz). 2005; 64: 101–108.

6. Vijayabhaskar P, Baral P, Vaishya R, Shrestha RN (2008) Supernumerary head of biceps brachii: a rare occurrence in the Nepalese population. Kathmandu Univ Med J 6:225– 227.

7. Enad JG. Bifurcate origin of the long head of the biceps tendon. Arthroscopy. 2004; 20: 1081–1083. 8. Abu-Hijleh MF. Three-headed biceps brachii muscle associated with duplicated musculocutaneous nerve. Clin. Anat. 2005; 18: 376–379.

9. G. Sreedevi, S.S. Sarada Devi, K. Krupadanam, K. Anasuya. Bilateral occurrence of additional heads of biceps brachii-A case report. Int J Res Dev Health.Nov 2013;Vol1(4):195-9.

10. Vazquez T, Rodriguez-Niedenfuhr M, Parkin I, Sanudo JR. A rare case of a four-headed biceps brachii muscle with a double piercing by the musculocutaneous nerve. Surg. Radiol. Anat. 2003; 25: 462–464.

11. Poudel PP, Bhattaraj C. Study of the supernumerary heads of biceps brachii muscle in Nepalese. Nepal Med Coll J. 2009 Jun; 11 (2):96-8.

12. Greig HW, Anson BJ ,Budinger JM:Quart Bull Northwestern Univ M. School , 26:241,1952 (Quoted by ,W.Henry Hollinshead,’The Back And Limbs ‘, Third edition , Vol 3:354, 1982).

13. Bergmann RA, ThomsonSA and Saadeh F.A Compendium of human anatomic variation urban &schwarzebergMunich.1988; 139-143.

14. Falsenthal, G., Mondell, DL., Reischer, MA., Mack, RH. Forearm pain secondary to compression syndrome of the lateral cutaneous nerve of the forearm. Archaeological Physical Medical Rehabilitation, 1984, vol. 65, p. 139-141. PMid:6608339.

15. Kim, SM., Goodrich, JA. Isolated proximal musculocutaneous nerve palsy: Case report. Archaeological Physical Medical Rehabilitation, 1984, vol. 65, p. 735-736.

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Best Article Award

A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19


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