Clinical implications of the absence of musculocutaneous nerve with a nerve to biceps from the median nerve in brachial plexus injuries: A case report

Abstract

BackgroundThe cadaveric and in vivo absence or anomalous variations in the musculocutaneous and median nerve are two different entities. Documentation of the cadaveric reports needs to have clinical use. Case detailsWe report a challenging case of C5,6 brachial plexus avulsion injuries that required elbow flexion distal nerve transfers in the arm. Exploring the arm showed an absent musculocutaneous nerve but an intact nerve from the median nerve to the biceps. This avoided the nerve transfer to the biceps, and the patient recovered elbow flexion without nerve transfers. ConclusionsThe surgeons must understand the possibilities of anomalous variations in the median and musculocutaneous nerve in the infraclavicular brachial plexus exploration. The decision to perform the distal nerve transfer depends on the intact and active anomalous branch that supplies the elbow flexors. The distal nerve may be avoided, such as when a rare variant of the biceps branch originates from the intact median nerve despite the total absence of the musculocutaneous nerve.