Abstract
Variations in the arterial pattern of the upper limbs are commonly encountered in routine dissection. In-depth information of the vascular structure of the upper extremities is not only important for diagnostic interventions and surgical approaches, but has medico-legal implications. We report the unusual variation of an additional muscular branch of the brachial artery entrapping the median nerve in the middle of the arm. This anomaly was present in both upper extremities of an adult male Indo-Malaysian cadaver. The abnormality reported here might result in neurovascular compression symptoms in the upper limbs. Knowledge of the vascular dissimilarity of the brachial artery and its division, and possible neurovascular entrapment is important to surgeons and medical practitioners for anticipating nerve compression and for confirmation via motor and sensory examination.
Highlights
The brachial artery is a continuation of the third part of the axillary artery and is superficial throughout its course in the arm
We found an additional muscular branch of the brachial artery entrapping the median nerve in the center of the arm (Figure 1)
After comparing both upper limbs, we documented the presence of the muscular branch of the brachial artery in both arms winding over the median nerve (Figure 5), but the origin of the muscular artery was much higher
Summary
The brachial artery is a continuation of the third part of the axillary artery and is superficial throughout its course in the arm. The median nerve is formed by medial and lateral roots from the medial and lateral cords of the brachial plexus respectively, and runs down the arm from the axilla at the inferior margin of the teres major muscle. It descends along the lateral side of the third part of the axillary artery and the proximal part of the brachial artery. In the middle of the arm, opposite the coracobrachialis insertion, the nerve crosses tangentially in front of the artery and runs along the medial side of the brachial artery It subsequently appears in the cubital fossa beneath the bicipital aponeurosis and rests on the brachialis. The nerve exits the cubital fossa through a gap between the superficial and deep heads of the pronator teres [1]
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