Abstract
IntroductionMedian nerve is normally formed by the union of medial and lateral root arising from the medial and the lateral cords of the brachial plexus respectively. However, variations in the formation and its relation with the axillary vessels are not uncommon. Therefore, knowledge of the variations in the nerve formation and course is useful for the clinicians during surgery and for differential diagnosis of uncommon clinical conditions.Case presentationDuring the routine dissection in the department of anatomy, Kasturba Medical Collage, Manipal, India, we found unique anatomical variations in the formation and the course of the roots of the median nerve forming the neural loops around the axillary artery and vein.ConclusionHere we report the detailed description of these variations along with its clinical, embryological relevance and review of literature.
Highlights
Median nerve is normally formed by the union of medial and lateral root arising from the medial and the lateral cords of the brachial plexus respectively
The anterior divisions of the upper and middle trunks form the lateral cord, the anterior division of the lower trunk continues as the medial cord and the posterior divisions of all three roots form the posterior cord and supply the upper limb
The medial root had its normal single origin from the medial cord of the brachial plexus, but it was winding round the axillary vein lateral to the pectoralis minor muscle before joining the lateral root
Summary
The brachial plexus is formed normally by the fusion of the anterior primary rami of C5-8 and T1 spinal nerves and supplies the muscles of the back and the upper limb. The medial root had its normal single origin from the medial cord of the brachial plexus, but it was winding round the axillary vein lateral to the pectoralis minor muscle before joining the lateral root Another neural loop of the lateral and medial root of the median nerve was formed around the axillary vein (Figure 1). The distal part of the lateral root (dLr) was arising from the lateral cord (Lcd) of the brachial plexus medial to pectoralis minor muscle (Pm) and winds round the axillary artery (Aa) before joining the lateral cord again. TtnrFhioevhiegoceeutatedrxi(dsipeislLltua2aorerl)ylpatanoterdtfroetaohrlfymectno(hAmrdedael)va(d,Ltiimaaectnrdeaa)jsnlooewrfroitivtoyehteo(p(fMdbrtoLrnharx)ec)imhfaibfatel rpsalewrwxtinueodsrfeibnthyjguecsrotlanuctenorednac-lThe distal part of the lateral root (dLr) after winding round the axillary artery (Aa), majority of the fibers were just connected to lateral cord (Lcd) of the brachial plexus by connective tissue and deviates with proximal part of the lateral root (pLr) to form median nerve (Mn). The course and the origin of the lateral and medial roots of the median nerve was normal in the left axilla
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