Special anatomy series: understanding fascicular anatomy of the brachial plexus: reverse mouse in maze game

Abstract

The objective of this paper is to teach the physician fascicular anatomy of the brachial plexus. To achieve this, we will reach back to historical references that researched brachial plexus fascicular anatomy. An applied anatomy system was created by which the lesion in the brachial plexus can rapidly be localized. This system is called the “reverse mouse in maze” game, which is a teaching tool created at this institution for resident physicians. Color coding helps localize the lesion rapidly. Black indicates where the lesion is not. Overlap of other colors points to where the lesion likely is. Finally, if the colors do not overlap, there could be 2 lesions. Example hypothetical cases are reviewed as part of this manuscript. Fascicular anatomy can be dizzying to learn and difficult to memorize for the novice physician. To localize the lesion rapidly in the clinical setting and for real-time oral board exams, we found this technique to be useful. Conclusion: Awareness that fascicular anatomy of the brachial plexus exists helps localize and explain needle findings on electromyography that may be confusing. The “reverse mouse in maze” localization strategy helps rapidly localize the lesion(s) and also hopefully prevents unnecessary needle testing sampling during the electromyography test.