IJAR.2018.361

Type of Article:  Original Research

Volume 6; Issue 4.2 (November 2018)

Page No.: 5853-5860

DOI: https://dx.doi.org/10.16965/ijar.2018.361

VARIATION OF ROOTS IN THE FORMATION OF MEDIAN NERVE

Vinay Sharma 1, C.S. Ramesh Babu *2, Vishnu Gupta 3.

1,*2 Associate Professor, Department of Anatomy, Muzaffarnagar Medical College, Muzaffarnagar, UttarPradesh, India.

3 Professor, Department of Anatomy, Muzaffarnagar Medical College, Muzaffarnagar, UttarPradesh, India.

Corresponding Author: C.S. Ramesh Babu, M.Sc., Associate Professor of Anatomy, Muzaffarnagar Medical College, N.H. 58, Opp. Begrajpur Industrial Area, Muzaffarnagar- 251203, UttarPradesh, India. Mobile no. +91-9897249202 E-Mail: csrameshb@gmail.com

ABSTRACT:

Background: Median nerve formation exhibits several variations in the form of additional roots and /or communications which are relevant to the surgical explorations of shoulder, axilla and arm.

Aim: To study the variations in the formation of median nerve and its communications with musculocutaneous nerve in cadaveric upper limbs.

Materials and Methods: The study was done in 34 formalin fixed cadavers (68 upper limbs) and 10 isolated limbs.  All cadavers were conventionally dissected and observed for median nerve formation and dissected up to cubital fossa for presence of any communications.

Observations:   Out of the 78 upper limbs dissected, 12 limbs (15.38%) showed two lateral roots and one medial root contributing to the formation of median nerve. One case of bilateral presence of extra lateral root was found. The extra lateral root or communication from the musculocutaneous nerve was arising distal to coracobrachialis in 2 cases and proximal to the muscle in 10 cases. In three cases, absence of musculocutaneous nerve was observed and median nerve was supplying either all or some muscles of the flexor compartment. One of the cases of absent musculocutaneous nerve had two medial roots and one lateral root that is a very rare combination of variation not reported in the literature. In all cases of two lateral roots, the median nerve was formed medial or anterior to axillary artery. So we observed median nerve variation in 16 upper limbs [20.51%]

Conclusion: Thorough understanding of variations in the formation and communications of median nerve and its vascular relations is important for successful surgical outcome and clinical interpretation of lesions of the nerve.

Key Words: Median nerve, Musculocutaneous nerve, Double lateral roots, Double medial roots.

REFERENCES

  1. R Chitra. Multiple bilateral neuroanatomical variations of the nerves of the arm. Neuroanatomy. 2007; 6: 43-5.
  2. Badawoud MHM. A Study on the Anatomical Variations of Median Nerve Formation. Bahrain Medical Bulletin 2003; 25(4).169-171
  3. Aggarwal A, Harjeet K, Sahni D, Aggarwal A. Bilateral multiple complex variations in the formation and branching pattern of brachial plexus. Surg Radiol Anat 2009; 31(9): 723-731
  4. Master NT, Gupta SD. Analysis of morphological variation between musculocutaneous nerve and median nerve. Indian J Clin Anat Physiol. 2016; 3 (3): 326-331
  5. Chaudhary P., Kalsey G., Singla R., Arora K. Communication between musculocutaneous and median nerve –different type and their incidence in north indian population. Indian J Clin Pract. 2013; 24(3): 364-371.
  6. Samarawickrama, MB. A study of anatomical variations of median nerve formation and its relation to the arteries in the axilla and arm. Int. J. Morphol., 2017; 35(2):698-704.
  7. Channabasanagouda, Shrish P., Shinde V, JevoorP S ,Nidoni MA. Study of anatomical variations of median nerve in human cadavers. International Journal of Biomedical Research. 2013; 04 (12):682-690.
  8. Padur A.A., Kumar N, Shanthakumar S.R., Shetty S.D., Prabhu G.S., Patil J. Unusual and Unique Variant Branches of Lateral Cord of Brachial Plexus and its Clinical Implications- A Cadaveric Study. J Clin Diagn Res. 2016; 10(4): AC01-AC04.
  9. Chitra P. S, Anandhi V. A study of the different types of formation of the median nerve. Int J Anat Res. 2016; 4(2):2397-2400.
  10. Le Minor JM. A rare variation of the median and musculocutaneous nerves in man. Arch Anat Histol Embryol. 1990;73:33-42
  11. Budhiraja V, Rastogi R, Asthana AK, Sinha P, Krishna A, Trivedi V. Concurrent variations of median and musculocutaneous nerves and their clinical correlation– a cadaveric study ,Italian J Anat and Embryol IJAE , 2011, 116 (2): 67- 72.
  12. Kaur N, Singla RK. Different types of communications between musculocutaneous nerve and median nerve -a cadaveric study in north Indian population. CIBTech J Surg. 2013; 2 (1): 21-28.
  13. Ballesteros L.E, Forero P.L., Edna, Buitrago R.- Communication between the musculocutaneous and median nerves in the arm: an anatomical study and clinical implications  Rev Bras Ortop.  2015; 50(5):567–572
  14. Venieratos, D., Anagnostopoulou, S. Classification of communications between the musculocutaneous and median nerves. Clin Anat. 1998; 11:327-331.
  15. Saha D., Bhattacharya B. Variation in Formation of Median and Musculocutaneous Nerves and their Unusual Branches —  A case study, Indian Journal of Basic and Applied Medical Research;  2016: 5,(4): 111-115
  16. Eglseder E, Goldman M. Anatomical Variations of the Musculocutaneous Nerve in the Arm. Am J Orthop 1997; 26(11):777-80.
  17. Uzun A, Seelig LL Jr A variation in the formation of the median nerve; communicating branch between the musculocutaneous and median nerves in man. Folia Morphol (Warsz) 2001; 80: 99–101.
  18. Chauhan R, Roy TS. Communication between the median and musculocutaneous nerve- a case report.  Journal of the Anatomical Society of India.2002: 52(1): 72-5.
  19. Satyanarayana N, Reddy CK, Sunitha P, Jayasri N, Nitin V, Praveen G, Guha R, Datta AK, Shaik MM Formation of median nerve by three roots – a case report. J College of Medical Sci-Nepal 2010; 6: 47-50.
  20. Saeed M, Rufai AA- Median nerve and musculocutaneous nerves: variant formation and distribution. Clinical Anatomy.2003: 16: 453-7
  21. Talhar S., Sontakke B. R., Bokariya P., Tarnekar A.M., ShendeM. R., Bilateral Variation in Formation of Median Nerve. IOSR Journal of Pharmacy. 2012; 2 (6):   05-07.
  22. Sakharam R.R., Mahadeo D.J., Sacchidanand J.S., Mahadeo P.S., Bilateral presence of third root of median nerve: a case report, International Journal of Anatomical Variations. 2013; 6:  74–76
  23. Pandey SK, Shukla VK. Anatomical variations of the cords of brachial plexus and the median nerve. Clin Anat. 2007; 20: 150–156.
  24. Yang ZX, Pho RW, Kour AK, Pereira BP. The musculocutaneous nerve and its branches to the biceps and brachialis muscles. J Hand Surg Am 1995;20(4):671-5.
  25. Sarkar A, Saha A.  Bilateral Absence of Musculocutaneous Nerve: A Case Report, Journal of Clinical and Diagnostic Research. 2014; 8(9): AD06-AD07.
  26. Pankaj A.K., Ramesh BabuCS , Rani A,  Rani A,  Chopra J, Verma R.K.,  Kumar N, SrivastavaAK. Absence of musculocutaneous nerve: Embryological basis. Asian Journal of Medical Sciences 2012; 3:  21-24
  27. Paranjape V, Swamy P.V. and Mudey A,. Variant Median and Absent Musculocutaneous Nerve. J Life Sci, 2012; 4(2): 141-144.
  28. Bhanu S P.,Devishanker K. Bilateral absence of musculocutaneous nerve with unusual pattern of lateral cord and median nerve of brachial plexus .Anat. Cell Biol.2012; 45:207-10
  29. Ravishankar M.V., Jevoor P.S., Saha l. Bilateral absence of musculocutaneous nerve , J Sci Soc 2012 ; 39(1) 34-36
  30. .Patil D.A., Jadhav A.S., Bhingardeve C.V., Katti A.S. Variation in the formation, communication and distribution of median nerve: a cadaveric study, Asian Pac. J. Health Sci., 2016; 3 (4):17-22
  31. Larson WJ. Development of peripheral nervous system.3rd ed. Pennsylvania: Churchill Livingstone, 2001, 115-156.
  32. Choi D, Rodríguez-Niedenführ M, Vázquez T, Parkin I, Sañudo JR. Patterns of connections between the musculocutaneous and median nerves in the axilla and arm. Clin Anat 2002;15(1):11-7.
  33. Leffert RD. Brachial plexus injuries. In: Anatomy of the Brachial Plexus. Churchill Livingstone: New York 1985:p.384. 

Cite this article: Vinay Sharma, C.S. Ramesh Babu, Vishnu Gupta. VARIATION OF ROOTS IN THE FORMATION OF MEDIAN NERVE. Int J Anat Res 2018;6(4.2):5853-5860. DOI: 10.16965/ijar.2018.361