DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20151469

An accessory brachialis muscle associated with abnormal arrangement of structures in the cubital fossa

Md. Jawed Akhtar, Nafees Fatima, Sanjay Kumar, Binod Kumar, Vinod Kumar

Abstract


An unusual variation of brachialis muscle was reported in the left superior extremity of a 61 year old North Indian female cadaver during routine dissection classes. It was observed that an additional belly of the accessory brachialis muscle was originated from the anteromedial surface of the shaft along with the medial supracondylar ridge of the left humerus. This additional muscle belly merged with the fibres of pronator teres in the cubital fossa & finally inserted on the lateral surface of the shaft of the radius, which was supplied by the musculocutaneous nerve. In the upper arm, the median nerve  lies along the lateral side of brachial artery but at the middle of the arm  the nerve  did not cross from lateral to medial side rather it continue along the lateral side of the brachial artery. In the lower part, they passed superficial to the brachialis muscle but lie deep to this additional slip of muscle. After separating the fibres of muscles it was found that median nerve was present just lateral to the brachial artery in the cubital fossa, its contents from medial to lateral side were brachial artery, median nerve, accessory brachialis muscle, biceps tendon and radial nerve just under cover of brachioradialis. The knowledge about these variations is helpful to physicians while facing the patients of compression neuropathy of median nerve. Before planning the surgery around the elbow joint these variations should be considered to minimize the complications. These information are also useful to interventional cardiologist while performing brachial catheterization & radiologist also who performed various radio diagnostic  procedures & angiographic studies around the cubital fossa.

 


Keywords


Accessory slip of brachialis, Median nerve, Brachial artery, Cubital fossa, Variation

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References


Johnson D. Upper arm. In: Standring S. Gray’s Anatomy: The Anatomical Basis of Clinical Practices, 40th ed. New York, USA: Elsevier. Churchill Livingstone. 2008;823-30.

Biswas S, Adhigari A, Kundu P. Variations in the cubital fossa. Int J of Anat Var. 2010;3:122-4.

Krishnamurthy A, David S, Bagoji IB. Accessory brachialis muscle associated with high division of brachial artery. Int J of Anat Var. 2010;3:160-1.

Loukas M, Louis RG Jr, South G, Alsheik E, Christopherson C. A case of an accessory brachialis muscle. Clin Anat. 2006;19:550-3.

Vadgaonkar R, Rai R, Ranade AV, Nayak SR, Pai MM, Lakshmi R. A case report on accessory brachialis muscle. Romanian J of Morphology and Embryology. 2008;49(4):581-3.

Pai MM, Nayak SR, Vadgaonkar R, Ranade AV, Prabhu LV, Thomas M, et al. Accessory brachialis muscle: a case report. Morphologie. 2008;92(296):47-9.

Bilecenoglu B, Uz A, Karalezli N. Possible anatomic structures causing entrapment neuropathies of the median nerve: An anatomic study. Acta Orthop Belg. 2005;71:169-76.

George BM, Nayak SB. Median nerve and brachial artery entrapment in the abnormal brachialis muscle – a case report. Neuroanatomy. 2008;7:41-2.

Paraskevas G, Natsis K, Loannidis O, Papaziogas B, Kitsoulis P, Spanidou S. Accessory muscles in the lower part of the anterior compartment of the arm that may entrap neurovascular elements. Clin Anat. 2008;21:246-51.

Macon WL IV, Futrell JW. Median nerve neuropathy after percutaneous puncture of the brachial artery in patients receiving anticoagulants. N Engl J Med. 1973;288:1396.

Chuang YM, Luo CB, Chou YH, Cheng YC, Chang CY, Chiou HJ. Sonographic diagnosis and treatment of a median nerve epineural hematoma caused by brachial artery catheterization. J Ultrasound Med. 2002;21:705-8.

Muscular system. In: Sander TW, Langman’s Medical Embyology. 11ed. New Delhi: Wolter’s Kluwer (India) Pvt Ltd. 2010;147-54.