A Rare Variation of the Brachial Plexus Involving The Trunks and Cords: A Case Report

Yıl 2022, Cilt: 3 Sayı: 3, 195 - 198, 30.07.2022

Zekiye Karaca Bozdağ , Özcan Gayretli , Buse Naz Çandır , Zafer Arı

Öz

Anatomical variations of the brachial plexus are common. This
study presents a case of brachial plexus detected during a cadaver dissection. During routine dissections at the Department of
Anatomy, Faculty of Medicine, Istanbul Yeni Yüzyıl University,
a variation in the formation and distribution of the left brachial
plexus was found in a 74-year-old female cadaver. In this case,
the roots of the C5 and C6 spinal nerves fuse to form the superior trunk. However C7, C8 and T1 spinal nerve roots formed a
single common trunk instead of the middle and inferior trunk.
The anterior branches of these two trunks formed a single lateral
cord. The medial cord is located lateral to the axillary artery in
the same extremity. The brachial plexus formation on the right
is in the classical pattern. Knowing the variations in brachial
plexus formation and distribution is guiding and important in
clinical practice.

Anahtar Kelimeler

Brachial plexus, trunks, cords, axillary artery, anatomic variations

Kaynakça

• 1. Moore KL, Dalley AF. Upper limb. In: Clinically Oriented Anatomy. Lippincott Williams and Wilkins 4th ed. Philadelphia; 1999, p. 714-5.
• 2. O’rahilly R, Gardner E. The timing and sequence of events in the development of the limbs in the human embryo. Anat Embryol. 1975;148:1-23. https://doi.org/10.1007/BF00315559.
• 3. Shinohara H, Naoro H, Hashimoto R, Hatta T, Tanaka D. Development of the innervation pattern in the upper limb of stuged human embryos. Acta Anat Basel. 1999; 138 (3): 265-9. doi: 10.1159/000146950.
• 4. Kerr, AT. The brachial plexus of nerves in man, the variations in its formation and branches. Am. J. Anat. 1918;23:285-395.
• 5. Bergman RA, Thompson SA, Afifi AK. Compendium of human anatomic variation. Text, Atlas and World Literature. Urban and Schwarzenberg, Munich. 1988.
• 6. Orebaugh SL, Williams BA. Brachial plexus anatomy: normal and variant. The Scientific World Journal. 2009;9:300-312.
• 7. Nayak S, Somayaji N, Venkata RV, Raghunathan D, Rodrigues V, Samuel VP, Alathady Malloor P. A rare variation in the formation of the upper trunk of the brachial plexus-a case report. Neuroanatomy. 2005;4(1):37-38. ISSN 1303-1775.
• 8. Uysal II, Seker M, Karabulut AK, Buyukmumcu M, Ziylan T. Brachial plexus variations in human fetuses. Neurosurgery. 2003;53:676-684. doi:10.1227/01.neu.0000079485.24016.70.
• 9. Aragão JA, Melo LO, Barreto ATF, Da Silva Leal AT, Reis FP. Variations in the formation of the trunks of brachial plexus. J. Morphol. 2014;31(1):48-50. doi:10.1007/s00276-010-0683-8.
• 10. Singla RK, Shree B, Sekhon J. A two trunked brachial plexus: a case report. J Clin Diagn Res. 2013; 7(4): 704-705. ISSN: 2277-2103. doi: 10.7860/JCDR/2013/4580.2886.
• 11. Satyanarayana N, Vishwakarrna N, Kumar GP, Guha R, Datta AK, Sunitha P. Variation in relation of cords of brachial plexus and their branches with axillary and brachial arteries: A case report. Nepal Med Coll J. 2009;11(1):69-72. PMID:19769245.
• 12. Havaldar PP, Gupta A, Rajasekhar HV. Case report: Variation in the formation of cords of brachial plexus and its relation with axillary artery. Current Neurobiology 2012;3(1):7-9. ISSN 0975-9042.
• 13. Buitenhuis S et al., Obstetric brachial plexus lesions and central developmental disability. Early Hum Dev. 2012;88(9):731-4.
• 14. Joaquim AF, Makhni MC, Riew KD. Post-operative nerve injuries after cervical spine surgery. Int Orthop. 2019;43(4):791-795.
• 15. LeBrun DG, Sneag DB, Feinberg JH, McCarthy MM, Gulotta LV, Lee SK, Wolfe SW. Surgical Treatment of Iatrogenic Nerve Injury Following Arthroscopic Capsulolabral Repair. J Hand Surg Am. 2021;46(12):1121.e1-1121.e11.
• 16. Acea Nebril B, Domenech Pina E, Díaz Carballada C, García Novoa A. Brachial Plexus Lesions in Breast Surgery. Recommendations for Prevention. Cirugía Española (English Edition). 2016;94(4), 251–253.
• 17. Vučemilo L, Lajtman Z, Mihalj J, Plašćak J, Mahović Lakušić D, Mužinić D. Brachial Plexus Schwannoma-Case Report and Literature Review. Acta Clin Croat. 2018;57(2):366-371.
• 18. Tapar H, Süren M, Kaya Z, Semih A, Karaman S, Kahveci M. Peripheral block anesthesia of upper extremity and its complications. Journal of Contemporary Medicine. 2012;2:195-200.
• 19. Tran DQ, Elgueta MF, Asenjo JF. Upper extremity nerve blocks. In Essentials of Regional Anesthesia. 2018;331-356.