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JOURNAL OF
THE ANATOMICAL SOCIETY OF INDIA

Vol. 49, No. 2, December, 2000


In this issue :

Editorial
Dr. Patnaik V.V.Gopichand

Gross Anatomy of the Caudate Lobe of the Liver
Sahni, D., Jit, I., Sodhi L. Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Branching Pattern of Axillary Artery - A Morphological Study
*Patnaik V.V.G., Kalsey, G; Singla Rajan, K. Department of Anatomy, Government Medical College, Amritsar, *Patiala. INDIA

The Course, Relations and The Branching Pattern Of The Middle Meningeal Artery In South Indians
Manjunath, K.Y. & Thomas, I.M. Department of Anatomy, St. John�fs Medical College, Bangalore-560 034 INDIA

Morphometry of the Human Inferior Olivary Nucleus
Dhall, U; Chhabra, S. & Rathi, S.K. Department of Anatomy, Pt. B.D. Sharma P.G.I.M.S., Rohtak. INDIA

Management of Turner Syndrome in India Using Anthropometric Assessment of Response to Hormone Replacement Therapy.
Sehgal R. and Singh A. Department of Anatomy, Maulana Azad Medical College and Associated Lok Nayak, G.B. Pant & G.N.E.C. Hospitals, New Delhi ? 110 002 INDIA.

Insertion Of Umbilical Cord On The Placenta In Hypertensive Mother
Rath* G, Garg** K, and Sood*** M. *Department of Anatomy, ***Department of Obstetrics & Gynaecology, Lady Hardinge Medical College, New Delhi-110001 **Department of Anatomy, Santosh Medical College, Gaziabad. INDIA

Utility Of Finger Prints in Myocardial Infarction Patients
Dhall, U; Rathee, S.K; *Dhall, A; Department of Anatomy & *Medicine, Pt. B.D. Sharma, PGIMS, Rohtak. INDIA

The Prenatal Parotid Gland
Fouzia Nayeem, Sagaff S., *Krishna G., **Rao S. Department of Anatomy, K.A.A.U. Jeddah. Department of *Pediatrics & **Surgery, Osmania Medical College, Hyderabad. INDIA

Possibility of Cell Death Induced Skeletal Malformations Of The Upper Limb
Sinha, D.N. Department of Anatomy, B.R.D. Medical College, Gorakhpur?273013 INDIA,

Efficacy of Manual Bladder Expression in Relieving Urine Retention After Traumatic Paraplegia In Experimental Animals.
Preeths, T.S., Sankar, V. Muthusamy, R. Department of Anatomy, Dr. A. Lakshmanasamy Mudaliar Postgraduate Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai 600 113, India.

Stress And Serum Cholesterol Levels-An Experimental Study
Jain, S.K. *Pandey, S.N. *Srivastava, R.K. Ghosh, S.K. Department of Anatomy, D.R.P.G. Medical College, Kangra at Tanda. * Department of Anatomy, G.S.V. Medical College, Kanpur.

Effect of Ibuprofen On White Cell Series of Bone Marrow Of Albino Rats
* Bhargava, R., Chandra, N., Naresh, M., *Sakhuja S. * Department of Anatomy, M.L.N. Medical College, Allahabad * Lady Hardinge Medical College, N. Delhi, India.

JB4 An Embedding Medium For Flourescent Tracer Technique
*Gupta, M; **Mishra, S., ***Sengupta P. Department of Anatomy, *PGI, Chandigarh; **AIIMS, N. Delhi; ***UCMS, New Delhi. INDIA

Comparative Anatomy of Cardiac Veins in Mammals
Kumar Keshaw Department of Anatomy, Institute of Medical Sciences B.H.U., Varanasi?5. INDIA

Aplasia Cutis Type 9 With Trisomy-13 Syndrome ? A Rare Association
Adhisivam, B, Narayanan, P, Vishnu Bhat, B, *Ramachandra Rao. R*, *Rao. S*, Kusre, G.* Department Pediatrics & *Anatomy, JIPMER, Pondicherry - 605 006

Absence of Musculocutaneous Nerve And The Innervation of Coracobrachialis, Biceps Brachii And Brachialis From The Median Nerve
Sud, M.; Sharma A. Department of Anatomy, Christian Medical College, Ludhiana. Punjab INDIA.

A Rare Pseudo Ansa Cervicalis: A Case Report
Indrasingh I. and Vettivel S. Department of Anatomy, Christian Medical College, Vellore, India

A Rare Variation In The Relation Of Omohyoid Muscle: A Case Report
Vettivel, S. Korula, A. and Koshy S. Department of Anatomy, Christian Medical College, Vellore, India

Surgical Incisions ? Their Anatomical Basis Part II - Upper Limb
1Patnaik V.V.G., 2Singla Rajan. K., 3 Gupta P.N. Department of Anatomy, Government Medical College, Patiala1, Amritsar2, 3Department of Orthopedics, Government Medical College, Chandigarh. INDIA

Anatomy Of Temporomandibular Joint?A Review
1Patnaik V.V.G., 3Bala Sanju; 2Singla Rajan K. Department of Anatomy, Govt. Medical College, 1Patiala, 2Amritsar, 3Department of Oral & Maxillofacial Surgery, Pb. Govt. Dental College, Amritsar


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J Anat. Soc. India 49(2) 176-177 (2000)
Absence of Musculocutaneous Nerve And The Innervation of Coracobrachialis, Biceps Brachii And Brachialis From The Median Nerve

Sud, M.; Sharma A. Department of Anatomy, Christian Medical College, Ludhiana. Punjab INDIA.

Abstract : Absence of the Musculocutaneous nerve was noted in a cadaver during routine dissection. The various muscles, which are normally supplied by the musculocutaneous nerve, were, instead, supplied by the median nerve from its lateral aspect, and also the lateral cutaneous nerve of the forearm was given off from the lateral {outer aspect} side of median nerve.

Keywords : Musculocutanous, Median Nerve, Brachial Plexus.

Introduction :

Variations are found in the formation of the brachial plexus. Normally the brachial plexus is formed by the lower four cervical ventral rami and the greater part of the first thoracic ventral ramus. The fourth cervical ramus normally gives a branch to the fifth and the first thoracic frequently receives one from the second thoracic. The ventral rami are the roots of the plexus, almost equal in size but variable in their mode of function. Commonly the fifth and sixth rami unite at the lateral border of the scalenus medius to form the upper trunk, the seventh cervical forms the middle trunk and the eighth cervical and first thoracic join to form the lower trunk. All these trunks incline laterally and behind the clavicle. There they bifurcate into anterior and posterior divisions. These divisions unite to form various cords in the axilla. The anterior divisions of the upper and middle trunk unite to form the lateral cord, which lies lateral to the axillary artery in the axilla. The anterior division of the lower trunk forms the medial cord, lying first beind, then medial to the axillary artery. The posterior divisions of all the trunks unite to form the posterior cord, which lies behind the axillary artery.

Normally, the lateral cord gives its first branch to the pectoralis major muscle, named the lateral pectoral nerve and then it divides into the musculo-cutaneous nerve and the lateral root of the median nerve.

The lateral root of the median nerve then joins the medial root from the medial cord to form the median nerve, which lies anterior to the third part of the axillary artery.

Case Report :

In this particular case, during routine dissection in the dissection hall of the Christian Medical College, Ludhiana, absence of the musculocu-taneous nerve was noted. The lateral cord gave a branch just below the outer border of the first rib to the pectoralis major muscle {i.e. lateral pectoral nerve}. Instead of giving musculocutaneous nerve, there were two lateral roots joining the median nerve {as shown in the photograph}. The first root given to the median nerve was 5 cm from the outer border of the first rib; the second root given to the median nerve was 10 cm from the outer border of the first rib. Both these roots were observed to join the median nerve in front of the axillary artery.

From the lateral side of the median nerve, 6cm from the outer border of the first rib, a branch was given to the corocobrachialis. Another branch was given to biceps brachii from its lateral side at a distance of 16.5 cm from the outer border of the first rib. The lateral cutaneous nerve of the forearm was also given from the lateral side of the median nerve about 17 cm from the main point i.e. outer border of the first rib.

The lateral cutaneous nerve of the forearm gave a branch 20cm from the outer border of the first rib to the brachialis muscle. This branch to the brachialis, after supplying the brachialis, pierced its substance and emerged to supply the biceps brachii.

Discussion :

Normally the musculocutaneous nerve is given off opposite the lower border of the pectoralis minor muscle. It pierces the coracobrachialis and


Photograph Showing

LC - Lateral Cord.
1. Lateral pectoral nerve
Ir - First lateral root to median nerve
2r - second lateral root to the median nerve
NC - Nerve to coracobrachialis
NBB2 - N to Biceps brachii
C - Coracobrachialis
BB - Biceps Brachii
NB - Nerve to brachialis
B - Brachialis
LCN - lateral cutaneous nerve of forearm

descends laterally between the biceps and the branchialis to the lateral side of the arm. Just below the elbow it pierces the deep fascia lateral to the tendon of the biceps and continues as the lateral cutaneous nerve of the forearm. Variations in the course and branches of the musculocutaneous nerve have been noted by Clements (1985) and Bergman et al (1988). Its absence was noted by Le Minor (1990). In this particular case there was complete absence of the musculocutaneous nerve. The median nerve from its lateral side supplied the coracobrachialis, biceps brachii and brachialis muscle. Lateral cutaneous nerve of forearm was given from the lateral side of the median nerve. This anomalous type of distribution by the median nerve has not been reported till now.

References :

1. Bergman RA, Tompson SA, Afifi AK, Saadeh FA (1988) : Compendium of Human Anatomic variation Munich : Urban And Schwarzenberg. pp 139-143.
2. Buch-Hansen K (1955) : Uber Varietaten des Nervus medianus and des Nervus musculocutaneous and deren Beziehungen. Anatomisher Anzeiger 102, 187-203.
3. Clemente CD, (1985) : Gray�fs Anatomy, 30th end, Philadelphia: Lea & Febiger; pp 1205-1221.
4. Nakalani, Tanak, Mizukami. (1994) : Absence of the musculocutanous nerve with innervation of coracobrachialis, biceps brachii, brachialis and the lateral border of the forearm by branches from the lateral cord of the brachial plexus, 191 (1?4): 459.



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