Entrapment of the Median Nerve by a Muscular Branch of the Brachial Artery: A Case Report

Snehlata P. Samberkar, Normadiah M. Kassim, Siti Rosmani M. Zin, Prashant Samberkar

Department of Anatomy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Forensic Medicine and Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

DOI: 10.4236/fmar.2014.23010                

Abstract

Variations in the arterial pattern of the upper limbs are commonly encountered in routine dissection. In-depth information of the vascular structure of the upper extremities is not only important for diagnostic interventions and surgical approaches, but has medico-legal implications. We report the unusual variation of an additional muscular branch of the brachial artery entrapping the median nerve in the middle of the arm. This anomaly was present in both upper extremities of an adult male Indo-Malaysian cadaver. The abnormality reported here might result in neurovascular compression symptoms in the upper limbs. Knowledge of the vascular dissimilarity of the brachial artery and its division, and possible neurovascular entrapment is important to surgeons and medical practitioners for anticipating nerve compression and for confirmation via motor and sensory examination.

Keywords

Anatomical Variation, Brachial Artery, Median Nerve, Bilateral Upper Extremity, Trapped Nerve

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Richard, S. (2008) Clinical Anatomy by Regions. Lippincott Williams &Wilkins, Philadelphia.
[2]	Kanagasuntheram, R., Krishnamurti, A. and Sivanandasingham, P. (1980) A New Approach to Dissection of the Human Body. 2nd Edition, Singapore University Press, Singapore City.
[3]	Whitney, L. (2007) Pronator Teres Syndrome. Vol. 07 (5). Retrieved from Massage Today Website. http://www.massagetoday.com/mpacms/mt/article.php?id=13625
[4]	George, M.B. and Nayak, B.S. (2008) Median Nerve and Brachial Artery Entrapment in the Abnormal Brachialis Muscle—A Case Report. Neuroanatomy, 7, 41-42.
[5]	Ciervo, A., Kahn, M. and Pangilinan, A.J. (2001) Absence of the Brachial Artery: Report of A Rare Human Variation and Review of Upper Extremity Artery Anomalies. Journal of Vascular Surgery, 33, 191-194. http://dx.doi.org/10.1067/mva.2001.112212
[6]	Standring, S. (2005) Grays Anatomy. Elsevier Churchill Livingstone, Edinburgh.
[7]	Malcic, G.J., Gurunluoglu, R., Ozdogmus, O. and Yalin, A. (2002) Unique Case of Trifurcation of the Brachial Artery: Its Clinical Significance. Clinical Anatomy, 15, 224-227. http://dx.doi.org/10.1002/ca.10005
[8]	Yalcin, B., Kocabiyik, N., Yazar, F., Kirici, Y. and Ozan, H. (2006) Arterial Variations of the Upper Extremities. Anatomical Science International, 81, 62-64. http://dx.doi.org/10.1111/j.1447-073X.2006.00110.x
[9]	Vollala, R.V., Nagabhooshana, S. and Bhatt, M.S. (2008) Trifurcation of Brachial Artery with Variant Course of Radial Artery: Rare Observation. Anatomical Science International, 83, 307-309. http://dx.doi.org/10.1111/j.1447-073X.2008.00235.x
[10]	Baral, P., Vijayabhaskar, P., Roy, S., Kumar, S., Ghimire, S. and Shrestha, U. (2009) Multiple Arterial Anomalies in Upper Limb. Kathmandu University Medical Journal, 27, 293-299.
[11]	McCormack, L.J., Cauldwell, E.W. and Anson, B.J. (1953) Brachial and Antebrachial Arterial Patterns. The Journal of Surgery, Gynecology and Obstetrics, 96, 43-54.
[12]	Kumar, H., Srijit, D. and Gaur, S. (2007) Entrapment of the Median Nerve and the Brachial Artery by the Lacertus Fibrosus. Archives of Medical Science, 3, 284-286.
[13]	Rodrigues, V., Nayak, S., Nagabhooshana, S. and Vollala, R.V. (2008) Median Nerve and Brachial Artery Entrapment in the Tendinous Arch of Coracobrachialis Muscle. The International Journal of Acoustics and Vibration, 1, 28-29.
[14]	Paval, J. (2008) A Rare Case of Possible Median Nerve Entrapment. Neuroanatomy, 5, 35-38.
[15]	Mas, N., Pelin, C., Zagyapan, R. and Bahar, H. (2008) Unusual Relation of the Median Nerve with the Accessory Head of the Biceps Brachii Muscle: An Original Case Report. International Journal of Morphology, 24, 581-584.
[16]	Cavolli, R., Eryilmaz, S. and Ozyurda, U. (2007) Report of the Anatomic Variation of the Brachial Artery in A Patient Undergoing Transradial Cardiac Catherization. Journal of Vascular Nursing, 25, 19-20. http://dx.doi.org/10.1016/j.jvn.2006.12.001