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Erschienen in: Surgical and Radiologic Anatomy 3/2018

09.11.2017 | Original Article

Connections between radial and ulnar nerve at high humeral level in cadavers: incidence, topography, and literature review

verfasst von: Konstantinos Natsis, A. Giannakopoulou, M. Piagkou, N. Lazaridis, T. Tegos, M. R. Colonna

Erschienen in: Surgical and Radiologic Anatomy | Ausgabe 3/2018

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Abstract

Purpose

Although communications between branches and cords of the brachial plexus have been extensively published, there is a scarcity of reports concerning radial and ulnar nerve (RN–UN) communication in the arm. The current study aims to demonstrate the incidence, topography, and length of communicating branches between RN and UN. Any additional coexisted variations were also recorded.

Materials and methods

Two hundred and sixty-six upper limbs collected from one hundred and thirty-three (81 males and 52 females) Greek cadavers were dissected.

Results

Three out of one hundred and thirty-three cadavers, accounting for an incidence of up to 2.3%, were found to have an atypical communicating branch originating at a high humeral level from RN towards UN. In two cadavers, communicating branches were detected on the left side and in one cadaver bilaterally.

Conclusions

The study of atypical communications between RN and UN attracts great attention for its clinical importance, mainly in cases of peripheral neuropathies with diagnostic dilemma or upper limb nerve injury producing an otherwise unexpected symptomatology due to the aberrant nerve supply. Familiarity with these variations is crucial in avoiding misdiagnosis and preserving valuable communicating branches, thus achieving an uneventful outcome in cases of upper limb nerve injury repair.
Literatur
1.
Zurück zum Zitat Ajayi NO, Lazarus L, Satyapal KS (2012) Multiple variations of the branches of the brachial plexus with bilateral connections between ulnar and radial nerves. Int J Morphol 30:656–660CrossRef Ajayi NO, Lazarus L, Satyapal KS (2012) Multiple variations of the branches of the brachial plexus with bilateral connections between ulnar and radial nerves. Int J Morphol 30:656–660CrossRef
2.
Zurück zum Zitat Arachchi A, Loo ZY, Maung H, Vasudevan A (2013) A rare anatomical variation between the radial and ulnar nerves in the arm. Int J Anat Var 6:131–132 Arachchi A, Loo ZY, Maung H, Vasudevan A (2013) A rare anatomical variation between the radial and ulnar nerves in the arm. Int J Anat Var 6:131–132
3.
Zurück zum Zitat Arquez HF (2017) anastomosis between ulnar and radial nerve, a cadaveric study. Int Arch Med Sect Hum Anat 10:1–6 Arquez HF (2017) anastomosis between ulnar and radial nerve, a cadaveric study. Int Arch Med Sect Hum Anat 10:1–6
4.
Zurück zum Zitat Bekler H, Wolfe VM, Rosenwasser MP (2009) A cadaveric study of ulnar nerve innervation of the medial head of triceps brachii. Clin Orthop Relat Res 467:235–238CrossRefPubMed Bekler H, Wolfe VM, Rosenwasser MP (2009) A cadaveric study of ulnar nerve innervation of the medial head of triceps brachii. Clin Orthop Relat Res 467:235–238CrossRefPubMed
5.
Zurück zum Zitat Candan B, Ozturk K, Albay S (2016) Bilateral absence of musculocutaneous nerve with unusual communicating branch between radial and ulnar nerves. Int J Anat Var 9:39–42 Candan B, Ozturk K, Albay S (2016) Bilateral absence of musculocutaneous nerve with unusual communicating branch between radial and ulnar nerves. Int J Anat Var 9:39–42
6.
Zurück zum Zitat Chakrabarti S, Rajendran M, Agarwal V (2013) Abnormal communication between radial and ulnar nerves. Int J Anat Sci 4:23–25 Chakrabarti S, Rajendran M, Agarwal V (2013) Abnormal communication between radial and ulnar nerves. Int J Anat Sci 4:23–25
7.
Zurück zum Zitat Chauhan R, Roy TS (2002) Communication between the median and musculocutaneous nerve—a case report. J Anat Soc India 51:72–75 Chauhan R, Roy TS (2002) Communication between the median and musculocutaneous nerve—a case report. J Anat Soc India 51:72–75
8.
Zurück zum Zitat Darji A, Chauhan H, Khatri H, Aterkar S, Pensi CA (2013) Variations in branching pattern of brachial plexus : a cadaveric study. Int J Biomed Adv Res 4:174–178CrossRef Darji A, Chauhan H, Khatri H, Aterkar S, Pensi CA (2013) Variations in branching pattern of brachial plexus : a cadaveric study. Int J Biomed Adv Res 4:174–178CrossRef
9.
Zurück zum Zitat Das S, Paul S (2005) Anomalous branching pattern of lateral cord of brachial plexus. Int J Morphol 23:289–292CrossRef Das S, Paul S (2005) Anomalous branching pattern of lateral cord of brachial plexus. Int J Morphol 23:289–292CrossRef
10.
Zurück zum Zitat Dogan NU, Uysal II, Seker M (2008) The communications between the ulnar and median nerves in upper limb. Neuroanatomy 8:15–19 Dogan NU, Uysal II, Seker M (2008) The communications between the ulnar and median nerves in upper limb. Neuroanatomy 8:15–19
11.
Zurück zum Zitat Gopal K, Anurag, Singh O (2016) Anatomical variations of brachial plexus: anomalous branching pattern. Int J Res Med Sci 4:3376–3380CrossRef Gopal K, Anurag, Singh O (2016) Anatomical variations of brachial plexus: anomalous branching pattern. Int J Res Med Sci 4:3376–3380CrossRef
12.
Zurück zum Zitat Gupta M, Goyal N, Harjeet (2005) Anomalous communications in the branches of brachial plexus. J Anat Soc India 54:22–25 Gupta M, Goyal N, Harjeet (2005) Anomalous communications in the branches of brachial plexus. J Anat Soc India 54:22–25
13.
Zurück zum Zitat Guru A, Kumar N, Ravindra Shanthakumar S, Patil J, Nayak Badagabettu S, Aithal Padur A, Nelluri VM (2015) Anatomical study of the ulnar nerve variations at high humeral level and their possible clinical and diagnostic implications. Anat Res Int. http://dx.doi.org/10.1155/2015/378063 Guru A, Kumar N, Ravindra Shanthakumar S, Patil J, Nayak Badagabettu S, Aithal Padur A, Nelluri VM (2015) Anatomical study of the ulnar nerve variations at high humeral level and their possible clinical and diagnostic implications. Anat Res Int. http://​dx.​doi.​org/​10.​1155/​2015/​378063
14.
Zurück zum Zitat Hur MS, Lee KS (2013) An unusual communication between the radial and the ulnar nerves. Korean J Phys Anthropol 26:55–59CrossRef Hur MS, Lee KS (2013) An unusual communication between the radial and the ulnar nerves. Korean J Phys Anthropol 26:55–59CrossRef
15.
Zurück zum Zitat Kaur J, Mehta V, Suri RK, Goel A (2015) Multiple interneural communications of brachial plexus—anatomical description and clinical significance. Rec Adv Path Lab Med 1:21–23 Kaur J, Mehta V, Suri RK, Goel A (2015) Multiple interneural communications of brachial plexus—anatomical description and clinical significance. Rec Adv Path Lab Med 1:21–23
16.
Zurück zum Zitat Kerr AT (1918) The brachial plexus of nerves in man, the variations in its formation and branches. Am J Anat 23:285–395CrossRef Kerr AT (1918) The brachial plexus of nerves in man, the variations in its formation and branches. Am J Anat 23:285–395CrossRef
17.
Zurück zum Zitat Koizumi M, Sakai T (1997) On the morphology of the brachial plexus of the platypus (Ornithorhynchus anatinus) and the echidna (Tachyglossus aculeatus). J Anat 190(Pt 3): 447–455CrossRefPubMedPubMedCentral Koizumi M, Sakai T (1997) On the morphology of the brachial plexus of the platypus (Ornithorhynchus anatinus) and the echidna (Tachyglossus aculeatus). J Anat 190(Pt 3): 447–455CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Kosugi K, Morita T, Koda M, Yamashita H (1986) Branching pattern of the musculocutaneous nerve. 1. Case possessing normal biceps brachii. Jikeikai Med J 33:63–71 Kosugi K, Morita T, Koda M, Yamashita H (1986) Branching pattern of the musculocutaneous nerve. 1. Case possessing normal biceps brachii. Jikeikai Med J 33:63–71
19.
Zurück zum Zitat Lalit M, Kullar JS, Piplani S (2014) Communication between radial and ulnar nerve at a high humeral level. Int J Anat Res 2:315–317 Lalit M, Kullar JS, Piplani S (2014) Communication between radial and ulnar nerve at a high humeral level. Int J Anat Res 2:315–317
20.
Zurück zum Zitat Leis AA, Wells KJ (2008) Radial nerve cutaneous innervation to the ulnar dorsum of the hand. Clin Neurophysiol 119:662–666CrossRefPubMed Leis AA, Wells KJ (2008) Radial nerve cutaneous innervation to the ulnar dorsum of the hand. Clin Neurophysiol 119:662–666CrossRefPubMed
21.
Zurück zum Zitat Linell EA (1921) The distribution of nerves in the upper limb, with reference to variabilities and their clinical significance. J Anat 55:79–112PubMedPubMedCentral Linell EA (1921) The distribution of nerves in the upper limb, with reference to variabilities and their clinical significance. J Anat 55:79–112PubMedPubMedCentral
22.
Zurück zum Zitat Lombardo DJ, Buzas D, Siegel G, Afsari A (2015) Aberrant radial–ulnar nerve communication in the upper arm presenting as an unusual radial nerve palsy: a case report. Surg Radiol Anat 37:411–413CrossRefPubMed Lombardo DJ, Buzas D, Siegel G, Afsari A (2015) Aberrant radial–ulnar nerve communication in the upper arm presenting as an unusual radial nerve palsy: a case report. Surg Radiol Anat 37:411–413CrossRefPubMed
23.
Zurück zum Zitat Loukas M, Abel N, Tubbs RS, Matusz P, Zurada A, Cohen-Gadol AA (2011) Neural interconnections between the nerves of the upper limb and surgical implications. J Neurosurg 114:225–235CrossRefPubMed Loukas M, Abel N, Tubbs RS, Matusz P, Zurada A, Cohen-Gadol AA (2011) Neural interconnections between the nerves of the upper limb and surgical implications. J Neurosurg 114:225–235CrossRefPubMed
24.
Zurück zum Zitat Loukas M, Louis RG Jr, Wartmann CT, Tubbs RS, Turan-Ozdemir S, Kramer J (2008) The clinical anatomy of the communications between the radial and ulnar nerves on the dorsal surface of the hand. Surg Radiol Anat 30:85–90CrossRefPubMed Loukas M, Louis RG Jr, Wartmann CT, Tubbs RS, Turan-Ozdemir S, Kramer J (2008) The clinical anatomy of the communications between the radial and ulnar nerves on the dorsal surface of the hand. Surg Radiol Anat 30:85–90CrossRefPubMed
25.
Zurück zum Zitat Mahan A, Spinner RJ (2016) Nerves of the upper extremity. Shane R, Tubbs MM, Shoja, Loukas M (eds) Bergman’s comprehensive encyclopedia of human anatomic variation. Wiley, Hoboken, New Jersey, pp 1068–1112. (Ch: 91) Mahan A, Spinner RJ (2016) Nerves of the upper extremity. Shane R, Tubbs MM, Shoja, Loukas M (eds) Bergman’s comprehensive encyclopedia of human anatomic variation. Wiley, Hoboken, New Jersey, pp 1068–1112. (Ch: 91)
26.
Zurück zum Zitat Miller RA (1934) Comparative studies upon the morphology and distribution of the brachial plexus. Am J Anat 54:143–175CrossRef Miller RA (1934) Comparative studies upon the morphology and distribution of the brachial plexus. Am J Anat 54:143–175CrossRef
27.
Zurück zum Zitat Natsis K, Paraskevas G, Tzika M (2016) Five roots pattern of median nerve formation. Acta Med 59:26–28 Natsis K, Paraskevas G, Tzika M (2016) Five roots pattern of median nerve formation. Acta Med 59:26–28
28.
Zurück zum Zitat Orebaugh SL, Williams BA (2009) Brachial plexus anatomy: normal and variant. Sci World J 9:300–312CrossRef Orebaugh SL, Williams BA (2009) Brachial plexus anatomy: normal and variant. Sci World J 9:300–312CrossRef
29.
Zurück zum Zitat Ozguner G, Desdicioglu K, Albay S (2010) Connection between radial and ulnar nerves at high humeral level extremity. Brachial plexus and its terminal branches. Int J Anat Var 3:49–50 Ozguner G, Desdicioglu K, Albay S (2010) Connection between radial and ulnar nerves at high humeral level extremity. Brachial plexus and its terminal branches. Int J Anat Var 3:49–50
30.
Zurück zum Zitat Pascual-Font A, Vazquez T, Marco F, Sanudo JR, Rodriguez-Niedenfuhr M (2013) Ulnar nerve innervation of the triceps muscle: real or apparent? An anatomic study. Clin Orthop Relat Res 471:1887–1893CrossRefPubMedPubMedCentral Pascual-Font A, Vazquez T, Marco F, Sanudo JR, Rodriguez-Niedenfuhr M (2013) Ulnar nerve innervation of the triceps muscle: real or apparent? An anatomic study. Clin Orthop Relat Res 471:1887–1893CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Pattanshetti SV, Jevoor PS, Shirol VS, Dixit D, Bhimalli S (2012) A study of the formation and branching pattern of brachial plexus and its variations in adult human cadavers of north Karnataka. J Sci Soc 39:70–77 Pattanshetti SV, Jevoor PS, Shirol VS, Dixit D, Bhimalli S (2012) A study of the formation and branching pattern of brachial plexus and its variations in adult human cadavers of north Karnataka. J Sci Soc 39:70–77
33.
Zurück zum Zitat Pontell M, Scali F, Marshall E (2011) A unique variation in the course of the musculocutaneous nerve. Clin Anat 24:968–970CrossRefPubMed Pontell M, Scali F, Marshall E (2011) A unique variation in the course of the musculocutaneous nerve. Clin Anat 24:968–970CrossRefPubMed
34.
Zurück zum Zitat Sanes HD, Reh TA, Harris WA (2000) Development of the nervous system, 1st edn. Academic Press, New York. pp 189–197 Sanes HD, Reh TA, Harris WA (2000) Development of the nervous system, 1st edn. Academic Press, New York. pp 189–197
35.
Zurück zum Zitat Singh R (2017) Variations of cords of brachial plexus and branching pattern of nerves emanating from them. J Craniofac Surg 28:543–547CrossRefPubMed Singh R (2017) Variations of cords of brachial plexus and branching pattern of nerves emanating from them. J Craniofac Surg 28:543–547CrossRefPubMed
36.
Zurück zum Zitat Swamy RS, Kumar N, Nayak SB, Shetty SD, Aithal A (2015) Presence of communication between radial and ulnar nerve at high humeral level and its distribution to triceps brachii muscle. Int J Health Allied Sci 4:39–41CrossRef Swamy RS, Kumar N, Nayak SB, Shetty SD, Aithal A (2015) Presence of communication between radial and ulnar nerve at high humeral level and its distribution to triceps brachii muscle. Int J Health Allied Sci 4:39–41CrossRef
37.
Zurück zum Zitat Taheri MMH, Afshar M (2015) Connection between radial and ulnar nerves at humeral level and its clinical significance: a cadaveric case report. Int J Morphol 33:1559–1562CrossRef Taheri MMH, Afshar M (2015) Connection between radial and ulnar nerves at humeral level and its clinical significance: a cadaveric case report. Int J Morphol 33:1559–1562CrossRef
38.
Zurück zum Zitat Yadav Y, Chakradhar V, Goswami P, Nayeem SM (2014) Unilateral neural communication between radial and ulnar nerves at high humeral level. Eur J Acad Essays 1:94–96 Yadav Y, Chakradhar V, Goswami P, Nayeem SM (2014) Unilateral neural communication between radial and ulnar nerves at high humeral level. Eur J Acad Essays 1:94–96
Metadaten
Titel
Connections between radial and ulnar nerve at high humeral level in cadavers: incidence, topography, and literature review
verfasst von
Konstantinos Natsis
A. Giannakopoulou
M. Piagkou
N. Lazaridis
T. Tegos
M. R. Colonna
Publikationsdatum
09.11.2017
Verlag
Springer Paris
Erschienen in
Surgical and Radiologic Anatomy / Ausgabe 3/2018
Print ISSN: 0930-1038
Elektronische ISSN: 1279-8517
DOI
https://doi.org/10.1007/s00276-017-1939-3

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