Anatomical Variations of Brachial Plexus in Adult Cadavers; A Descriptive Study

Document Type : RESEARCH PAPER


1 Department of Neurosurgery, Brachial Plexus and Peripheral Nerve Injury Center, Guilan University of Medical Science, Rasht, Iran

2 Department of Neurosurgery, Guilan University of Medical Sciences, Rasht, Iran

3 Orthopedic Research Center, Mashhad University of Medical Science, Department of Neurosurgery, Mashhad, Iran

4 Legal Medicine Organization, Rasht, Iran


Variations of the brachial plexus are common and a better awareness of the variations is of crucial importance to achieve successful results in its surgical procedures. The aim of the present study was to evaluate the anatomical variations of the brachial plexus in adult cadavers. 


Bilateral upper limbs of 32 fresh cadavers (21 males and 11 females) consecutively referred to Guilan legal medicine organization from November 2011 to September 2014, were dissected and the trunks, cords and terminal nerves were evaluated.
Six plexuses were prefixed in origin. The long thoracic nerve pierced the middle scalene muscle in 6 cases in the supra clavicular zone. The suprascapular nerve in 7 plexuses was formed from posterior division of the superior trunk. Five cadavers showed anastomosis between medial brachial cutaneous nerve and T1 root in the infra clavicular zone. Terminal branches variations were the highest wherein the ulnar nerve received a communicating branch from the lateral cord in 3 cases. The median nerve was formed by 2 lateral roots from lateral cord and 1 medial root from the medial cord in 6 cadavers. Some fibers from C7 root came to the musculocutaneous nerve in 8 cadavers.
The correlation analysis between the variations and the demographic features was impossible due to the small sample size. The findings of the present study suggest a meta-analysis to assess the whole reported variations to obtain a proper approach for neurosurgeons.


1. Butz JJ, Shiwlochan DG , Brown KC , Prasad AM,
Murlimanju BV, Viswanath S. Bilateral variations
of brachial plexus involving the median nerve and
lateral cord: an anatomical case study with clinical
implications. Australas Med J. 2014; 7(5):227-31.
2. Parchand MP, Patil ST. Absence of musculocutaneous
nerve with variations in course and distribution of
the median nerve. Anat Sci Int. 2013; 88(1):58-60.
3. Aydin ME, Kale A, Edizer M, Kopuz C, Demir MT,
Corumlu U. Absence of the musculocutaneous nerve
together with unusual innervation of the median
nerve. Folia Morphol (Warsz). 2006; 65(3):228-31.
4. Soleymanha M, Mobayen M, Asadi K, Adeli A,
Haghparast-Ghadim-Limudahi Z. Survey of 2582
cases of acute orthopedic trauma. Trauma Mon.
2014; 19(4):e16215.
5. Chaudhary P, Singla R, Arora K, Kalsey G. Formation
and branching pattern of cords of brachial plexus-a
cadaveric study in north Indian population. Int J Ana
Res. 2014; 2(1):225-33.
6. Budhiraja V, Rastogi R, Asthana AK. Variations in
the formation of the median nerve and its clinical
correlation. Folia Morphol (Warsz). 2012; 71(1):28-
7. Uysal II, Seker M, Karabulut AK, Buyukmumcu M,
Ziylan T. Brachial plexus variations in human fetuses.
Agur AM, Dalley AF. Grant’s atlas of anatomy. 13th ed.
Philadelphia: Lippincott Williams & Wilkins; 2012.
9. Peter L. Williams. Gray’s Anatomy. 40th ed. Great
Britain: Churchill Livingstone; 2008. P. 1266-74.
10. Orebaugh SL, Williams BA. Brachial plexus anatomy:
normal and variant. Sci World J. 2009; 9:300-12.
11. Snell RS. Clinical anatomy. 7th ed. Philadelphia:
Lippincott Williams and Wilkins; 2004. P. 477.
12. Hollinshead W. General survey of the upper limb-the
back and limbs. Anatomy for Surgeons. New York:
Hoeber-Harper; 1958. P. 225-8.
13. Kerr AT. The brachial plexus of nerves in man the
variations its formation and branches. Am J Ana.
1918; 23(2):285-395.
14. Aggarwal A, Puri N, Aggarwal AK, Harjeet K, Sahni
D. Anatomical variation in formation of brachial
plexus and its branching. Surg Radiol Anat. 2010;
15. Lee HY, Chung IH, Sir WS, Kang HS, Lee HS, Ko JS, et al.
Variations of the ventral rami of the brachial plexus. J
Korean Med Sci. 1992; 7(1):19-24.
16. Aktan ZA, Ӧ􀇆 ztürk L, Bilge O, Ӧ􀇆 zer MA, Pinar YA. A
cadaveric study of the anatomic variations of the
brachial plexus nerves in the axillar region and arm.
Turk J Med Sci. 2001; 31(2):147-50.
17. Fazan VP, Amadeu AD, Caleffi AL, Rodrigues Filho OA.
Brachial plexus variations in its formation and main
branches. Acta Cir Bras. 2003; 18(5):14-8.
18. Uzel AP, Bulla A, Steinmann G, LaurentJoye M, Caix
P. Absence of the musculocutaneous nerve and its
distribution from median nerve: about two cases and
literature review. Morphology. 2011; 95(311):146-
19. Bala A, Sinha P, Tamang BK, Sarda RK. Anatomical
variation: median nerve formation - a case vignette. J
Clin Diagn Res. 2014; 8(6):AD03–4.
20. Radunovic M, Vukasanovic-Bozaric A, Radojevic
N, Vukadinovic T. A new anatomical variation
of the musculocutaneous and the median nerve
anastomosis. Folia Morphol (Warsz). 2013;
21. Rastogi R, Budhiraja V, Bansal K. Posterior cord
of brachial plexus and its branches: anatomical
variations and clinical implication. ISRN Anat. 2013;
22. Fazan VP, Amadeu AD, Caleffi AL, Filho OA. Brachial
plexus variations in its formation and main branches.
Acta Cir Bras. 2003; 18(5):14-8.
23. Kirazlı Ö􀇆 , Tatarlı N, Ceylan D, Hacıoğlu H, Uygun S,
Şeker A, et al. A variation of the cords of the brachial
plexus on the right and a communication between
the musculocutaneous and median nerves on the left
upper limb: a unique case. J Neurol Surg A Cent Eur
Neurosurg. 2013; 74(Suppl 1):e176-9.
24. El Falougy H, Selmeciova P, Kubikova E, Stenova J,
Haviarova Z. The variable communicating branches
between musculocutaneous and median nerves:
a morphological study with clinical implications.
Bratisl Lek Listy. 2013; 114(5):290-4
25. Hoogbergen MM, Kauer JM. An unusual ulnar nervemedian
nerve communicating branch. J Anat. 1992;
181(Pt 3):513-6.
26. Nakatani T, Tanaka S, Mizukami S. Two rare anomalies
of the brachial plexus. J Anat. 1998; 192(Pt 2):303-4.
27. Sargon MF, Uslu SS, Celik HH, Akşit D. A variation of
the median nerve at the level of brachial plexus. Bull
Assoc Anat (Nancy). 1995; 79(246):25-6.