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Variations of neurovascular structures of the upper limb

Introduction. Anatomical variations of neurovascular structures of the upper limb are not uncommon. Ulnar and radial arteries terminate in palm usually forming complete superficial palmar arch. However, variations of incomplete superficial palmar arch are less frequent. Musculocutaneous nerve arises from the lateral chord of brachial plexus and passes through coracobrachialis, travels between biceps and brachialis and continues as the lateral cutaneous nerve of the forearm. Rarely, it adheres for some distance to the median nerve and passes behind biceps. Median nerve arises with two roots from the lateral and medial chord of brachial plexus, enters the arm lateral to the brachial artery and crosses in front of the artery descending to cubital fossa medial to the artery. Rarely, median nerve crosses brachial artery from behind. Material and methods. During dissection of the female specimen we found multiple neurovascular variations in the single upper limb. Results. In our specimen, we found formation of incomplete superficial palmar arch. Superficial palmar branch of radial artery didn’t anastomose with ulnar artery. Instead, it gave one common palmar digital artery (later divided into two proper palmar digital arteries for contiguous sides of index and middle fingers) and one proper palmar digital artery for lateral side of index finger. Ulnar artery gave remaining two common palmar digital arteries. The palmar digital artery for the medial side of the little finger arised from third common palmar digital artery. Musculocutaneous nerve adhered median nerve and didn’t pass through coracobrachialis. Median nerve after entering the arm lateral to the brachial artery crossed artery from behind. Conclusion. Although, anatomical variations of vessels and nerves of the upper limb are quite common, multiple neurovascular variations in the single upper limb are, probably, less frequent. However, as seen from our case, they do coexist and that should be taken into consideration during various diagnostic, surgical or other medical procedures.

anatomical variations; upper limb; superficial palmar arch; musculocutaneous nerve; median nerve

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