Bilateral Variations in Median Nerve Formation with Embryological Basis and Clinical Correlation
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Jul-Dec 2016 | Vol 2 | Issue 2 | Page :3-6

Bikash Chandra Satapathy1, Soumitra Trivedi2

1Senior Resident, Department of Anatomy, AIIMS Raipur.
1Assistant Professor, Department of Anatomy, AIIMS Raipur.

How to cite this article:Satapathy BC, Trivedi S. Bilateral Variations in Median Nerve Formation with Embryological Basis and Clinical Correlation. Acad. Anat. Int. 2016;2(2):3-6.


During routine dissection of upper limb of a 68 year old male cadaver bilateral variations in median nerve were observed. On the left side the lateral cord pierced coracobrachialis without giving the lateral root of median nerve and after coming out of coracobrachialis it bifurcated in to musculocutaneous nerve and lateral root of median nerve. The medial root of median nerve continued up to the middle of arm and joined the lateral root and formed the median nerve in the middle of arm instead of axilla. On the right side there were two lateral roots of the median nerve that joined the medial root to form the median nerve. The musculocutaneous nerve after piercing coracobrachialis gave a communicating branch to the median nerve in the lower part of front of arm. These variations can lead to unusual innervation and entrapment neuropathies. Identification of these variants are valuable during surgeries performed in and around axilla and flexor compartment of arm.

Keywords:Brachial plexus, Median nerve, Musculocutaneous nerve, Lateral cord, Communication, Nerve compression.

  1. Williams P, Bannister L, Berry M, Collins P, Dyson M, Dussek J. Nervous System. Gray’s Anatomy. 38th ed. London: Churchil Livingstone; 1999. p. 1270.
  2. Chauhan R, Roy T. Communication Between The Median And Musculocutaneous. J Anat Soc India. 2002;51(1):72–5.
  3. Venieratos D, Anagnostopoulou S. Classification of communications between the musculocutaneous and median nerves. Clin Anat. 1998;11(5):327–31.
  4. Le Minor JM. [A rare variation of the median and musculocutaneous nerves in man]. Arch d’anatomie, d'histologie d'embryologie Norm expe?rimentales. 1990;73:33–42.
  5. Shyamal A, Tarnekar AM, Bokariya P. Communication between the musculocutaneous and median nerves in the arm. J Hand Surg Eur Vol. 2010 Oct;35(8):685–7.
  6. Patil ST, Meshram MM, Kasote AP, Kamdi NY. Formation of median nerve from single root on left side and communicating branch from median nerve to musculocutaneous nerve on right side. Morphologie. 2012.
  7. Kirazl? Ö, Tatarl? N, Ceylan D, Hac?o?lu H, Uygun S, ?eker 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 Dec; 74 Suppl 1: e176–9.
  8. Kumar N, Guru A, D’Souza MR, Patil J, Nayak B S. Incidences and Clinical Implications of Communications between Musculocutaneous Nerve and Median Nerve in the Arm - A Cadaveric Study. West Indian Med J. 2013 Nov; 62(8):744–7.
  9. Bala A, Sinha P, Tamang BK, Sarda RK. Anatomical variation: median nerve formation - a case vignette. J Clin Diagn Res. 2014 Jun;8(6):AD03–4.
  10. Butz JJ, Shiwlochan DG, Brown KC, Prasad AM, Murlimanju B V, 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.
  11. Ballesteros LE, Forero PL, Buitrago ER. Communication between the musculocutaneous and median nerves in the arm: an anatomical study and clinical implications. Rev Bras Ortop (English Ed. 2015;50(5):567–72.
  12. Natsis K, Paraskevas G, Tzika M. Five Roots Pattern of Median Nerve Formation. Acta medica (Hradec Kra?love?)/Univ Carolina, Fac Medica Hradec Kra?love?. 2016; 59(1):26–8.
  13. Padur AA, Kumar N, Shanthakumar SR, Shetty SD, Prabhu GS, Patil J. Unusual and Unique Variant Branches of Lateral Cord of Brachial Plexus and its Clinical Implications- A Cadaveric Study. J Clin Diagn Res. 2016 Apr; 10(4):AC01–4.
  14. Sir Sydney Sunderland. The Musculocutaneous Nerve. Nerves and Nerve Injuries. 2nd ed. Edinburg: Churchil Livingstone; 1978. p. 796–801.
  15. Choi D, Rodríguez-Niedenführ M, Vázquez T, Parkin I, Sañudo JR. Patterns of connections between the musculocutaneous and median nerves in the axilla and arm. Clin Anat. 2002 Jan; 15(1):11–7.
  16. Guerri-Guttenberg RA, Ingolotti M. Classifying musculocutaneous nerve variations. Clin Anat. 2009 Sep; 22(6): 671–83.
  17. Maeda S, Kawai K, Koizumi M, Ide J, Tokiyoshi A, Mizuta H, et al. Morphological study of the communication between the musculocutaneous and median nerves. Anat Sci Int. 2009 Apr; 84(1-2): 34–40.
  18. Sannes H, Rey T, Harris W. Development of the Nervous System. Axon Growth and Guidance. New York: Academic Press; 2000. p. 189–97.

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