scholarly journals Surgical Implications of Innervation Pattern of the Triceps Muscle: A Cadaveric Study

2018 ◽  
Vol 10 (03) ◽  
pp. 139-142 ◽  
Author(s):  
Prashant Chaware ◽  
John Santoshi ◽  
Manmohan Patel ◽  
Mohtashim Ahmad ◽  
Bertha Rathinam
Keyword(s):  
Radial Nerve ◽  
Axillary Nerve ◽  
Nerve Supply ◽  
Upper Limbs ◽  
Innervation Pattern ◽  
Medial Head ◽  
Triceps Muscle ◽  
Muscle Transfers ◽  
Long Head ◽  
Lateral Head

AbstractThe innervation pattern of triceps is complex and not fully comprehended. Anomalous innervations of triceps have been described by various authors. We have attempted to delineate the nerve supply of the triceps and documented the anomalous innervations of its different heads. The brachial plexus and its major branches (in the region of the axilla and arm) and triceps were dissected in 36 embalmed cadaver upper limbs. Long head received one branch from radial nerve in 31 (86%) specimens. Four (11%) specimens received two branches including one that had dual innervation from the radial and axillary nerves, and one (3%) specimen had exclusive innervation from a branch of the axillary nerve. Medial head received two branches arising from the radial nerve in 34 (94%) specimens. One (3%) specimen received three branches from the radial nerve whereas one (3%) had dual supply from the radial and ulnar nerves. Lateral head received multiple branches exclusively from the radial nerve, ranging from 2 to 5, in all (100%) specimens. Knowledge of the variations in innervation of the triceps would not only help the surgeon to avoid inadvertent injury to any of the nerve branches but also offers new options for nerve and free functional muscle transfers.

scholarly journals Ulnar nerve contribution in the innervation of the triceps brachii muscle ulnar nerve to the triceps brachii

1970 ◽  
Vol 6 (1) ◽  
pp. 834-839
Author(s):  
DLR Silva ◽  
MP Barros ◽  
TGS Freire ◽  
L Firmino Júnior ◽  
WRB Almeida Filho ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Terminal Branch ◽  
Upper Limbs ◽  
Triceps Brachii ◽  
Medial Head ◽  
Muscle Innervation ◽  
Triceps Brachii Muscle ◽  
Long Head ◽  
Lateral Head

The ulnar nerve is considered the thickest terminal branch of the medial cord in the brachial plexus and most authors does not mention the possibility of this nerve emitting branches to the arm. However, some studies reported that the ulnar nerve could supply the medial head of triceps brachii muscle. The main objective in this study was identifying the presence of ulnar nerve branches in triceps brachii muscle. Sixty upper limbs of adult Brazilian corpses of both sexes were used. The estimated age was between 25 and 80 years old. Every studied piece had the nerves and their branches quantified and measured with a manual mechanic caliper. The branches were photographed and had the data registered in individual files. Were found ulnar nerve branches for all the heads of triceps brachii muscle: 1 branch (9,1%) to lateral head, 2 branches (18,1%) to long head and 8 branches (72,7%) to medial head. Thus, we can conclude that the contribution of ulnar nerve to triceps brachii muscle constitutes an important anatomical variation.Key words: Ulnar nerve; Triceps brachii muscle; Innervation.

scholarly journals Triceps Innervation Pattern: Implications for Triceps Nerve to Deltoid Nerve Transfer

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Obaid Al-Meshal ◽  
Alain Gilbert
Keyword(s):  
Anatomical Study ◽  
Nerve Transfer ◽  
Deltoid Muscle ◽  
Innervation Pattern ◽  
Anatomical Studies ◽  
Triceps Muscle ◽  
Muscle Innervation ◽  
Long Head ◽  
Lateral Head ◽  
Single Branch

There are multiple nerve branches supplying the triceps. Traditionally, the nerve to the long head of triceps is utilized for nerve transfer to neurotize the deltoid muscle in patients with brachial plexus injuries. However, no anatomical studies were done to investigate which triceps nerve would be preferred for nerve transfer. This anatomical study was carried out to describe the innervation pattern of the triceps muscle to investigate the preferred triceps nerve for nerve transfer. Twenty-five cadaveric arms were dissected. The long head of the triceps received a single branch in 23 cases (92%) and double branches in 2 cases (8%) only. The medial head had a single branch in 22 cases (88%) and double branches in 3 cases (12%). The lateral head was the most bulky one and received more than one branch in all cases (100%), ranging from 2 to 5 branches. The transfer of the most proximal branch to the lateral head of the triceps seems to be the most preferred choice for deltoid muscle innervation.

Triceps Motor Nerve Branches as a Donor or Receiver in Nerve Transfers

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONS333-ONS339 ◽  
Author(s):  
Jayme A. Bertelli ◽  
Marcos A. Santos ◽  
Paulo R. Kechele ◽  
Marcos F. Ghizoni ◽  
Hamilton Duarte
Keyword(s):  
Radial Nerve ◽  
Latissimus Dorsi ◽  
Motor Nerve ◽  
Nerve Transfer ◽  
Motor Branch ◽  
Medial Head ◽  
Nerve Transfers ◽  
Axillary Region ◽  
Long Head ◽  
Lateral Head

AbstractObjective:The pattern of triceps innervation is complex and, as yet, has not been fully elucidated. The purposes of this study were 1) to clarify the anatomy of the triceps motor branches, and 2) to evaluate their possible uses as a donor or receiver for nerve transfer.Methods:The radial nerve and its motor and cutaneous branches were bilaterally dissected from the axilla and posterior arm regions of 10 embalmed cadavers.Results:A single branch innervates the triceps long head, whereas double innervation was identified for the lateral and medial heads. The upper branch to the lateral head originated from the radial nerve, whereas the lower branch to the lateral head stemmed from the lower medial head motor branch, which ultimately innervated the anconeus muscle. Both the long head and the upper medial head motor branches originated in the axillary region in the vicinity of the latissimus dorsi tendon.Conclusion:Each of the triceps’ motor branches might be used as a donor for transfer. The triceps long head motor branch should be used preferentially when the intention is to establish triceps reinnervation.

Triceps and cutaneous radial nerve branches investigated via an axillary anterior arm approach: new findings in a fresh-cadaver anatomical study

2021 ◽  
pp. 1-10
Author(s):  
Jayme A. Bertelli ◽  
Mayur Sureshlal Goklani ◽  
Neehar Patel ◽  
Elisa Cristiana Winkelmann Duarte
Keyword(s):  
Radial Nerve ◽  
Latissimus Dorsi ◽  
Cutaneous Nerve ◽  
Posterior Surface ◽  
Motor Branch ◽  
Medial Head ◽  
Triceps Muscle ◽  
Fresh Cadaver ◽  
New Findings ◽  
Lateral Head

OBJECTIVE The authors sought to describe the anatomy of the radial nerve and its branches when exposed through an axillary anterior arm approach. METHODS Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery. RESULTS Via the anterior arm approach, all triceps muscle heads could be dissected and individualized. The radial nerve overlaid the latissimus dorsi tendon, bounded by the axillar artery on its superior surface, then passed around the humerus, together with the lower lateral arm and posterior antebrachial cutaneous nerve, between the lateral and medial heads of the triceps. No triceps motor branch accompanied the radial nerve’s trajectory. Over the latissimus dorsi tendon, an antero-inferior bundle, containing all radial nerve branches to the triceps, was consistently observed. In the majority of the dissections, a single branch to the long head and dual innervations for the lateral and medial heads were observed. The triceps long and proximal lateral head branches entered the triceps muscle close to the latissimus dorsi tendon. The second branch to the lateral head stemmed from the triceps lower head motor branch. The triceps medial head was innervated by the upper medial head motor branch, which followed the ulnar nerve to enter the medial head on its anterior surface. The distal branch to the triceps medial head also originated near the distal border of the latissimus dorsi tendon. After a short trajectory, a branch went out that penetrated the medial head on its posterior surface. The triceps lower medial head motor branch ended in the anconeus muscle, after traveling inside the triceps medial head. The lower lateral arm and posterior antebrachial cutaneous nerve followed the radial nerve within the torsion canal. The lower lateral brachial cutaneous nerve innervated the skin over the biceps, while the posterior antebrachial cutaneous nerve innervated the skin over the lateral epicondyle and posterior surface of the forearm. The average numbers of myelinated fibers were 926 in the long and 439 in the upper lateral head and 658 in the upper and 1137 in the lower medial head motor branches. CONCLUSIONS The new understanding of radial nerve anatomy delineated in this study should aid surgeons during reconstructive surgery to treat upper-limb paralysis.

The anatomy of the anconeus nerve redefined

2021 ◽  
pp. 175319342110614
Author(s):  
Mauro Maniglio ◽  
Ezequiel E. Zaidenberg ◽  
Ezequiel F. Martinez ◽  
Carlos R. Zaidenberg
Keyword(s):  
Radial Nerve ◽  
Axillary Nerve ◽  
The Other ◽  
Anatomical Landmarks ◽  
Medial Head ◽  
Articular Capsule

The anconeus nerve is the longest branch of the radial nerve and suitable as a donor for the neurotization of the axillary nerve. The aim of this study was to map its topographical course with reference to palpable, anatomical landmarks. The anconeus nerve was followed in 15 cadaveric specimens from its origin to its entry to the anconeus. It runs between the lateral and the medial head of the triceps before entering the medial head and running intramuscularly further distal. Exiting the muscle, it lies on the periosteum and the articular capsule of the elbow, before entering the anconeus muscle. Two types of anconeus nerve in relation to branches innervating triceps were found: nine nerves also innervated the lateral triceps head, while the other six only contributed two branches to its innervation. The course of the anconeus nerve is important for harvesting as a donor nerve and to protect the nerve in surgical elbow approaches.

scholarly journals Radial to axillary nerve transfer

2018 ◽  
Vol 44 (videosuppl1) ◽  
pp. V1 ◽  
Author(s):  
Vicente Vanaclocha ◽  
Juan Manuel Herrera ◽  
Marlon Rivera-Paz ◽  
Deborah Martínez-Gómez ◽  
Leyre Vanaclocha
Keyword(s):  
Nerve Transfer ◽  
Axillary Nerve ◽  
Negative Consequences ◽  
Viable Option ◽  
Successful Result ◽  
Nerve Branch ◽  
Triceps Muscle ◽  
Traditional Procedure ◽  
Muscle Nerve ◽  
Long Head

Axillary nerve injury is common after brachial plexus injuries, particularly with shoulder luxation. Nerve grafting is the traditional procedure for postganglionic injuries. Nerve transfer is emerging as a viable option particularly in late referrals. At the proximal arm the radial and axillary nerves lie close by. Sacrificing one of the triceps muscle nerve branches induces little negative consequences. Transferring the long head of the triceps nerve branch is a good option to recover axillary nerve function. The surgical technique is presented in a video, stressing the steps to achieve a successful result.The video can be found here: https://youtu.be/WbVbpMuPxIE.

AXILLARY NERVE SUPPLYING MOTOR BRANCH TO LONG HEAD OF TRICEPS BRACHII MUSCLE: A CASE REPORT AND REVIEW OF LITERATURE

2021 ◽  
pp. 69-71
Author(s):  
Giridhar Dasegowda ◽  
Seema Shimoga Rangappa
Keyword(s):  
Radial Nerve ◽  
Axillary Nerve ◽  
Extensive Literature ◽  
Triceps Brachii ◽  
Motor Branch ◽  
Traumatic Injuries ◽  
Clinical Observations ◽  
Male Cadaver ◽  
Triceps Brachii Muscle ◽  
Long Head

All three heads of the triceps brachii are classically described as being innervated by the radial nerve in the textbooks. Some clinical observations of traumatic injuries of the axillary nerve with associated paralysis of the long head of triceps and cadaveric studies have suggested that the axillary nerve may innervate the long head of triceps. During routine dissection to undergraduate M.B.B.S students, we found axillary nerve giving a motor branch to long head of triceps brachii on right side, in an adult male cadaver aged about 60 years. We conducted extensive literature search to analyse the previous studies reporting such variations and the studies conducted on the radial nerve or triceps brachii innervation pattern. This variation is clinically important for surgeons, orthopedicians and anaesthetist while performing surgeries and pain management therapies on the upper limb.

scholarly journals Spinal accessory nerve to triceps muscle transfer using long autologous nerve grafts for recovery of elbow extension in traumatic brachial plexus injuries

2018 ◽  
Vol 129 (4) ◽  
pp. 1041-1047 ◽  
Author(s):  
Liselotte F. Bulstra ◽  
Nadia Rbia ◽  
Michelle F. Kircher ◽  
Robert J. Spinner ◽  
Allen T. Bishop ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Radial Nerve ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Elbow Extension ◽  
Motor Branch ◽  
Spinal Accessory ◽  
Triceps Muscle ◽  
Long Head ◽  
Grade 3

OBJECTIVEReconstructive options for brachial plexus lesions continue to expand and improve. The purpose of this study was to evaluate the prevalence and quality of restored elbow extension in patients with brachial plexus injuries who underwent transfer of the spinal accessory nerve to the motor branch of the radial nerve to the long head of the triceps muscle with an intervening autologous nerve graft and to identify patient and injury factors that influence functional triceps outcome.METHODSA total of 42 patients were included in this retrospective review. All patients underwent transfer of the spinal accessory nerve to the motor branch of the radial nerve to the long head of the triceps muscle as part of their reconstruction plan after brachial plexus injury. The primary outcome was elbow extension strength according to the modified Medical Research Council muscle grading scale, and signs of triceps muscle recovery were recorded using electromyography.RESULTSWhen evaluating the entire study population (follow-up range 12–45 months, mean 24.3 months), 52.4% of patients achieved meaningful recovery. More specifically, 45.2% reached Grade 0 or 1 recovery, 19.1% obtained Grade 2, and 35.7% improved to Grade 3 or better. The presence of a vascular injury impaired functional outcome. In the subgroup with a minimum follow-up of 20 months (n = 26), meaningful recovery was obtained by 69.5%. In this subgroup, 7.7% had no recovery (Grade 0), 19.2% had recovery to Grade 1, and 23.1% had recovery to Grade 2. Grade 3 or better was reached by 50% of patients, of whom 34.5% obtained Grade 4 elbow extension.CONCLUSIONSTransfer of the spinal accessory nerve to the radial nerve branch to the long head of the triceps muscle with an interposition nerve graft is an adequate option for restoration of elbow extension, despite the relatively long time required for reinnervation. The presence of vascular injury impairs functional recovery of the triceps muscle, and the use of shorter nerve grafts is recommended when and if possible.

scholarly journals Variations in the Biceps Brachii in North Bengal - An Observational Study

2021 ◽  
Vol 8 (23) ◽  
pp. 1993-1997
Author(s):  
Arnab Bhar ◽  
Ananya Biswas
Keyword(s):  
Observational Study ◽  
Upper Limb ◽  
Humeral Head ◽  
Biceps Brachii ◽  
Clinical Symptoms ◽  
Nerve Supply ◽  
Upper Limbs ◽  
Eastern India ◽  
Long Head ◽  
North Bengal

BACKGROUND Supernumerary heads of the biceps brachii are a common anatomical variation, with an incidence of 3.7 % to 20.5 % in various studies carried out around the world. They can occur in various forms, and produce a range of clinical symptoms, such as impingement syndromes at the shoulder joint, and nerve-compression syndromes in the arm. An awareness of these variations is helpful when assessing patients with pain symptoms in the region of the shoulder and arm. The purpose of this study was to examine the morphology, nerve supply, and variations in morphology, of the biceps brachii in a population in Eastern India. METHODS This observational study was carried out on 20 (17 males, 3 females) formalinembalmed cadavers during routine gross anatomy dissection of the upper limb, using standard dissection methods. We examined the morphology, nerve supply, and variations in morphology, of the biceps brachii in a population in Eastern India. RESULTS Three upper limbs (7.5 % out of 40 limbs) showed supernumerary heads. In one male, a third humeral head of origin, from the anteromedial surface of the shaft of the humerus was observed in the left upper limb. In another male cadaver, we found a unique case with bilateral third heads with an aponeurotic origin from the capsule of the shoulder joint, with the third head comparable in size and bulk to the long and short heads. The remaining upper limbs showed the usual morphology, with the long head originating intracapsularly from the supraglenoid tubercle of the humerus and the glenoid labrum, and the short head from the tip of the coracoid process of the scapula. Insertions were usual. CONCLUSIONS Our study found an incidence of 7.5 % in a population sample from Eastern India, North Bengal. Supernumerary heads can occur in various forms, and can result in varied clinical symptoms. KEYWORDS Biceps Brachii, Biceps Brachii Variations, Supernumerary Head, Third Head, Humeral Head, Long Head of Biceps

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