Variant anatomy and codes of the human brachial plexus

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Abstract

Background. Understanding the complexities of formation and structural features of the brachial plexus remains important for diagnosis, effective surgical treatment and regional anesthesia.

Aim. To identify variants of the brachial plexus structure and develop a system for their coding.

Material and methods. Macroscopic anatomical layer-by-layer and macro-microscopic intratubular dissection of 121 brachial plexus preparations were performed in 105 cadavers of men and women aged 40–100 years. A database was formed from the obtained indicators in the MS Excel 2012 program, and their processing was carried out using Statistica for Windows 12. All indicators were tested for the normal distribution using the Shapiro–Wilco criterion. When describing the studied indicators, the median (Me) and interquartile intervals [Q1, Q3] were determined, as well as the significance of intergroup differences according to the Mann–Whitney test.

Results. It was established that the farther from the spinal cord, the more variants of the macroscopic and macro-microscopic structure of the brachial plexus elements exist: roots — 3, trunks — 7, divisions — 3, bundles — 12–16, and a total of 20 variants of the general structure were identified. The roots of spinal nerves C6 (66.1%), C7 (66.4%) and C8 (64.2%) take the greatest part in the formation of brachial plexus bundles, 2 times less often — C5 (34.8%) and Th1 (33.3%), very rarely — C4 (2.5%) and Th2 (0.8%). Reverse coding of variants of the brachial plexus structure in the direction: bundle ← division ← trunk (root) allows to briefly and clearly display the entire morphological diversity of the nervous system of the human upper limb. The results obtained should be taken into account when diagnosing injuries, performing regional anesthesia, reconstructive operations, rehabilitation measures, creating neurosimulators, neurochips, and nerve conductors.

Conclusion. 20 different variants of the general structure of the human brachial plexus have been identified and a reverse coding system has been developed.

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About the authors

Nikolay S. Gorbunov

Krasnoyarsk State Medical University named after V.F. Voino-Yasenetsky; Scientific Research Institute of Medical Issues of the North

Author for correspondence.
Email: gorbunov_ns@mail.ru
ORCID iD: 0000-0003-4809-4491
ResearcherId: W-4527-2017

M.D., D. Sci. (Med.), Prof., Depart. of Operative Surgery and Topographic Anatomy; Leading Researcher

Russian Federation, Krasnoyarsk, Russia; Krasnoyarsk, Russia

Kristina V. Kober

Krasnoyarsk Regional Clinical Oncological Dispensary named after A.I. Kryzhanovsky

Email: kober@mail.ru
ORCID iD: 0000-0001-5209-182X
ResearcherId: D-9666-2019

M.D.

Russian Federation, Krasnoyarsk, Russia

Eduard V. Kasparov

Scientific Research Institute of Medical Issues of the North

Email: rsimpn@scn.ru
ORCID iD: 0000-0002-5988-1688

M.D., D. Sci. (Med.), Prof., Director

Russian Federation, Krasnoyarsk, Russia

Sergey I. Rostovtsev

Krasnoyarsk State Medical University named after V.F. Voino-Yasenetsky

Email: rostovcev.1960@mail.ru
ORCID iD: 0000-0002-1462-7379

M.D., D. Sci. (Med.), Assoc. Prof., Depart. of Anesthesiology and Resuscitation

Russian Federation, Krasnoyarsk, Russia

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Supplementary files

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2. Fig. 1. Macropreparation of the right brachial plexus of a 78-year-old woman’s cadaver: 1, spinal cord; 2, C5 root; 3, C6; 4, C7; 5, C8; 6, Th1; 7, upper trunk; 8, middle trunk; 9, lower trunk; 10, supraspinous nerve; 11, lateral thoracic nerve; 12, lateral bundle; 13, medial bundle; 14, posterior bundle; 15, musculocutaneous nerve; 16, median nerve; 17, medial thoracic nerve; 18, ulnar nerve; 19, radial nerve; 20, inferior subclavian nerve; 21, medial cutaneous nerve of the forearm; 22, medial cutaneous nerve of the upper arm; 23, axillary nerve; 24, sternospinal nerve; and 25, superior subclavian nerve.

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3. Fig. 2. Formation of the trunks of the right brachial plexus in three cadavers: a 68-year-old man (A), a 71-year-old man (B), and an 85-year-old woman (C): 1, spinal nerve C4; 2, C5; 3, C6; 4, C7; 5, C8; 6, Th1; 7, upper trunk, 8, middle trunk, and 9, lower trunk.

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