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PURPOSE: The brachioradialis muscle (BRM) belongs to the lateral group of forearm muscles and contributes to the elbow flexion. Accessory brachioradialis muscle (ABRM) or "brachioradialis accessorius" represents an uncommon BRM variant, not been enough studied. The present study investigates the prevalence of the ABRM, along with its origin, insertion, and innervation. MATERIALS: Eighty-three upper limbs were meticulously dissected at the arm, forearm, and cubital fossa to investigate the ABRM presence. When the variant muscle was identified, morphometric measurements were obtained. RESULTS: The ABRM was identified in two upper limbs (2/83, 2.4%), in a male cadaver, bilaterally. Its origin was located along with the typical BRM, and its insertion was identified into the anterior surface of the radius (proximal third). The ABRM was innervated by the radial nerve, coursing posteriorly (deeply). CONCLUSIONS: In the current study, the variant muscle was observed in 2.4%. Radial nerve compression, at the forearm, is not an uncommon entrapment neuropathy. The relationship between the radial nerve and the ABRM could precipitate radial neuropathy.

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Awareness of unique path of the superficial branch of the radial nerve and its unusual sensory distribution can help avoid potential diagnostic confusion. We present a unique case encountered during a routine dissection of a Central European male cadaver. An unusual course of the superficial branch of the radial nerve was found in the right forearm, where the superficial branch of the radial nerve originated from the radial nerve distally, within the supinator canal, emerged between the extensor digitorum and abductor pollicis longus muscles and supplied the second and a radial half of the third digit, featuring communications with the lateral antebrachial cutaneous nerve and the dorsal branch of the ulnar nerve. Due to dorsal emerging of the superficial branch of the radial nerve the dorsal aspect of the thumb was innervated by the lateral antebrachial cutaneous nerve. To our best knowledge such variation of the superficial branch of the radial nerve has never been reported before. This variation dramatically changes aetiology and manifestation of possible entrapment syndromes which clinicians should be aware of.

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CASE: Two patients sustained comminuted extra-articular distal humerus fractures. One patient was neurovascularly intact preoperatively. The other patient had a complete radial motor palsy with preserved sensation. Intraoperatively, both exhibited anatomic variants of the radial sensory nerve of the arm that pierced the triceps rather than branching from the distal third of the radial nerve proper, as is traditionally reported. CONCLUSIONS: Although rare, variations in the radial nerve may exist about the distal humerus. Surgeons should be aware of these variations to avoid iatrogenic injury.

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The superficial radial nerve (SRN) is the terminal pure sensory branch of the radial nerve supplying dorsal aspects of the proximal portion of the lateral three and a half digits including the lateral two-thirds of the dorsum of the hand. It transits from its submuscular position to a subcutaneous position by passing between the brachioradialis and extensor carpi radialis longus tendons around 7 to 9 cm proximal to the radial styloid. We present a case where this nerve instead of its normal forearm course, pierced the brachioradialis tendon to become subcutaneous.

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We have found an interesting coincidental variation of the superficial branch of the radial nerve and the brachioradialis muscle in a male cadaver. The superficial branch of the radial nerve was duplicated with one branch taking an aberrant course between two bellies of the brachioradialis muscle. The variant brachioradialis muscle featured two muscle bellies, a superficial one and a deep one, with one common origin and one common insertional tendon. The accessory nerve branch was impinged by two blood vessels and pierced through muscle bundles connecting two bellies of the brachioradialis muscle. The knowledge of this neuromuscular variant is of clinical relevance for the differential diagnosis of pain and paresthesia on the dorsoradial aspect of the hand and for the surgical management of the Wartenberg's syndrome.

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An unusual communication between the radial and ulnar nerves was observed during repair of a fracture of the humerus in an adult patient who presented with unusual physical exam findings. The patient had loss of radial and ulnar nerve motor function, as well as decreased sensation in both nerve distributions. Radial nerve injury following fracture of the humerus is a common condition, and anatomic variations are therefore of importance to clinicians. Communications between branches of the brachial plexus are also not uncommon findings; however there is very little mention of communication between the radial and ulnar nerves in the literature. An appreciation of unusual nerve anatomy is important in explaining unusual finding in patients.

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In the present case study, there is an anomalous pattern of superficial branch of radial nerve (SBRN) that can be recognized as an anatomical variant of the left upper limb of a 60 years old donated embalmed male cadaver in the Department of Human Anatomy, Universiti Putra Malaysia, in which the superficial branch of radial nerve supplies the extensor carpi radialis longus and extensor carpi radialis brevis muscle. The superficial branch of radial nerve gave off branch to supply the proximal fusion part of extensor carpi radialis longus and extensor carpi radialis brevis muscles immediately after bifurcation of the radial nerve into the superficial branch of radial nerve and deep branch of radial nerve. This variation is very important to the surgeon as the presence of the variant will make them more careful in dealing with nerve entrapment surgery, reconstructive surgery and in the pain management services, the variation giving indications for treatment.

En el presente estudio se observó un caso de un patrón anómalo del ramo superficial del nervio radial (RSNR) reconocido como una variante anatómica del miembro superior izquierdo en un cadáver de sexo masculino de 60 años perteneciente al Departamento de Anatomía Humana de la Universidad Putra, Malasia. En este caso el ramo superficial del nervio radial inervaba a los músculos extensores radial largo y corto del carpo. El ramo superficial del nervio radial otorgaba un ramo a nivel del origen fusionado de los músculos extensores radiales del carpo, inmediatamente después de la división en ramos superficial y profundo del nervio radial. Esta variación es de importancia para el cirujano debido a que requiere un mayor cuidado en el tratamiento quirúrgico de atrapamiento del nervio o cirugía reconstructiva para el manejo del dolor.

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INTRODUCTION: The Froment-Rauber nerve is a rarely described anomalous nerve arising from 1 of the terminal branches of the radial nerve that provides innervation to intrinsic hand muscles. We describe a 26-year-old man who had a traumatic radial nerve injury that resulted in first dorsal interosseous muscle wasting. He presented to our clinic 2.5 years post-injury, after having had unnecessarily undergone surgical exploration of the ulnar nerve. METHODS: The patient's history, clinical examination, and multiple electrodiagnostic tests were reviewed. RESULTS: All findings were consistent with a diagnosis of anomalous innervation via a Froment-Rauber nerve. CONCLUSIONS: Understanding this rare phenomenon may aid in diagnosing confusing clinical cases and prevent unnecessary procedures.

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BACKGROUND: The superficial branch of the radial nerve is frequently encountered when performing the harvest for a radial forearm free tissue transfer. METHODS AND RESULTS: We present an abnormal course of this nerve which has not been described in the literature. During a harvest of a radial forearm free flap, we encountered a nerve that was not deep to the brachioradialis muscle in the proximal arm; rather, the superficial branch of the radial nerve was found to be superficial to this muscle through its entire course. An in-depth literature review was performed, and there was no documented abnormality identified resembling the abnormality we encountered. CONCLUSION: Knowledge of the normal and abnormal anatomy is essential for the microvascular surgeon to assure the safety of this nerve.

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La distribución de los ramos nerviosos sensitivos en el borde lateral y en el dorso de la mano han sido descritos con mayor exactitud en las últimas décadas, debido al avance de nuevas técnicas de diagnóstico, las cuales han permitido detectar que alrededor del 40 por ciento de la población examinada presenta algún grado de variación anatómica en el territorio de distribución de los nervios involucrados. Conocer el número de fibras que componen un ramo nervioso cutáneo de la región de la mano, ha adquirido mayor relevancia con el desarrollo de técnicas de microcirugía y de ultrasonografía, procedimientos que han demostrado la utilidad de este conocimiento en el diagnóstico y tratamiento de las lesiones nerviosas. Así, la arquitectura fascicular, el área adiposa y el área vascular de un ramo nervioso determinado constituyen datos que se ha demostrado se modifican con la edad y, en consecuencia, van condicionar la conducta terapéutica y el pronóstico de las lesiones nerviosas. En este caso presentamos una variación anatómica bilateral extremadamente rara, que involucra al ramo superficial del nervio radial y al nervio cutáneo lateral antebraquial; situación que aparece descrita en la literatura especializada sólo una vez y que modifica notablemente la inervación sensitiva del borde radial de la mano...

The distribution of sensory nerve branches in the lateral and the back of the hand have been described more accurately in recent decades due to advances in new diagnostic techniques, which have identified that about 40 percent of the population examined have some degree of anatomical variation in the distribution area of the sensitive nerves involved. The knowledge of the number of fibers forming a sensitive nerve of the hand has become more important with the development of microsurgical techniques and ultrasonography; procedures that have demonstrated the usefulness of this information in the diagnosis and treatment of nerve injuries. Thus, the fascicular architecture, adipose tissue area and the vascular area of a nerve branch, data that has been demonstrated that change with age, will determine the therapeutic and prognosis of nerve injuries. In this case we present an extremely rare and bilateral anatomical variation, involving the superficial branch of radial nerve and the lateral antebrachial cutaneous nerve, a situation that is described in the literature only once and which notably alter the sensory innervations of the radial edge of the hand...

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INTRODUCTION: Nerve anastomoses in the hand are deviations from the anatomical norm. They do not lead to illness, but still they are events related with electrodiagnostic difficulties and, due to their unexpected presentation, also with iatrogenesis in regional surgical interventions. CASE REPORT: We report the neurophysiological study conducted on a 45-year-old female who was found to have Riche-Cannieu-type motor anastomosis between the median and ulnar branches in the palm of the hand, complete innervation of the 4th finger by the ulnar nerve and complete innervation by the superficial radial of the back of the hand. CONCLUSIONS: Anatomical descriptions of abnormal innervations in the hand are frequent, especially of the sensory kind. They do not usually give rise to any problems, even when the communicating branch is injured, probably owing to the scant participation of axons that usually occurs in anastomosis. They are not difficult to recognise by means of electroneurography if we are aware of their different types and we have a good knowledge of the anatomical routes. This will enable us to develop accurate diagnostic protocols. Knowledge of these variants will prevent electrodiagnostic errors and surgical iatrogenic effects from occurring.

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La distribución de los ramos nerviosos sensitivos en el borde lateral y en el dorso de la mano han sido descritos con mayor exactitud en las últimas décadas, debido al avance de las técnicas de electrodiagnóstico que ofrecen un alto rendimiento, las cuales han permitido detectar que alrededor del 40 por ciento de la población examinada presenta algún grado de variación anatómica en el territorio de distribución de los nervios involucrados. En este caso presentamos una variación anatómica bilateral extremadamente rara, que involucra al ramo superficial del nervio radial (NRS) y al nervio cutáneo antebraquial lateral (CABL); donde NRS se conecta de forma íntegra con el ramo medial de CABL, formándose así un tronco común (TC) que se distribuye por la región dorsal de la mano. Por su parte, el ramo lateral de CABL se distribuye por el borde lateral de la mano, ocupando el territorio cutáneo de NRS; situación que aparece descrita en la literatura especializada sólo una vez. El hallazgo de estas variaciones anatómicas en los cadáveres disecados con fines docentes en nuestro Departamento de Anatomía, tienen un valor formativo indiscutible para nuestros alumnos de pregrado y especialmente para los de postgrado, quienes pueden comprobar de primera mano la enorme variabilidad del ser humano, valorando las implicancias en la clínica diaria de este conocimiento anatómico.

The distribution of the sensory nerve branches in the lateral and the back of the hand have been described more accurately in the past decades due to advancement of high performance electro-diagnostic variation techniques, which indicate that approximately 40 percent of the population examined have some degree of anatomical variation in the distribution area of the nerves involved. In this case we present an extremely rare, bilaterally detected variation, involving the superficial branch of the radial nerve (SBRN) and lateral antebrachial cutaneous nerve of the forearm (LABCN), where the SBRN is connected integrally with the medial branch of LABCN, forming a common trunk (CT) distributed by the dorsal region of the hand. Furthermore, the lateral branch of the LABCN is distributed in the lateral border of the hand, occupying the area of the skin of the SBRN, an event that is described only once in the literature. The discovery of these anatomical variations in dissected cadavers for teaching purposes, in the Department of Anatomy, have an undeniable educational value for our undergraduate students and especially for the graduate who can observe the enormous variability of human beings first hand, and value implications of this anatomical knowledge in daily clinic.

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A 62-year-old man presented with a nonunion of the humerus shaft. Using a standard triceps splitting approach, a longitudinal incision along the posterior aspect of the arm was created. Three independent radial nerves coursed posteriorly and inferolaterally around the humerus were identified in spiral groove. Three nerves resembled in the size, color, and course in the operative field. Although the prevalence of the anomaly is probably quite low, the possibility of identification of this anomalous condition of radial nerve should be kept in mind when performing posterior approach on the humerus.

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This report describes two incidental findings of aberrant branches of the radial digital nerves in the middle finger of a 52-year-old man who cut himself with a grinding machine, and in the index finger of a 45-year-old female who sustained a flexor sheath infection following a dog bite. In both patients, two equally sized radial digital nerves were found and both nerves originated from one common digital nerve.

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We report a case of bilateral multiple variations of the brachial plexus in a 60-year old Caucasian female cadaver. In the right upper limb the musculocutaneous nerve was absent. The flexors of the arm and skin of the lateral aspect of forearm were supplied by branches from the medial cord of the brachial plexus and median nerve. In the left upper limb, the median nerve was formed by four roots; three from the lateral cord and one from the medial cord of the brachial plexus. The radial nerve also had two roots, one from the posterior cord and another from the medial cord, which formed a loop anterior to the subscapular artery. Such a combination of variations in a single cadaver is rare. The frequent anatomic variations of the brachial plexus should always be considered as an important risk factor while performing surgery of the axilla (AU)

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During routine dissection in the Department of Anatomy, multiple variations of forearm muscles in relation to the radial nerve and its branches were observed on the right side of a 34 year old male cadaver. Brachioradialis close to its origin was receiving muscle fibers from the brachialis and the radial nerve was passing in between them. Extensor carpi radialis brevis was absent and the extensor carpi radialis longus was giving two tendons in the second compartment of extensor retinaculum before its insertion while passing deep to the abductor pollicis longus. Absence of extensor carpi radialis brevis can be explained with the arrangement in lower mammals, where the two extensores carpi radiales are represented by one muscle. Ontogeny repeats phylogeny and anatomical variations have developmental basis. Henee, the pattern of muscular arrangement in this case can be said to be less evolved than the usual arrangement. The course of radial nerve between the two heads of brachioradialis makes it highly vulnerable to compression and injury, which may manifest as wrist drop (radial nerve palsy) or radial tunnel syndrome (compression of posterior interosseous nerve).

Durante una disección de rutina en el Departamento de Anatomía, se observaron múltiples variaciones de los músculos del antebrazo, en relación con el nervio radial y sus ramos, en el lado derecho de un cadáver de 34 años de edad, de sexo masculino. Cerca de su origen el músculo braquioradial recibía fibras del músculo braquial y el nervio radial cruzaba entre ellos. El músculo extensor radial corto del carpo se encontraba ausente y el músculo extensor radial largo del carpo se continuaba con dos tendones en el segundo compartimiento del retináculo extensor, bajo el músculo abductor largo de pulgar, antes de su inserción. La ausencia del músculo extensor radial corto del carpo se puede explicar en mamíferos inferiores, donde los dos músculos extensores radiales están representados por un sólo músculo. La ontogenia repite la filogenia y las variaciones anatómicas inciden en su desarrollo. Por lo tanto, de acuerdo al patrón muscular se puede afirmar que en este caso existe menos evolución que lo habitual. El curso del nervio radial entre las dos cabezas del músculo braquioradial, lo hace muy vulnerable a la compresión y las lesiones, que pueden manifestarse son, caída de la muñeca (parálisis del nervio radial) o el síndrome del túnel radial (compresión del nervio interóseo posterior).

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