Musculocutaneous nerve

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Musculocutaneous nerve
Nerves of the left upper extremity.gif
Nerves of the left upper extremity. (Musculocutaneous labeled at upper right.)
Details
From Lateral cord (C5-C7)
To Lateral cutaneous nerve of forearm
Innervates Anterior compartment of the arm
Identifiers
Latin nervus musculocutaneus
MeSH D009138
TA98 A14.2.03.024
TA2 6421
FMA 37064
Anatomical terms of neuroanatomy

The musculocutaneous nerve is a mixed branch of the lateral cord of the brachial plexus derived from cervical spinal nerves C5-C7. It arises opposite the lower border of the pectoralis major. It provides motor innervation to the muscles of the anterior compartment of the arm: the coracobrachialis, biceps brachii, and brachialis. It provides sensory innervation to the lateral forearm (via its terminal branch). [1] It courses through the anterior part of the arm, terminating 2 cm above elbow;[ citation needed ] after passing the lateral edge of the tendon of biceps brachii it is becomes known as the lateral cutaneous nerve of the forearm. [1]

Contents

Structure

Course

Musculocutaneous nerve on superficial dissection. Musculocutaneous nerve 2.jpg
Musculocutaneous nerve on superficial dissection.
Musculocutaneous nerve on deep dissection. Brachial region.jpg
Musculocutaneous nerve on deep dissection.

Musculocutaneous nerve arises from the lateral cord of the brachial plexus with root value of C5 to C7 of the spinal cord. It follows the course of the third part of the axillary artery (part of the axillary artery distal to the pectoralis minor) laterally and enters the frontal aspect of the arm where it penetrates the coracobrachialis muscle. It then passes downwards and laterally between the biceps brachii (above) and the brachialis muscles (below), to the lateral side of the arm; at 2 cm above the elbow it pierces the deep fascia lateral to the tendon of the biceps brachii and is continued into the forearm as the lateral cutaneous nerve of the forearm. [2]

Distribution

Motor innervation

In its course through the arm it innervates the coracobrachialis, biceps brachii, and the greater part of the brachialis. [2]

Sensory innervation

Its terminal branch, the lateral cutaneous nerve of the forearm, supplies the sensation of the lateral side of the forearm from the elbow to the wrist. [2]

The musculocutaneous nerve also gives articular branches to the elbow joint and to the humerus. [2]

Variation

The musculocutaneous nerve presents frequent variations and communications with the median nerve. [3] [4]

  1. It may adhere for some distance to the median and then pass outward, beneath the biceps brachii, instead of through the coracobrachialis.
  2. Some of the fibers of the median may run for some distance in the musculocutaneous and then leave it to join their proper trunk; less frequently the reverse is the case, and the median sends a branch to join the musculocutaneous. [5]
  3. The nerve may pass under the coracobrachialis or through the biceps brachii.
  4. Occasionally it gives a filament to the pronator teres, and it supplies the dorsal surface of the thumb when the superficial branch of the radial nerve is absent.

Nerve injuries

Injury to the musculocutaneous nerve can be caused by three mechanisms: repeated microtrauma, indirect trauma or direct trauma on the nerve. Overuse of coracobrachialis, biceps, and brachialis muscles can cause the stretching or compression of musculocutaneous nerve. Those who have it can complain of pain, tingling or reduced sensation over the lateral side of the forearm. This symptom can be reproduced by pressing over the region below the coracoid process (positive Tinel's sign). Pain can also be reproduced by flexing the arm against resistance. Other differential diagnoses that can mimick the symptoms of musculocutaneous palsy are: C6 radiculopathy (pain can be produced by movement of the neck), long head of biceps tendinopathy (no motor or sensory deficits), pain of the bicipital groove (relieved by shoulder joint injection). Electromyography test shows slight neural damage at the biceps and the brachialis muscles with slower motor and sensory conduction over the Erb's point. [6]

In indirect trauma, violent abduction and retroposition of the shoulder can stretch the nerve and result tension of the coracobrachialis with musculocutaneous nerve lesion. Those with this type of lesion is presented with pain, reduced sensation, and tingling of the lateral part of forearm (lateral antebrachial cutaneous nerve - terminal sensory only branch of Musculocutaneous nerve) with reduced strength of elbow flexion. Tinel's sign can be positive. Differential diagnosis includes C5 and C6 nerve root lesions of the brachial plexus where the abduction, external rotation, and elbow flexion is lost. On the other hand, rupture of the biceps can cause the loss of flexion of the elbow without sensory deficits. Rupture of the SHORT HEAD of the biceps can decrease elbow flexion strength, where the brachialis muscle is intact. Rupture of the LONG HEAD of the biceps results in mild weakening of forearm supination as long as the supinator muscle is intact. Electromyography test is negative. [6]

In direct trauma, fracture of the humerus, gun shot, glass pieces injuries and more, can cause the musculocutaneous nerve lesion. [6]

Iatrogenic nerve injuries (for example during orthopedic surgery involving an internal fixation of the humerus) are relatively common and in a certain percentage of cases probably inevitable, though an adequate knowledge of the surgical anatomy can help to reduce its frequency. [7]

To diagnose traumatic nerve injury, operative exploration should be performed without delay. If reconstruction of the motor function of the musculocutaneous nerve (elbow flexion) is needed then there are several options, depending on the injury pattern and timeframes. If the nerve is in-continuity and the fascicles appear healthy under the operating microscope then Neurolysis may be sufficient. When there is a division or segment of non-viable nerve then interpositional autografting is preferred. If reinnervation is likely to take months (e.g. if the injured segment is long and long grafts are needed, or in the case of proximal injuries such as root avulsion or upper trunk injury) then nerve transfer is preferred as this will reinnervate the muscle faster; in the case of upper trunk injuries, the ideal neurotisation appears to be the double Oberlin transfer [8] ., although data on this topic are sparse and heterogeneous.

Related Research Articles

<span class="mw-page-title-main">Arm</span> Proximal part of the free upper limb between the shoulder and the elbow

In human anatomy, the arm refers to the upper limb in common usage, although academically the term specifically means the upper arm between the glenohumeral joint and the elbow joint. The distal part of the upper limb between the elbow and the radiocarpal joint is known as the forearm or "lower" arm, and the extremity beyond the wrist is the hand.

<span class="mw-page-title-main">Biceps</span> Muscle on the front of the upper arm

The biceps or biceps brachii are a large muscle that lies on the front of the upper arm between the shoulder and the elbow. Both heads of the muscle arise on the scapula and join to form a single muscle belly which is attached to the upper forearm. While the biceps crosses both the shoulder and elbow joints, its main function is at the elbow where it flexes the forearm and supinates the forearm. Both these movements are used when opening a bottle with a corkscrew: first biceps screws in the cork (supination), then it pulls the cork out (flexion).

<span class="mw-page-title-main">Brachioradialis</span> Muscle of the upper limb

The brachioradialis is a muscle of the forearm that flexes the forearm at the elbow. It is also capable of both pronation and supination, depending on the position of the forearm. It is attached to the distal styloid process of the radius by way of the brachioradialis tendon, and to the lateral supracondylar ridge of the humerus.

<span class="mw-page-title-main">Radial nerve</span> Nerve in the human body that supplies the posterior portion of the upper limb

The radial nerve is a nerve in the human body that supplies the posterior portion of the upper limb. It innervates the medial and lateral heads of the triceps brachii muscle of the arm, as well as all 12 muscles in the posterior osteofascial compartment of the forearm and the associated joints and overlying skin.

<span class="mw-page-title-main">Median nerve</span> Nerve of the upper limb

The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus.

<span class="mw-page-title-main">Brachial plexus</span> Network of nerves

The brachial plexus is a network of nerves formed by the anterior rami of the lower four cervical nerves and first thoracic nerve. This plexus extends from the spinal cord, through the cervicoaxillary canal in the neck, over the first rib, and into the armpit, it supplies afferent and efferent nerve fibers to the chest, shoulder, arm, forearm, and hand.

<span class="mw-page-title-main">Brachialis muscle</span> Flexor muscle in the upper arm

The brachialis is a muscle in the upper arm that flexes the elbow. It lies beneath the biceps brachii, and makes up part of the floor of the region known as the cubital fossa. It originates from the anterior aspect of the distal humerus; it inserts onto the tuberosity of the ulna. It is innervated by the musculocutaneous nerve, and commonly also receives additional innervation from the radial nerve. The brachialis is the prime mover of elbow flexion generating about 50% more power than the biceps.

<span class="mw-page-title-main">Axillary nerve</span> Nerve of the human body near the armpit

The axillary nerve or the circumflex nerve is a nerve of the human body, that originates from the brachial plexus at the level of the axilla (armpit) and carries nerve fibers from C5 and C6. The axillary nerve travels through the quadrangular space with the posterior circumflex humeral artery and vein to innervate the deltoid and teres minor.

<span class="mw-page-title-main">Ulnar nerve</span> Nerve which runs near the ulna bone

In human anatomy, the ulnar nerve is a nerve that runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest in the human body unprotected by muscle or bone, so injury is common. This nerve is directly connected to the little finger, and the adjacent half of the ring finger, innervating the palmar aspect of these fingers, including both front and back of the tips, perhaps as far back as the fingernail beds.

<span class="mw-page-title-main">Wrist drop</span> Medical condition

Wrist drop is a medical condition in which the wrist and the fingers cannot extend at the metacarpophalangeal joints. The wrist remains partially flexed due to an opposing action of flexor muscles of the forearm. As a result, the extensor muscles in the posterior compartment remain paralyzed.

<span class="mw-page-title-main">Upper limb</span> Consists of the arm, forearm, and hand

The upper limbs or upper extremities are the forelimbs of an upright-postured tetrapod vertebrate, extending from the scapulae and clavicles down to and including the digits, including all the musculatures and ligaments involved with the shoulder, elbow, wrist and knuckle joints. In humans, each upper limb is divided into the arm, forearm and hand, and is primarily used for climbing, lifting and manipulating objects.

<span class="mw-page-title-main">Erb's palsy</span> Paralysis of the arm usually caused during birth

Erb's palsy is a paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the severing of the upper trunk C5–C6 nerves. These form part of the brachial plexus, comprising the ventral rami of spinal nerves C5–C8 and thoracic nerve T1. These injuries arise most commonly, but not exclusively, from shoulder dystocia during a difficult birth. Depending on the nature of the damage, the paralysis can either resolve on its own over a period of months, necessitate rehabilitative therapy, or require surgery.

<span class="mw-page-title-main">Cubital fossa</span> The human elbow pit

The cubital fossa, chelidon or inside of elbow is the area on the anterior side of the upper part between the arm and forearm of a human or other hormid animals. It lies anteriorly to the elbow when in standard anatomical position.

<span class="mw-page-title-main">Coracobrachialis muscle</span> Muscle of the upper arm

The coracobrachialis muscle is a muscle in the upper medial part of the arm. It is located within the anterior compartment of the arm. It originates from the coracoid process of the scapula; it inserts onto the middle of the medial aspect of the body of the humerus. It is innervated by the musculocutaneous nerve. It acts to adduct and flex the arm.

The pronator teres is a muscle that, along with the pronator quadratus, serves to pronate the forearm. It has two origins, at the medial humeral supracondylar ridge and the ulnar tuberosity, and inserts near the middle of the radius.

<span class="mw-page-title-main">Lateral cutaneous nerve of forearm</span>

The lateral cutaneous nerve of forearm is a sensory nerve representing the continuation of the musculocutaneous nerve beyond the lateral edge of the tendon of the biceps brachii muscle. The lateral cutaneous nerve provides sensory innervation to the skin of the lateral forearm. It pierces the deep fascia of forearm to enter the subcutaneous compartment before splitting into a volar branch and a dorsal branch.

<span class="mw-page-title-main">Medial cutaneous nerve of forearm</span>

The medial cutaneous nerve of the forearm is a sensory branch of the medial cord of the brachial plexus derived from the ventral rami of spinal nerves C8-T1. It provides sensory innervation to the skin of the medial forearm and skin overlying the olecranon. It descends through the (upper) arm within the brachial fascia alongside the basilic vein, then divides into an anterior branch and a posterior branch upon emerging from the brachial fascia; the two terminal branches travel as far distally as the wrist.

<span class="mw-page-title-main">Fascial compartments of arm</span> Anatomical compartments

The fascial compartments of arm refers to the specific anatomical term of the compartments within the upper segment of the upper limb of the body. The upper limb is divided into two segments, the arm and the forearm. Each of these segments is further divided into two compartments which are formed by deep fascia – tough connective tissue septa (walls). Each compartment encloses specific muscles and nerves.

<span class="mw-page-title-main">Elbow</span> Joint between the upper and lower parts of the arm

The elbow is the region between the upper arm and the forearm that surrounds the elbow joint. The elbow includes prominent landmarks such as the olecranon, the cubital fossa, and the lateral and the medial epicondyles of the humerus. The elbow joint is a hinge joint between the arm and the forearm; more specifically between the humerus in the upper arm and the radius and ulna in the forearm which allows the forearm and hand to be moved towards and away from the body. The term elbow is specifically used for humans and other primates, and in other vertebrates it is not used. In those cases, forelimb plus joint is used.

<span class="mw-page-title-main">Median nerve palsy</span> Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

References

PD-icon.svgThis article incorporates text in the public domain from page 935 of the 20th edition of Gray's Anatomy (1918)

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  5. Guerri-Guttenberg, Roberto A.; Ingolotti, Mariana (2009). "Classifying musculocutaneous nerve variations". Clinical Anatomy. 22 (6): 671–83. doi:10.1002/ca.20828. PMID   19637305. S2CID   2457543.
  6. 1 2 3 Celli, Andrea; Celli, Luigi; F Morrey, Bernard (25 January 2008). "28 - Traumatic isolated lesions of musculocutaneous nerve". Treatment of Elbow Lesions: New Aspects in Diagnosis and Surgical Techniques. Springer. pp. 299–302. ISBN   9788847005914 . Retrieved 26 January 2018.
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  8. Vernon Lee, Chung Yan; Cochrane, Elliott; Chew, Misha; Bains, Robert D.; Bourke, Gráinne; Wade, Ryckie G. (January 2023). "The Effectiveness of Different Nerve Transfers in the Restoration of Elbow Flexion in Adults Following Brachial Plexus Injury: A Systematic Review and Meta-Analysis". The Journal of Hand Surgery: S0363502322007158. doi: 10.1016/j.jhsa.2022.11.013 .