Multiple neurovascular variations in the upper limb – a rare case report

Introduction The brachial plexus is a complex structure which is divided into roots, trunks, divisions and cords. The brachial plexus is formed by the union of ventral rami of C5, C6, C7, C8 and greater part of T1.These ventral rami are the roots of brachial plexus, almost equal in size but variable in their mode of junction. Ventral rami of C5 and C6 unite at the lateral border of the scalenus medius to form upper trunk and C7 continues as middle trunk while C8 and T1 unite behind scalenus anterior to form lower trunk. All these trunks incline laterally, just above or behind the clavicle where each one bifurcates into anterior and posterior divisions. The anterior divisions of upper and middle trunks unite to form a lateral cord, lateral to the axillary artery and the anterior division of the lower trunk descends at first behind, then medial to the axillary artery, forming medial cord. Posterior divisions of all the three form the posterior cord, at first above and then behind the axillary artery [1]. The axillary artery is the continuation of subclavian artery from the lateral edge of first rib and continues as brachial artery as it crosses the lower border of teres major. Just distal to the elbow the brachial artery divides into radial and ulnar arteries. The ulnar artery gives rise to common interosseous artery. Both ulnar and radial arteries terminate in the palm by forming superficial and deep palmar arches [2]. The brachial plexus is a complex structure, where variations in formation of roots, trunks, divisions and cords are common and so the vessels of upper limb. The aim of this presentation is to contribute to existing knowledge of the variations in the anatomy of brachial plexus and vessels of upper limb explaining its morphological and clinical significance.