Variations in the cubital fossa

The brachial artery begins as a continuation of the axillary artery and is superficial throughout its course in the arm. When it enters the cubital fossa it lies anterior to the brachialis muscle and lateral to the median nerve. In cubital fossa it lies deep to bicipital aponeurosis which separates the artery from median cubital vein. The median nerve descends along the lateral side of the proximal part of brachial artery. At the middle of the arm the nerve crosses from lateral to medial, usually in front of the artery and then passes along the medial side of the brachial artery. It appears in cubital fossa beneath the bicipital aponeurosis and rests on the brachialis. In cubital fossa, usually the structures lying from lateral to medial are tendon of biceps brachii, brachial artery and median nerve (TAN). No literature is available stating median nerve to be lateral to the brachial artery in cubital fossa. Both brachial artery and median nerve lie superficial to the brachialis muscle in the front of arm. But authors like Bilecenoglu et al. and George & Nayak described abnormal slip arising from brachialis muscle passing superficial to and causing entrapment of the nerve and the artery [1,2]. Loukas et al. reported a case of an accessory brachialis muscle, which originated medially from the mid-shaft of the humerus and the medial intermuscular septum [3]. During its course medially, toward the elbow, it crossed both the brachial artery and the median nerve. Sharmistha BISWAS [1] Anjan ADHIKARI [2] Panchanan KUNDU [1]