Destination of the C4 component of the prefixed brachial plexus.

This study was carried out to elucidate the destination of the C4 ventral ramus that forms the prefixed brachial plexus. A total of 43 sides of Korean adults (male, 22; female, 18; unknown: 3 and right, 23; left, 20) were investigated. The various C4 destinations and their frequencies were as follows: suprascapular nerve, 97.7% (42/43); musculocutaneous nerve, 79.1% (34/43); the axillary nerve, 48.8% (21/43); and the nerve to subclavius, 16.2% (7/43). The mean quantity of nerve fibers destined to the suprascapular, musculocutaneous, and axillary nerves and the nerve to subclavius was 441.8 ± 316.5 (Mean ± S.D.), 298.2 ± 209.8, 245.8 ± 239.0, and 66.4 ± 17.2, respectively. The mean nerve fibers number of C4 contributing to the brachial plexus was 983.6 ± 618.0 (range: 100-1729). The main component that contributes to the terminal nerves (suprascapular, musculocutaneous, axillary nerves, and nerve to subclavius) is C5. These results may be useful to surgeons and clinicians dealing with terminal nerves of the brachial plexus, especially the suprascapular, musculocutaneous, and axillary nerves.

Spinal origins of the nerve branches innervating the coracobrachialis muscle: clinical implications.

The coracobrachialis muscle (Cb M) receives nerve branches from the musculocutaneous nerve (Mc N). Many textbooks describe that the Cb M is innervated by the C5, C6, and C7 spinal nerves. The present study was performed to identify the spinal nerve composition of the nerve branches innervating the Cb M and to evaluate the number of myelinated axons of the nerve branches. Two types of spinal nerve compositions were observed: type I, composed of both C6 and C7 nerves, comprised 88.9% (40/45) of the sides; and type II, composed of only C7 nerves, comprised 11.1% (5/45) of the sides. Of the type I branches, 245.4 +/- 26.3 (mean +/- SD, range 201-267) of the myelinated nerve fibers were derived from C6 and 520.0 +/- 41.8 (range 469-567) of the fibers were derived from C7. Of the type II branches, 836.4 +/- 125.5 (range 709-991) of the nerve fibers were derived from C7. Imbroglio Modometer version 2.0 was used to count the number of fibers innervating the Cb M. The main component of these nerve branches was the C7 spinal nerve. The C5 spinal nerve, did not contribute to innervating the Cb M in the present study. The number of branches varied from one to four, with C7 being concentrated in the first and second branches. Therefore, these two branches may be suitable for the neurotization procedure as a donor nerve at the upper trunk (C5 and C6) lesion of the brachial plexus.