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Localization of motor entry points and terminal intramuscular nerve endings of the musculocutaneous nerve to biceps and brachialis muscles

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Abstract

To determine the 3D location of the intramuscular motor nerve endings of the biceps brachii and brachialis, we identified from 56 fresh cadaveric arms the regions where the intramuscular branches were most densely located in relation to a reference line connecting the medial epicondyle of humerus and the coracoid process. For the biceps, these points were most densely distributed at a length from 64.6 to 70.3% point of the reference line with the coracoid process as starting point, at a width of 21.6–32.6 mm lateral to the reference line. For the brachialis muscle, these points were located at a length of 75.4% point and width of 27.1–35.4 mm lateral to the reference line. At these points, the biceps was located at a depth of the upper two-third portion and the brachialis at the lower one-third portion of the upper arm, from skin to humeral bone.

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References

  1. Amirali A, Mu L, Gracies JM, Simpson DM (2007) Anatomical localization of motor endplate bands in the human biceps brachii. J Clin Neuromuscul Dis 9:306–312

    Article  PubMed  Google Scholar 

  2. Aquilonius SM, Arvidsson B, Askmark H, Gillberg PG (1982) Topographical localization of end-plates in cryosections of whole human biceps muscle. Muscle Nerve 5:418

    CAS  PubMed  Google Scholar 

  3. Berweck S, Schroeder AS, Fietzek UM, Heinen F (2004) Sonography-guided injection of botulinum toxin in children with cerebral palsy. Lancet 363:249–250

    Article  PubMed  Google Scholar 

  4. Bhakta BB, Cozens JA, Bamford JM, Chamberlain MA (1996) Use of botulinum toxin in stroke patients with severe upper limb spasticity. J Neurol Neurosurg Psychiatry 61:30–35

    Article  CAS  PubMed  Google Scholar 

  5. Borodic GE, Ferrante R, Pearce LB, Smith K (1994) Histologic assessment of dose-related diffusion and muscle fiber response after therapeutic botulinum A toxin injections. Mov Disord 9:31–39

    Article  CAS  PubMed  Google Scholar 

  6. Buchanan TS, Erickson JC (1996) Selective block of the brachialis motor point. An anatomic investigation of musculocutaneous nerve branching. Reg Anesth 21:89–92

    CAS  PubMed  Google Scholar 

  7. Chiarapattanakom P, Leechavengvongs S, Witoonchart K, Uerpairojkit C, Thuvasethakul P (1998) Anatomy and internal topography of the musculocutaneous nerve: the nerves to the biceps and brachialis muscle. J Hand Surg [Am] 23:250–255

    Article  CAS  Google Scholar 

  8. Childers MK, Kornegay JN, Aoki R, Otaviani L, Bogan DJ, Petroski G (1998) Evaluating motor end-plate-targeted injections of botulinum toxin type A in a canine model. Muscle Nerve 21:653–655

    Article  CAS  PubMed  Google Scholar 

  9. Chin TY, Duncan JA, Johnstone BR, Graham HK (2005) Management of the upper limb in cerebral palsy. J Pediatr Orthop B 14:389–404

    PubMed  Google Scholar 

  10. Chin TY, Graham HK (2003) Botulinum toxin A in the management of upper limb spasticity in cerebral palsy. Hand Clin 19:591–600

    Article  PubMed  Google Scholar 

  11. Corry IS, Cosgrove AP, Walsh EG, McClean D, Graham HK (1997) Botulinum toxin A in the hemiplegic upper limb: a double-blind trial. Dev Med Child Neurol 39:185–193

    Article  CAS  PubMed  Google Scholar 

  12. Deshpande S, Gormley ME, Carey JR (2006) Muscle fiber orientation in muscles commonly injected with botulinum toxin: an anatomical pilot study. Neurotox Res 9:115–120

    Article  CAS  PubMed  Google Scholar 

  13. Esquenazi A, Mayer N, Garreta R (2008) Influence of botulinum toxin type A treatment of elbow flexor spasticity on hemiparetic gait. Am J Phys Med Rehabil 87:305–310

    Article  PubMed  Google Scholar 

  14. Hurvitz EA, Conti GE, Brown SH (2003) Changes in movement characteristics of the spastic upper extremity after botulinum toxin injection. Arch Phys Med Rehabil 84:444–454

    Article  PubMed  Google Scholar 

  15. Im S, Han SH, Choi JH, Lee JH, Ko YJ, Lee JI, Kim HW (2008) Anatomic localization of motor points for the neuromuscular blockade of hand intrinsic muscles involved in thumb-in-palm. Am J Phys Med Rehabil 87:703–709

    Article  PubMed  Google Scholar 

  16. Kawamura A, Campbell K, Lam-Damji S, Fehlings D (2007) A randomized controlled trial comparing botulinum toxin A dosage in the upper extremity of children with spasticity. Dev Med Child Neurol 49:331–337

    Article  PubMed  Google Scholar 

  17. Keenan MA, Tomas ES, Stone L, Gersten LM (1990) Percutaneous phenol block of the musculocutaneous nerve to control elbow flexor spasticity. J Hand Surg [Am] 15:340–346

    Article  CAS  Google Scholar 

  18. Kong KH, Chua KS (1999) Neurolysis of the musculocutaneous nerve with alcohol to treat poststroke elbow flexor spasticity. Arch Phys Med Rehabil 80:1234–1236

    Article  CAS  PubMed  Google Scholar 

  19. Kosugi K, Shibata S, Yamashita H (1992) Supernumerary head of biceps brachii and branching pattern of the musculocutaneous nerve in Japanese. Surg Radiol Anat 14:175–185

    Article  CAS  PubMed  Google Scholar 

  20. Leonello DT, Galley IJ, Bain GI, Carter CD (2007) Brachialis muscle anatomy. A study in cadavers. J Bone Joint Surg Am 89:1293–1297

    Article  PubMed  Google Scholar 

  21. Lepage D, Parratte B, Tatu L, Vuiller F, Monnier G (2005) Extra- and intramuscular nerve supply of the muscles of the anterior antebrachial compartment: applications for selective neurotomy and for botulinum toxin injection. Surg Radiol Anat 27:420–430

    Article  CAS  PubMed  Google Scholar 

  22. Lowe K, Novak I, Cusick A (2007) Repeat injection of botulinum toxin A is safe and effective for upper limb movement and function in children with cerebral palsy. Dev Med Child Neurol 49:823–829

    Article  PubMed  Google Scholar 

  23. Mahakkanukrauh P, Somsarp V (2002) Dual innervation of the brachialis muscle. Clin Anat 15:206–209

    Article  PubMed  Google Scholar 

  24. Mayer NH, Whyte J, Wannstedt G, Ellis CA (2008) Comparative impact of 2 botulinum toxin injection techniques for elbow flexor hypertonia. Arch Phys Med Rehabil 89:982–987

    Article  PubMed  Google Scholar 

  25. Pacha Vicente D, Forcada Calvet P, Carrera Burgaya A, Llusa Perez M (2005) Innervation of biceps brachii and brachialis: anatomical and surgical approach. Clin Anat 18:186–194

    Article  CAS  PubMed  Google Scholar 

  26. Park BK, Shin YB, Ko HY, Park JH, Baek SY (2007) Anatomic motor point localization of the biceps brachii and brachialis muscles. J Korean Med Sci 22:459–462

    Article  PubMed  Google Scholar 

  27. Parratte B, Tatu L, Vuillier F, Diop M, Monnier G (2002) Intramuscular distribution of nerves in the human triceps surae muscle: anatomical bases for treatment of spastic drop foot with botulinum toxin. Surg Radiol Anat 24:91–96

    Article  CAS  PubMed  Google Scholar 

  28. Shaari CM, Sanders I (1993) Quantifying how location and dose of botulinum toxin injections affect muscle paralysis. Muscle Nerve 16:964–969

    Article  CAS  PubMed  Google Scholar 

  29. Yang TF, Fu CP, Kao NT, Chan RC, Chen SJ (2003) Effect of botulinum toxin type A on cerebral palsy with upper limb spasticity. Am J Phys Med Rehabil 82:284–289

    Article  PubMed  Google Scholar 

  30. Yang ZX, Pho RW, Kour AK, Pereira BP (1995) The musculocutaneous nerve and its branches to the biceps and brachialis muscles. J Hand Surg [Am] 20:671–675

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, 137-701, Korea

    Je-Hun Lee, Xiaochun An, Mi-Sun Lee, U-Young Lee & Seung-Ho Han

  2. Department of Rehabilitation Medicine, Kangnam St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Hye-Won Kim & Sun Im

Authors
  1. Je-Hun Lee
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  2. Hye-Won Kim
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  3. Sun Im
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  4. Xiaochun An
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  5. Mi-Sun Lee
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  6. U-Young Lee
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  7. Seung-Ho Han
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Correspondence to Seung-Ho Han.

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Lee, JH., Kim, HW., Im, S. et al. Localization of motor entry points and terminal intramuscular nerve endings of the musculocutaneous nerve to biceps and brachialis muscles. Surg Radiol Anat 32, 213–220 (2010). https://doi.org/10.1007/s00276-009-0561-4

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  • DOI: https://doi.org/10.1007/s00276-009-0561-4

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