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      Distal Insertional Footprint of the Brachialis Muscle: 3D Morphometric Study

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          Abstract

          Objective. The purpose of this study is to describe the three-dimensional morphometry of the brachialis muscle at its distal attachment to the ulna. Methods. Fifty cadaveric elbows were dissected and the brachialis distal insertion was isolated on the ulna bone and probed with a three-dimensional digitizer, to create a three-dimensional model of the footprint. Measurements and analysis of each footprint shape were recorded and compared based on gender and size. Results. There was significant gender difference in the surface length ( P= 0.002) and projected length ( P= 0.001) of the brachialis footprint. The shapes of the footprint also differed among the specimens. Conclusion. The shape of the brachialis muscle insertion differed among all the specimens without significant variation in gender or sides. There was also a significant difference in muscle length between males and females with little difference in the width and surface area. Significance. The information obtained from this study is important for kinematic understanding and surgical procedures around the elbow joint as well as the understanding of the natural age related anatomy of the brachialis footprint morphology.

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          Soft tissue attachments of the ulnar coronoid process. An anatomic study with radiographic correlation.

          Suzanne Abrams, Derrick J. Callahan, M J Botte … (1995)
          Regan and Morrey proposed a 3-type coronoid fracture classification observing that the incidence of concommitant elbow dislocation was proportional to fragment size. Elbow instability associated with coronoid fractures presumably is related to disrupted bony architecture and ineffective stabilizers attached to the free fragment. Twenty cadaveric elbows were dissected, measuring medial collateral ligament, anterior capsule, and brachialis muscle insertion loci on the coronoid. Radiographs were taken after radiopaque labeling of the stabilizer insertions. The anterior bundle of the medial collateral ligament insertion averaged 18.4 mm dorsal to the coronoid tip. Only in Type III fractures would it be attached to the free fragment. The capsule inserted an average of 6.4 mm distal to the coronoid tip. Rarely should Type I fractures result from a capsular avulsion, because only 3 of 20 specimens had the capsule inserting on the tip. The brachialis had a musculoaponeurotic insertion onto the elbow capsule, coronoid, and proximal ulna. The bony insertion averaged 26.3 mm in length, with its proximal margin averaging 11 mm distal to the coronoid tip. In only Type III fractures is the fragment large enough to include the brachialis bony insertion.
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            Brachialis muscle anatomy. A study in cadavers.

            Gregory I. Bain, Bruce D. Carter, Ian Galley … (2007)
            There have been conflicting descriptions of brachialis muscle anatomy in the literature. The purpose of the present study was to clarify brachialis muscle anatomy in order to refine surgical techniques around the elbow. Eleven cadaveric upper limbs were dissected under loupe magnification. The gross morphological characteristics, relationships, and nerve supply of the brachialis muscle were recorded. The nerve supply was examined histologically to confirm the gross findings. In all specimens, the brachialis muscle had two heads. The larger, superficial head originated from the anterolateral aspect of the humerus, proximal to the smaller, deep head. The superficial head contained longitudinal fibers, which inserted by means of a thick round tendon onto the ulnar tuberosity. The deep head fibers were fan-shaped and converged to insert by means of an aponeurosis onto the coronoid process. In all specimens, a branch of the radial nerve supplied the inferolateral fibers of the deep head. Our observations of brachialis muscle anatomy differ considerably from the descriptions in the current literature. The larger, superficial head has the mechanical advantage of a more proximal origin and a more distal insertion, which may enable it to provide the bulk of flexion strength. The smaller, oblique, deep head has a more anterior insertion on the coronoid, which may facilitate the initiation of elbow flexion from full extension. The radial nerve-innervated inferolateral fibers of the deep head run in a direction similar to the anconeus muscle, forming a muscular sling around the elbow. This complex may act to dynamically stabilize the ulnohumeral joint. This information may enhance surgical techniques about the elbow. The identification of an internervous plane may allow for improvement in the current anterior and anterolateral surgical approaches to the humerus. The tendon of the superficial head is well positioned to allow its transfer to the radial tuberosity, potentially improving supination strength in the absence of a distal biceps tendon. It is possible that the tendon of the superficial head might also be used to reconstruct the anular ligament or the medial collateral ligament of the elbow.
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              Dual innervation of the brachialis muscle.

              Pasuk Mahakkanukrauh, Vichit Somsarp (2002)
              A study of the innervation of the brachialis muscle was carried out on 45 male and 31 female Thai cadavers between the ages of 15 and 92 years (mean = 59 years). The dissections revealed that all brachialis muscles received innervation from the musculocutaneous nerve and that 81.6% were also innervated by a branch from the radial nerve. Among the brachialis muscles with a dual nerve supply, two patterns of branching from the radial nerve were observed: in one pattern the branch to the brachialis had a descending course (58%) and in the other pattern the nerve ascended or recurred (42%) to innervate the muscle. The radial nerve branch penetrated the inferolateral part of the brachialis muscle in 83% of cases (103/124) and its middle third in 17% of specimens (21/124). The basis for the dual innervation may result from fusion of two different embryonic muscular primordia: the ventral (flexor) and the dorsal (extensor) muscle masses. In contrast to a brachialis muscle innervated by the musculocutaneous nerve only, a muscle with dual innervation may be spared significant denervation by an anterior approach to the humerus through a longitudinally bisected muscle. In a dually innervated muscle, however, separation of the brachialis and brachioradialis muscles during surgery may put the radial nerve branch to the brachialis at risk. Copyright 2002 Wiley-Liss, Inc.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Anat Res Int
                Journal ID (iso-abbrev): Anat Res Int
                Journal ID (publisher-id): ARI
                Title: Anatomy Research International
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-2743
                ISSN (Electronic): 2090-2751
                Publication date (Print): 2015
                Publication date (Electronic): 10 November 2015
                Volume: 2015
                Electronic Location Identifier: 786508
                Affiliations
                Elbow Shoulder Research Centre, University of Kentucky Department of Orthopaedic Surgery and Sports Medicine, Kentucky Clinic, 740 South Limestone, Lexington, KY 40536-0284, USA
                Author notes

                Academic Editor: Levent Sarikcioglu

                Article
                DOI: 10.1155/2015/786508
                PMC ID: 4657092
                SO-VID: a669f737-eef1-4851-a898-28d1c05aec75
                Copyright © Copyright © 2015 Srinath Kamineni et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 May 2015
                Date revision received : 9 September 2015
                Date accepted : 12 October 2015
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Anatomy & Physiology
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                ScienceOpen disciplines: Anatomy & Physiology

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