59 - Case Study on a Combination of Brachial Plexus Variations: Analysis and Visualization

Poster Board Number: 59
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Odd poster #s – first hour
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Co-authors:

James Collins - Student Physical Therapist, Physical Therapy, University of Maryland Eastern Shore; Lindsey Mosmiller - Student Physical Therapist, Physical Therapy, University of Maryland Eastern Shore; Brian Drummond - Student Physical Therapist, Physical Therapy, University of Maryland Eastern Shore; Marissa Swamy - Student Physical Therapist, Physical Therapy, University of Maryland Eastern Shore; Oluseun Ayoku - Student Physical Therapist, Physical Therapy, University of Maryland Eastern Shore; Molly Selba, PhD - Assistant Professor, Physical Therapy, University of Maryland Eastern Shore

Abstract Body : Understanding the components of the brachial plexus, its relationship with surrounding structures, and its variants is of vital importance in educational, clinical, and surgical settings. This case report presents a combination of the brachial plexus variations. While identification of variations in the brachial plexus is not uncommon, the specific combination of variants presented in this case report has not been identified simultaneously in the same donor.



A team of graduate students at the University of Maryland Eastern Shore performed a routine cadaveric dissection of the cervical region of a 94-year-old male. Dissection followed a protocol adapted from Grant’s Dissector 2023. Upon exposure of the brachial plexus on the right side, anomalous findings were noted unilaterally including combined variation in the trunk, divisions, contributions, and associated vasculature.



The morphological finding of the roots include the absence of the superior trunk due to the lack of fusion of the C5 and C6 roots. Suprascapular nerve was found branching from C5 root only. Trunks I-IV (root value- C5; C6; C7; C8, T1) contribute an anterior and posterior division to the associated cord. Specifically, the lateral cord receives anterior divisions from Trunks I-III. The posterior cord receives posterior divisions from Trunks I-IV. The medial cord receives anterior divisions from the Trunks III-IV. Two medial contributions from the lateral cord to the median nerve were also noted. Transverse cervical artery courses superficially to Trunks III-IV and dives between Trunks I-II. Lastly, the phrenic nerve passes superficially to the transverse cervical artery.



While each of these individual variations has been reported independently in the literature, this specific constellation of anomalies has not been previously documented. This case study represents novel combinations of brachial plexus variations.



Conceptualization of the brachial plexus itself, combined with the possibility for variation, creates an opportunity for implementing the visualization of complex morphology for broader impacts on educational, clinical, and surgical knowledge. In order to best convey variations such as the one described above, we created tangible visualizations of the anatomy at different levels of accessibility including: 3D prints, 3D PDFs, pipe cleaner models, and 2D medical illustrations.