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High-frequency ultrasonography for the motor branchesof the musculocutaneous nerve innervating biceps brachii: from the branching location to the distribution in the muscle
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Abstract
Purpose: The aim of this study was to investigate the ability of high-frequency ultrasonography in examing the motor branches
of the musculocutaneous nerveinnervating biceps brachii in the correlation with anatomical and histological knowledge. We analysed the location where they exit the main nerve trunk, penetrate the muscle epimysium and distribute inside the muscle.
Methods: Sixteen healthy volunteers (eight males and eight females, ages 20-60, mean age 35) were examined on both sides of
the musculocutaneous nerves and their branches innervating biceps brachii. The 5-18 MHz and 16-23 Mhz multi-frequency transducers along with the latest high-resolution ultrasound systems were used to examine the musculocutaneous nerves slowly and continuously in cross section from the coracoid process of the scapula to the elbow. By analyzing the nerve bundles inside the musculocutaneous nerve and the epimysium of biceps brachii, we observed the position where one nervebranch
separated from the main trunk of the nerve, penetratedthe epimysium and distributedinside the muscle.Blood vessels were distinguished with nerves by Doppler ultrasound and compression method.
Results: One right arm of a 28-year-old womanwas found with the absence of the musculocutaneous nerve and the median nerve give the motor branches to the biceps brachii. Thirty one musculocutaneous nerves and their motor branches
to biceps brachii muscles were detected on ultrasound. Inside the muscle, the nerve branches were located in the hyperechoic bands while the surrounding muscular tissue was hypoechoic. In these hyperechoic bands, the nerves were identified because of hypoechoic structure and thicker than the thickness of the bands. The blood vessels were also foundin these bands. The minimum diameter of the nerve branches inside the muscles can be seen as 0.3 mm.
Conclusion: High-frequency ultrasonography can examine very small nervestructure, detemine the position where the motor
branches exit from the maintrunk of the nerve, penetrate the muscle epimysium and branching inside the muscle.
Article Details
Keywords
ultrasound, motor branch of the nerve, intramuscular nerve distribution, musculocutaneous nerve, biceps brachii muscle
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