Anatomical architecture of the brachial plexus in the common hippopotamus (Hippopotamus amphibius) with special reference to the derivation and course of its unique branches

The anatomy of the brachial plexus in the common hippopotamus (Hippopotamus amphibius), which has not been previously reported, was first examined bilaterally in a newborn hippopotamus. Our observations clarified the following: (1) the brachial plexus comprises the fifth cervical (C5) to first thoracic (T1) nerves. These formed two trunks, C5-C6 and C7-T1; in addition, the axillary artery passed in between C6 and C7, (2) unique branches to the brachialis muscle and those of the lateral cutaneous antebrachii nerves ramified from the median nerve, (3) nerve fibre analysis revealed that these unique nerve branches from the median nerve were closely related and structurally similar to the musculocutaneous (MC) nerve; however, they had changed course from the MC to the median nerve, and (4) this unique branching pattern is likely to be a common morphological feature of the brachial plexus in amphibians, reptiles and certain mammals.     

Sex-related macrostructural organization of the deer's brachial plexus

We describe the morphological organization of the deer brachial plexus in order to supply data to veterinary neuroclinics and anaesthesiology. The deer (Mazama gouazoubira) brachial plexus is composed of four roots: three cervical (C6, C7 and C8) and one thoracic (T1). Within each sex group, no variations are observed between the left and the right brachial plexus, though sex-related differences are seen especially in its origin. The origin of axillary and radial nerves was: C6, C7, C8 and T1 in males and C8-T1 (radial nerve) and C7, C8 and T1 (axillary nerve) in females; musculocutaneous nerve was: C6-C7 (males) and C8-T1 (females); median and ulnar nerves was: C8-T1 (males) and T1 (females); long thoracic nerve was: C7 (males) and T1 (females); lateral thoracic nerve was: C6, C7, C8 and T1 (males) and T1 (females); thoracodorsal nerve was: C6, C7, C8 and T1 (males) and C8-T1 (females); suprascapular nerve was: C6-C7 (males) and C6 (females) and subscapular nerve was: C6-C7 (males) and C7 (females). This study suggests that in male deer the origin of the brachial plexus is more cranial than in females and the origin of the brachial plexus is slightly more complex in males, i.e. there is an additional number of roots (from one to three). This sexual dimorphism may be related to specific biomechanical functions of the thoracic limb and electrophysiological studies may be needed to shed light on this morphological feature.     

Origin and distribution of the brachial plexus of the Van cats

Knowing the structure and variations of the plexus brachialis is important in neck and shoulder surgery. The knowledge of the brachial plexus reduces the injury rate of the nerves in surgical interventions to the axillary region. The major nerve trunks of the thoracic limb were the suprascapular, subscapular, axillary, radial, musculocutaneous, median and ulnar nerves. In Van cats, the brachial plexus was formed by the ventral branches of the spinal nerves, C6-C7-C8 and T1. The 7th cervical nerve was quite thick compared to the others. The subscapular nerve was the thinnest (on the right side, the average length was 6.55 ± 0.60 mm and on the left side was 6.50 ± 0.60 mm), and the radial nerve was the thickest (the average length on the right side was 28.48 ± 0.44 mm and on the left side was 29.11 ± 0.55 mm). The suprascapular nerve was formed by the ventral branch of the 6th cervical nerve. The subscapular nerves were formed by a branch originating from the 6th cervical nerve and the two medial and caudal branches originating from the 7th cervical nerve. No communicating branch between the ulnar nerve and the median nerve was observed in the palmar region. The axillary nerve was formed by the ventral branches of the 7th nerve, the musculocutaneous nerve was formed by ventral branches of the 6th and 7th cervical nerves, and the ulnar nerve was formed by ventral branches of the 8th cervical and the 1st thoracic nerves. The radial nerve was the thickest branch in the brachial plexus. In Van cats, the origin and distribution of nerves were similar to those reported in the literature for other species of cats, with the exception of the suprascapular, subscapular and axillary nerves.     

Ultrasonographic study of a modified axillary approach to block the major branches of the brachial plexus in dogs

ObjectiveTo provide ultrasonographic mapping of the axillary region of dogs to facilitate identification of the major branches of the brachial plexus in relation to the axillary artery.Study designProspective study.AnimalsA total of two dog cadavers and 50 client-owned, healthy dogs weighing >15 kg.MethodsIn Phase 1, anatomical dissections were performed to identify the relation of the major brachial plexus nerves to the axillary artery. In Phase 2, with the dogs in dorsal recumbency with thoracic limbs flexed naturally, the axillary space was scanned using a linear array probe oriented on the parasagittal plane until the axis transverse to nerves was found. Then, the transducer was rotated to a slight lateral angle approximately 30° to midline. The examination aimed to identify the axillary artery and the musculocutaneous, radial, median and ulnar nerves in addition to determining their position and distribution in four predefined sectors.ResultsThe musculocutaneous nerve was observed in all animals cranial to the axillary artery. The radial, ulnar and median nerves were distributed around the axillary artery, with >90% on the caudal aspect of the axillary artery (sectors 1 and 2).Conclusions and clinical relevanceUltrasonography identified the location of the brachial plexus nerves near the studied sectors, providing useful guidance for performing a brachial plexus nerve block.     

ULTRASONOGRAPHIC ANATOMY OF THE BRACHIAL PLEXUS AND MAJOR NERVES OF THE CANINE THORACIC LIMB

A technique for ultrasonography of the brachial plexus and major nerves of the canine thoracic limb is described based on examination of five canine cadavers and three healthy dogs. The ventral branches of the spinal nerves that contribute to the brachial plexus are identifiable at their exit from the intervertebral foramina. These nerves may be followed distally, cranial to the first rib, until they form the brachial plexus. The musculocutaneous, ulnar, and median nerves are identified on the medial aspect of mid‐humerus and followed proximally to the axillary region and distally to the elbow. The radial nerve, formed by multiple nerve components, is seen on the mediocaudal aspect of the humerus. Nerves appear as hypoechoic tubular structures with an internal echotexture of discontinuous hyperechoic bands, surrounded by a thin rim of highly echogenic tissue. Improved understanding of the ultrasonographic anatomy of the brachial plexus and its main branches supports clinical use of this modality.     

Ultrasound‐guided approach for axillary brachial plexus,femoral nerve,and sciatic nerve blocks in dogs

Objective To describe an ultrasound‐guided technique and the anatomical basis for three clinically useful nerve blocks in dogs. Study design Prospective experimental trial. Animals Four hound‐cross dogs aged 2 ± 0 years (mean ± SD) weighing 30 ± 5 kg and four Beagles aged 2 ± 0 years and weighing 8.5 ± 0.5 kg. Methods Axillary brachial plexus, femoral, and sciatic combined ultrasound/electrolocation‐guided nerve blocks were performed sequentially and bilaterally using a lidocaine solution mixed with methylene blue. Sciatic nerve blocks were not performed in the hounds. After the blocks, the dogs were euthanatized and each relevant site dissected. Results Axillary brachial plexus block Landmark blood vessels and the roots of the brachial plexus were identified by ultrasound in all eight dogs. Anatomical examination confirmed the relationship between the four ventral nerve roots (C6, C7, C8, and T1) and the axillary vessels. Three roots (C7, C8, and T1) were adequately stained bilaterally in all dogs. Femoral nerve block Landmark blood vessels (femoral artery and femoral vein), the femoral and saphenous nerves and the medial portion of the rectus femoris muscle were identified by ultrasound in all dogs. Anatomical examination confirmed the relationship between the femoral vessels, femoral nerve, and the rectus femoris muscle. The femoral nerves were adequately stained bilaterally in all dogs. Sciatic nerve block. Ultrasound landmarks (semimembranosus muscle, the fascia of the biceps femoris muscle and the sciatic nerve) could be identified in all of the dogs. In the four Beagles, anatomical examination confirmed the relationship between the biceps femoris muscle, the semimembranosus muscle, and the sciatic nerve. In the Beagles, all but one of the sciatic nerves were stained adequately. Conclusions and clinical relevance Ultrasound‐guided needle insertion is an accurate method for depositing local anesthetic for axillary brachial plexus, femoral, and sciatic nerve blocks.     

Spinal Root Origin of the Radial Nerve and Nerves Innervating Shoulder Muscles of the Dog

The ventral spinal root origin of the radial nerve, its muscle branches, and brachial plexus nerves which supply shoulder and thoracic musculature was determined in the dog. Electrophysiological signal averaging techniques measured evoked potential from specific ventral spinal roots to individual muscle nerves. The entire radial nerve received input from the sixth cervical (C6) through the second thoracic (T2) spinal roots. The most significant (p less than .05) input to triceps brachii came from C8 while the deep ramus of the radial nerve received its largest input from C7. The brachiocephalicus, suprascapular, and subscapular nerves all received their most significant (p less than .05) innervation from C6. Approximately 90% of the evoked potential to the axillary nerve originated from C7. The thoracodorsal nerve received most of its innervation from ventral roots C7 and C8. The lateral thoracic nerve which innervates the cutaneous trunci muscle was supplied by ventral roots C8-T2. Examination of innervation patterns suggests that only modest variation of spinal root input to specific nerves occurred between individual dogs.     

Assessment of dorsal nerve root and spinal cord dorsal horn function in clinically normal dogs by determination of cord dorsum potentials

OBJECTIVE: To establish normal predictive values for cord dorsum potential (CDP) onset latency after thoracic and pelvic limb sensory or mixed nerve stimulation in adult dogs. ANIMALS: 26 clinically normal adult dogs. PROCEDURE: Sensory nerve action potentials (SNAP) were recorded proximally from tibial and lateral superficial radial nerves after distal stimulation. The CDP were recorded from the L4-L5 interarcuate ligament for the tibial nerve and from the C7-T1 interarcuate ligament for the radial nerve. Linear regression analyses were performed for CDP onset latency, and mean +/- SD was calculated for CDP onset to peak latency differences and sensory nerve conduction velocities (SNCV). RESULTS: For the tibial nerve, expected CDP onset latency (CDPOL) = -1.194 + 0.014 X pelvic limb length (mm; R2 = 0.912); CDPOL = -2.156 + 0.011 X pelvic limb/spinal length (mm; R2 = 0.911); and CDPOL = 0.941 + 2.197 X tibial nerve SNAP latency (milliseconds; R2 = 0.903). For the radial nerve, CDPOL = -0.9 + 0.014 x thoracic limb length (mm; R2 = 0.873); and CDPOL = 1.454 + 1.874 X radial nerve SNAP latency (milliseconds; R2 = 0.903). Mean +/- SD for CDP onset to peak latency difference for tibial and radial nerves was 3.1+/-0.3 and 3.0+/-0.4 milliseconds, respectively. CONCLUSIONS: Strong linear associations exist between CDPOL and a number of easily measured peripheral independent variables in dogs. There is also a narrow range of normal values for CDP onset to peak latency differences that is independent of limb length. CLINICAL RELEVANCE: CDP evaluation can be used to accurately assess functional severity and distribution of abnormalities in proximal sensory nerves, dorsal nerve roots, and spinal cord dorsal horns in dogs with suspected neuropathy, radiculopathy, or myelopathy involving the brachial or lumbosacral intumescences.     

Patterns of cutaneous anesthesia associated with brachial plexus avulsions in the dog

Patterns of cutaneous anesthesia were determined in 4 dogs referred for evaluation of brachial plexus trauma. Using these patterns in conjunction with other clinical and electrophysiologic data, avulsion of spinal nerve roots contributing to the brachial plexus (brachial plexus avulsion) was diagnosed in each case. Two of the 4 dogs had avulsions of the C7-T1 nerve roots and the T2 branch to T1. One dog had C7 and C8 nerve root avulsion, and one had avulsion of the C8 and T1 nerve roots and the T2 communicating branch to T1. Each dog had a distinct pattern of cutaneous anesthesia.     

Macroanatomic investigations of the blood supply of thoracic limb of Kangal dogs

In this study, the arterial supply of the thoracic limb was investigated in Kangal dogs. Twelve adult healthy Kangal dogs of either sex were used. Latex was injected into the common carotid artery, and then the axillary artery was dissected. The axillary artery is a continuation of the subclavian artery and supplies the thoracic limb in Kangal dogs. The axillary artery gave off a deltoid branch and external thoracic, lateral thoracic, and subscapular thoracic arteries in its course along the thoracic wall. The axillary artery continues distally as the brachial artery in the arm. The brachial artery gives rise to the cranial humeral circumflex, deep brachial, bicipital, ulnar collateral, superficial brachial, transverse cubital, and common interosseus arteries. It continues as the median artery after giving off the common interosseus artery. It was observed that the deep antebrachial artery arose from the median artery at the proximal third of the forearm. In the distal third of the forearm, the median artery divided into the palmar carpal and dorsal carpal branches. The deep palmar branch of the radial artery and deep branch of the palmar branch of the caudal interosseus artery form the deep palmar arch. The median artery joined the superficial branch of the palmar branch of the caudal interosseus artery to constitute the superficial palmar arch. The radial artery and cranial interosseus artery contributed to the dorsal carpal rete. The ulnar artery contributed to the formation of the deep and superficial palmar arches.     

Computed tomography of masses of the brachial plexus and contributing nerve roots in dogs

A retrospective analysis of masses of the brachial plexus and contributing nerve roots in dogs seen at the University of Minnesota over a 17-year period was conducted. The goal of the study was to characterize their computed tomographic (CT) appearance and determine the minimum mass size confidently detectable. Twenty-four cases with a recorded diagnosis of brachial plexus or caudal cervical nerve root mass were found, wherein both the medical records and CT images were available for evaluation. These masses were characterized based on the presence or absence of contrast enhancement, margin character, size, extent of local invasion, and presence of vertebral canal or spinal cord involvement. Within the limits of this study, and the available histopathology, there appeared to be no clinically exploitable relationship between the tomographic appearance and the histologic interpretation. Twenty masses were noted to contrast enhance, typically with rim enhancement and a hypodense center. Only two dogs had a palpable axillary mass on physical examination. As measured, based on the largest dimension within a single slice, detectable masses ranged from 1.0 to 6.5 cm.     

Morphology of brachial plexus and axillary artery in bonobo (Pan paniscus)

A left brachial plexus and axillary artery of bonobo (Pan paniscus) were examined, and the interrelation between the brachial plexus and the axillary artery was discussed. This is the first report of the brachial plexus and the axillary artery of bonobo. The bonobo brachial plexus formed very similar pattern to that of other ape species and human. On the other hand, the branches of the bonobo axillary artery had uncommon architecture in comparison with human case. The axillary artery did not penetrate the brachial plexus and passes through all way along anterior to the brachial plexus. Only 4.9% of human forelimbs have this pattern. Moreover, the brachial artery runs through superficially anterior to branches of the brachial plexus.     

The time course of lymph drainage from the peritoneal cavity in beagle dogs

Lymph drainage routes from the abdominal and pelvic cavities in beagle dogs were observed serially by following the time course of India ink administered intraperitoneally. Four systems of lymph drainage routes from the peritoneal cavity were observed in this study. The earliest drainage returned to the cranial mediastinal lymph nodes via the sternal lymph vessels; subsequently, the sternal lymph nodes located along the internal thoracic artery became involved. Then, a drainage route via the lymph vessel along the left vagus nerve was observed. The final drainage route flowed into the lateral lymph vessel through the thoracic duct located on the vertebra. These results show that India ink is absorbed from the peritoneal cavity, and that the lymph drainage first flows mainly towards the cranial mediastinal lymph nodes through the ventral lymphatic channels. Our serial observations suggest that, over time, the lymph drainage routes changed from the ventral abdominal to the dorsal thoracic lymphatic channels in the thorax.     

CORRELATIVE ULTRASOUND ANATOMY OF THE FELINE BRACHIAL PLEXUS AND MAJOR NERVES OF THE THORACIC LIMB

Brachial plexus avulsions commonly occur in cats due to traumatic injuries involving the shoulder. Ultrasound may be an effective method for detecting injured nerves. Additional applications may include characterization of brachial plexus neoplasms and guidance of anesthetic nerve blocks. Aims of this study were to describe ultrasonographic approaches and the normal appearance of this plexus and other major nerves of the thoracic limb in cats. Eight feline cadavers were used to determine anatomic landmarks, obtain cross‐sectional anatomic images of the target nerves, and compare these with ultrasound images. An ultrasonographic study was performed in five fresh feline cadavers to assess the brachial plexus and its major components at the levels of the axilla and proximal, middle and distal (lateral and medial approaches) humeral regions. Five healthy adult cats were recruited for an in vivo ultrasonographic study using the same protocol described for the cadaver ultrasonographic study. The roots of the brachial plexus appeared as a cluster of small, round hypoechoic structures surrounded by a hyperechoic rim in the axillary approach. The radialis, medianus, and ulnaris nerves were individually visualized on proximal and middle humeral approaches. The medianus and ulnaris nerves were easily identified on the medial aspect of the humerus in the distal approach. The superficial branch of radialis nerve was seen on the lateral aspect of the distal humerus approach. The nerves appeared as oval‐to‐round hypoechogenic structures with a hyperechogenic rim. Future studies are needed to compare findings from this study with those in cats with confirmed brachial plexus injuries or other lesions.     

Gross morphological features of plexus brachialis in the chinchilla (Chinchilla lanigera)

This study documents the detailed features of the morphological structure and the innervation areas of the plexus brachialis in the chinchilla (Chinchilla lanigera). The animals (5 female and 5 male) were euthanased with ketamine hydrocloride and xylazine hydrocloride combination, 60 mg/kg and 6 mg/kg, respectively. Skin, muscles and nerves were dissected under a stereo-microscope. The brachial plexus of the chinchilla is formed by rami ventrales of C5-C8, T1 and T2, and possesses a single truncus. The subscapular nerve is formed by the rami of the spinal nerves originating from C6 (one thin ramus) and C7 (one thick and 2 thin rami). These nerves innervate the subscapular and teres minor muscles. The long thoracic nerve, before joining with the brachial plexus, obtains branches from C6 and C7 in 5 cadavers (3 male, 2 female), from C7 in 4 cadavers (2 male, 2 female) and from C6-C8 in only 1 female cadaver. These nerves disperse in variable combinations to form the extrinsic and intrinstic named, nerves of the thoracic limb. An undefined nerve branch originates from the rami ventrales of C7, C8 and T1 spinal nerves enter the coracobrachial muscle.     

Anatomical and experimental studies of brachial plexus, sciatic, and femoral nerve-location using peripheral nerve stimulation in the dog

OBJECTIVE: To investigate the anatomy of the brachial plexus, sciatic, and femoral nerves for the use of a peripheral nerve-stimulator to perform nerve blocks in dogs. STUDY DESIGN: Prospective experimental trial. ANIMALS: Four canine cadavers and four healthy adult dogs weighing 23 +/- 2.5 kg. METHODS: Phase I: in four canine cadavers, an anatomical study was conducted to evaluate accurate needle-insertion techniques. Phase II: the utility of these techniques, and the value of electrostimulation, were evaluated in four anesthetized dogs in lateral recumbency (medetomidine, 5 microg kg(-1)/ketamine 5 mg kg(-1)) using an electrical stimulator and shielded needles. RESULTS: For the brachial plexus, the needle was inserted cranial to the acromion, medial to the subscapularis muscle, at an angle of approximately 20-30 degrees in relation to a plane vertical to the surface on which the animal was lying, oriented parallel to the long axis of the animal, in a ventro-caudal direction. For the sciatic nerve, the needle was inserted just cranial to the sacrotuberous ligament, through the gluteus superficialis muscle, at an angle of approximately 60 degrees in relation to the horizontal plane, in a ventro-cranial direction, and up to the level of the ischium. For the femoral nerve, the needle was inserted perpendicular to the skin, just cranial to the femoral artery, and directed a little caudally. Using a peripheral nerve-stimulator, all nerves were located, and muscle contractions were elicited at a current of 0.2-0.4 mA. No complications were observed during the procedures. CONCLUSION: Electrostimulation of peripheral nerves is useful in locating the branches of the brachial plexus as well as the sciatic and femoral nerves in dogs. CLINICAL RELEVANCE: Peripheral nerve stimulation increases the reliability of a nerve block when compared with blind needle-insertion.     

A novel technique of ultrasound-guided brachial plexus block in calves

An interventional ultrasound technique to increase the safety of surgical treatment of the calf forelimb was tested. First, the brachial plexus was evaluated using ultrasonography and then 2% lidocaine was injected under ultrasound guidance. Ultrasonically, the brachial plexus appeared as multiple hypoechoic areas surrounded by a hyperechoic rim or a hyperechoic structure characterised by multiple discontinuous lines. It was located between the omotransverse muscle and axillary artery and vein. The sensitive effect in the forelimb was seen mainly in the area supplied by the musculocutaneous nerve, indicating successful blockage in the nerve plexus. Out of the eight forelimbs, the motor effect was observed in seven forelimbs. These results suggest the clinical feasibility of ultrasound-guided brachial plexus block in bovine medicine, although further studies are needed to examine various approaches, including the sites of needle insertion and the appropriate volume and dosage of anaesthetic.     

Gross Anatomy of the Brachial Plexus in the Giant Anteater (Myrmecophaga tridactyla)

Ten forelimbs of five Myrmecophaga tridactyla were examined to study the anatomy of the brachial plexus. The brachial plexuses of the M. tridactyla observed in the present study were formed by the ventral rami of the last four cervical spinal nerves, C5 through C8, and the first thoracic spinal nerve, T1. These primary roots joined to form two trunks: a cranial trunk comprising ventral rami from C5‐C7 and a caudal trunk receiving ventral rami from C8‐T1. The nerves originated from these trunks and their most constant arrangement were as follows: suprascapular (C5‐C7), subscapular (C5‐C7), cranial pectoral (C5‐C8), caudal pectoral (C8‐T1), axillary (C5‐C7), musculocutaneous (C5‐C7), radial (C5‐T1), median (C5‐T1), ulnar (C5‐T1), thoracodorsal (C5‐C8), lateral thoracic (C7‐T1) and long thoracic (C6‐C7). In general, the brachial plexus in the M. tridactyla is similar to the plexuses in mammals, but the number of rami contributing to the formation of each nerve in the M. tridactyla was found to be larger than those of most mammals. This feature may be related to the very distinctive anatomical specializations of the forelimb of the anteaters.     

Magnetic stimulation of the radial nerve in dogs and cats with brachial plexus trauma: a report of 53 cases

Brachial plexus trauma is a common clinical entity in small animal practice and prognostic indicators are essential early in the course of the disease. Magnetic stimulation of the radial nerve and consequent recording of the magnetic motor evoked potential (MMEP) was examined in 36 dogs and 17 cats with unilateral brachial plexus trauma.Absence of deep pain perception (DPP), ipsilateral loss of panniculus reflex, partial Horner’s syndrome and a poor response to MMEP were related to the clinical outcome in 29 of the dogs and 13 of the cats. For all animals, a significant difference was found in MMEP between the normal and the affected limb. Absence of DPP and unilateral loss of the panniculus reflex were indicative of an unsuccessful outcome in dogs. Additionally, the inability to evoke a MMEP was associated with an unsuccessful outcome in all animals. It was concluded that magnetic stimulation of the radial nerve in dogs and cats with brachial plexus trauma may provide an additional diagnostic and prognostic tool.     

Horner's syndrome in dogs and cats: 100 cases (1975-1985)

The medical records of 74 dogs and 26 cats with Horner's syndrome (HS) that were admitted to the New York State College of Veterinary Medicine between January 1975 and October 1985 were reviewed. In dogs, but not cats, HS was associated significantly (P less than 0.01) with increasing age. Dogs with hypothyroidism (defined liberally but not rigorously), intracranial neoplasia, or thoracic neoplasia, cats with otitis media/interna (defined liberally), and dogs and cats with brachial plexus root avulsion were at greater risk for developing HS than were animals that were hit by a car. Dogs and cats with otitis externa were at less risk of developing HS than were animals that were hit by a car. The cause of HS could not be determined in 50% of dogs and 42.3% of cats. The results of topical adrenergic drug testing in dogs were inconclusive in localizing lesion site. In dogs and cats, HS appeared to be unassociated with gender, breed, or right vs left side. The important causes of HS in dogs and cats were trauma (hit by car), brachial plexus root avulsion, intracranial and thoracic neoplasia, and otitis media/interna.