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Nerve plexuses are networks of interlacing nerves that serve as communication hubs to distribute and organize nerve action across various body regions. The nerve plexuses are organized into the cervical plexus located in the neck region, brachial plexus in the shoulder area, lumbar plexus found in the lower back, sacral plexus situated in the pelvis, and coccygeal plexus located in the coccygeal region.
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The brachial plexus - explaining its morphology and variability by a generic developmental model.

Joris N Leijnse¹, Bernadette S de Bakker², Katharina D'Herde¹

¹Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.

Journal of Anatomy

|December 10, 2019

Summary

This study presents a developmental model for brachial plexus (BP) variability, explaining common variations based on embryological factors like subclavian artery development. This model aids in understanding and teaching BP anatomy, moving beyond rote memorization.

Keywords:

anatomical variability anatomy brachial plexus development generic model morphology pectoral nerves peripheral nerves

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Area of Science:

Human Anatomy and Embryology
Developmental Biology
Morphological Analysis

Background:

The brachial plexus (BP) is often taught as a complex, rote-learned structure.
Dissections reveal significant variability, questioning the definition of 'anomalous' variations.
A standardized model linking BP morphology and variability to developmental parameters is needed for teaching and understanding.

Purpose of the Study:

To develop a model that explains brachial plexus morphology and variability based on causative developmental parameters.
To apply this model to anatomical specimens for validation and to standardize BP description and teaching.
To investigate the relationship between BP variations, subclavian artery development, and associated anatomical structures.

Main Methods:

Formulated a generic developmental model for the brachial plexus based on a comprehensive literature review.
Defined key factors contributing to plexus variability during embryogenesis.
Analyzed 56 brachial plexus specimens to assess the consistency of the proposed developmental principles with observed variations.

Main Results:

The model successfully explained observed brachial plexus variations, linking them to embryological constraints and developmental pathways.
The segmental position of the subclavian artery (originating from different intersegmental arteries) was identified as a major determinant of predictable plexus configurations.
A large split in the lateral cord was observed in 54% of specimens, and associations between subclavian artery variants and pectoral nerve variations were modeled.

Conclusions:

Brachial plexus variability is not random but reflects the possibilities of the embryological substrate, influenced by factors like arterial development.
The proposed model provides an insightful narrative of formative principles, potentially replacing rote learning in anatomy education.
Understanding these relationships is clinically relevant for brachial plexus surgery and reconstruction.