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Anatomical Entrapment of the Dorsal Scapular and Long Thoracic Nerves Secondary to Brachial Plexus Piercing Variation

Understanding and documenting anatomical variation plays a vital role for furthering the ability of a physician to diagnose, care, and treat patients. Despite the textbook definition of the typical or classical pattern of the brachial plexus as emerging between the anterior and middle scalene muscles, variants involving different patterns are becoming well documented, especially the high frequency of “piercing” variants, in which the superior and/or middle trunk of the brachial plexus courses through the belly of the anterior scalene muscle. While this variation is now widely acknowledged, it is currently unclear how these variants may influence branching patterns distally along the brachial plexus in branches such as the dorsal scapular and long thoracic nerves.