Bilateral four-headed biceps brachii muscles: the median nerve and brachial artery passing through a tunnel formed by a muscle slip from the accessory head

Clin Anat. 1998;11(3):209-12. doi: 10.1002/(SICI)1098-2353(1998)11:3<209::AID-CA10>3.0.CO;2-N.


Bilateral four-headed biceps brachii muscles were observed in the dissected cadaver of a 95-year-old Japanese woman. The third head on both sides originated from the humerus at the insertion of the coracobrachialis and inserted into the distal part of the biceps brachii and the proximal part of the common biceps tendon on the ipsilateral side. The fourth head on both sides arose from a thin fibrous origin from the intertubercular sulcus and the insertion of the pectoralis major, and inserted into the confluence of the biceps brachii and the third head. This anomaly is relatively rare. Moreover, the left third head gave off a muscle slip into the posterior fascia of the pronator teres, forming a tunnel. The median nerve and the brachial artery passed through the tunnel, where the nerve and artery seemed to be compressed. The possible production of clinical symptoms, given the anatomy, is discussed.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arm / abnormalities
  • Arm / blood supply
  • Arm / innervation
  • Brachial Artery / pathology*
  • Female
  • Humans
  • Median Nerve / pathology*
  • Muscle, Skeletal / abnormalities*
  • Muscle, Skeletal / blood supply
  • Muscle, Skeletal / innervation