Bifurcated distal biceps brachii tendon coexisting with separated bicipital aponeurosis: a complex variational case report

Variations appearing in biceps brachii muscle are common with accessory head, different origins, variant insertion, and different pattern of nerve innervation. However, variations appearing in both origin and insertion, and with other anomalous morphology at the same time are seldom. Here we report a complex variational case on the right arm of a 91-year-old Japanese female cadaver. The complex variations included (1) the biceps brachii muscle bifurcated at its distal ending; (2) the long head had its own tendon, which divided into two parts, i.e., a lateral part fused into the fascia between the brachioradialis and extensor carpi brevis, and a medial part attached to the radius about one centimeter ahead of the radial tuberosity; (3) the short head had an accessory origin from the shoulder capsule; (4) the bicipital aponeurosis was of two parts with an anterior superior layer formed by the long head and a posterior deep one formed by the short head; (5) the musculocutaneous nerve was especially underdeveloped that only innervated the coracobrachialis; (6) the existence of communicating branch between the musculocutaneous and median nerves, and the median nerve issued muscular branches to the biceps brachii and brachialis muscles, and (7) the brachioradial muscle had two accessory muscular bundles that originated from the fascia of the brachial muscle (proximal one) and from the bicipital aponeurosis (distal one).