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Anatomical variations of the blood supply to the forearm and hand can be identified with available high-frequency ultrasound equipment. Arterial variants immediately adjacent to the median nerve may occur in approximately 1 in 5 limbs. Practitioners should actively seek their presence or absence.

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During an ultrasound-guided axillary brachial plexus block, sonoanatomy demonstrated a delayed formation of the lateral root to the median nerve from the lateral cord, an accessory coracobrachialis brevis muscle, and a course of the lateral root to the median nerve 'spiralling' around the accessory muscle prior to locating lateral to the brachial artery. This rare variant is further discussed in the context of median, musculocutaneous and coracobrachialis variations.