The document discusses the brachial plexus, which is a network of nerves that supplies the upper limb. It begins with the formation of the brachial plexus from the ventral rami of cervical and thoracic spinal nerves. It then discusses the relations of the brachial plexus in the neck and axilla and describes the branches arising from the different cords. Important nerves like the median, ulnar, and radial nerves and their areas of supply are identified. Clinical conditions like Erb's palsy and Klumpke's palsy that result from brachial plexus injuries are also summarized.
The document discusses the brachial plexus, which is a network of nerves that supplies the upper limb. It begins with the formation of the brachial plexus from the ventral rami of cervical and thoracic spinal nerves. It then discusses the relations of the brachial plexus in the neck and axilla and describes the branches arising from the different cords. Important nerves like the median, ulnar, and radial nerves and their areas of supply are identified. Clinical conditions like Erb's palsy and Klumpke's palsy that result from brachial plexus injuries are also summarized.
The document discusses the brachial plexus, which is a network of nerves that supplies the upper limb. It begins with the formation of the brachial plexus from the ventral rami of cervical and thoracic spinal nerves. It then discusses the relations of the brachial plexus in the neck and axilla and describes the branches arising from the different cords. Important nerves like the median, ulnar, and radial nerves and their areas of supply are identified. Clinical conditions like Erb's palsy and Klumpke's palsy that result from brachial plexus injuries are also summarized.
The document discusses the brachial plexus, which is a network of nerves that supplies the upper limb. It begins with the formation of the brachial plexus from the ventral rami of cervical and thoracic spinal nerves. It then discusses the relations of the brachial plexus in the neck and axilla and describes the branches arising from the different cords. Important nerves like the median, ulnar, and radial nerves and their areas of supply are identified. Clinical conditions like Erb's palsy and Klumpke's palsy that result from brachial plexus injuries are also summarized.
At the end of this lecture students should be able to understand:
Mention formation of brachial plexus (roots, trunk, division, and cords)
Discuss the relation of brachial plexus also in connection to clavicle (Supra, retro, infra clavicular parts Enumerate the branches arising the different cords Able to draw the brachial plexus Describe cutaneous supply of arm
The trunks desend laterally above the clavicle and
bifurcate into anterior and posterior division FORMATION OF CORDS
The anterior division of the upper trunk and
middle trunk will unite to form the lateral cord.
The anterior division of the lower trunk
continues as the medial cord.
The posterior divisions of all the trunks will
unite to form the posterior cord.
RELATIONS OF THE BRACHIAL PLEXUS
Brachial plexus lies at the posterior triangle of
the neck between the angle formed by the clavicle and the stenocleidomastoid muscle.
Found to emerge between the scalenus anterior
and scalenus medius muscles.
It is covered by the skin, deep fascia, and
platysma muscle
It is also crossed by suprascapular nerve,
external jugular vein, and inferior belly of Omohyoid muscle RELATIONS OF THE BRACHIAL PLEXUS IN THE AXILLA
The cords of the brachial plexus derived their names
based on their relationship with the 2nd part of the axillary artery
The lateral cord and posterior cord lie
laterally to the 1st part of axillary artery The medial cord lies posterior to it. Below the pectoralis minor the lateral cord lies lateral of the 2nd part of the axillary artery posterior cord lies posteriorly The medial cord lies medially to the 2nd part of axillary artery. Below the pectoralis minor the cords gives their terminal branches BRANCHES OF BRACHIAL PLEXUS
BRANCHES FROM THE ROOT
1. Long thoracic nerve (C5,C6,C7). 2. Dorsal scapular nerve (C5). 3. Nerve to subclavius (C5, C6).
BRANCH FROM THE TRUNK
1. Suprascapular Nerve.
BRANCHES FROM THE LATERAL CORD
1. Lateral pectoral Nerve. ((C5, C6). 2. Musculocutaneous (C5,C6, C7) 3. Lateral root of median nerve (C5, C6, C7).
BRANCHES FROM THE MEDIAL
CORD 1. Medial pectoral nerve 2. Medial cutaneous nerve of arm 3. Medial cutaneous nerve of forearm 4. Ulnar nerve 5. Medial root of median nerve
1) MEDIAN NERVE ( Formed by both medial and lateral cord)
A) supplies all the flexors of the forearm( except flexor carpi ulnaris and medial half of flexor digitorum profundus) B) intrinsic muscles in the lateral palm including thenar eminence)
2) ULNAR NERVE Supplies the medial half of flexor digitorum profundus and the flexor carpi ulnaris B) supplies most of the intrinsic muscles of the hand including the hypothenar eminence, and skin on the medial side of the hand Clinical application Injury to median nerve- apes hand Injury to ulnar nerve- claw hand 3) MUSCULOCUTANEOUS NERVE Supplies the biceps, coracobrachialis and brachialis
4) AXILLARY NERVE - Supplies the deltoid and teres minor muscle - Supplies the shoulder joint
5) RADIAL NERVE - Supplies the triceps - Supplies the brachioradialis - Supplies most of the extensors of the forearm - * injury results in wrist drop
Cutaneous innervations of Upper Limb
Nerves of Brachial Plexus Supplying Upper limb
APPLIED ANATOMY OF THE BRACHIAL PLEXUS -ERBS PARALYSIS
This is the paralysis that occurs as a result of damage to the upper trunk of the brachial plexus
a result of accidental fall or birth injury
results in damage to the nerves that
have root value of C5 and C6 which include: Suprascapular nerve Nerve to subclavius Lateral pectoral nerve Axillary nerve Musculocutaneous nerve
The arm is placed in an adducted position and medially rotated, the forearm pronated and the palm facing backwards presenting the classical waiters tip position.
ERBS PARALYSIS
1. Loss of abduction of the arm due to the damage to
the suprascapular nerve which supply the supraspinatus muscle and the axillary nerve which supply the deltoid muscle.
2. The arm is medially rotated due to paralysis of the lateral rotator muscles of the arm which include the teres minor supplied by the axillary nerve and the infraspinatus muscle supplied by the suprascapular nerve.
3. Loss of flexion at the elbow joint due to paralysis of the biceps brachi muscle as a result of damage to the musculocutaneous nerve.
4. Forearm is pronated due to the unopposed action of pronator teres muscle as
a result of paralysis of the biceps.
Injury to the lower roots, C8 and T1, results in
Klumpke's Palsy.
The ulnar and median nerves affected
paralysis of all of the intrinsic muscles of hand
Claw hand due to hyperextension of
metacarpophalangeal joints and flexion of digits by forearm flexors unopposed by interossei.
Ulnar flexors of wrist and fingers are involved along
with cutaneous anaesthesia and analgesia along the ulnar border.
