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    3) Brachial Plexus 17

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    Kumar
    The brachial plexus is formed by the ventral rami of spinal nerves C5-T1. It innervates the upper limb and is divided into trunks, divisions, cords, and branches which provide motor and sensory innervation. Injuries to different parts of the brachial plexus can result in varying clinical presentations, such as Erb's palsy from injury to C5-C6 which causes shoulder drop and wrist drop, or Klumpke's palsy from injury to C8-T1 which results in a claw hand. Surgical repair or nerve transfers may help to restore function following brachial plexus injuries.

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    3) Brachial Plexus 17

    Uploaded by

    Kumar
    17 views35 pages
    The brachial plexus is formed by the ventral rami of spinal nerves C5-T1. It innervates the upper limb and is divided into trunks, divisions, cords, and branches which provide motor and sensory innervation. Injuries to different parts of the brachial plexus can result in varying clinical presentations, such as Erb's palsy from injury to C5-C6 which causes shoulder drop and wrist drop, or Klumpke's palsy from injury to C8-T1 which results in a claw hand. Surgical repair or nerve transfers may help to restore function following brachial plexus injuries.

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    brachial plexus

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    The brachial plexus is formed by the ventral rami of spinal nerves C5-T1. It innervates the upper limb and is divided into trunks, divisions, cords, and branches which provide motor and sensory innervation. Injuries to different parts of the brachial plexus can result in varying clinical presentations, such as Erb's palsy from injury to C5-C6 which causes shoulder drop and wrist drop, or Klumpke's palsy from injury to C8-T1 which results in a claw hand. Surgical repair or nerve transfers may help to restore function following brachial plexus injuries.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    17 views35 pages

    3) Brachial Plexus 17

    Uploaded by

    Kumar
    The brachial plexus is formed by the ventral rami of spinal nerves C5-T1. It innervates the upper limb and is divided into trunks, divisions, cords, and branches which provide motor and sensory innervation. Injuries to different parts of the brachial plexus can result in varying clinical presentations, such as Erb's palsy from injury to C5-C6 which causes shoulder drop and wrist drop, or Klumpke's palsy from injury to C8-T1 which results in a claw hand. Surgical repair or nerve transfers may help to restore function following brachial plexus injuries.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 35

    Brachial

    plexus

    Plexus of nerves that

    innervates the upper


    limb
    Formation :

    Ventral rami of spinal


    nerves C5,6,7,8 and T1
    Runs down between the
    Scalenus.anterior&medius
    muscle in the
    supraclavicular region
    Divided into trunks,
    divisions, cords and
    branches

    Variation in the brachial plexus


    Prefixed brachial

    plexus: with C4 root


    Postfixed brachial plexus: with T2 root

    Really Tired? Drink Coffee,


    Buddy!
    Roots
    Trunks
    Divisions
    Cords
    Branches

    Roots

    Trunk

    C5

    Division
    Anterior Division

    Upper Trunk
    C6

    Posterior Division
    Anterior Division

    C7

    Middle Trunk
    Posterior Division

    C8

    Anterior Division
    Lower Trunk

    T1

    Posterior Division

    Trunk

    Division

    Upper
    trunk

    Middle
    trunk

    Lower
    trunk

    Anterior Lateral Cord


    Posterior
    Anterior Medial Cord
    Posterior
    Anterior Posterior Cord
    Posterior

    Cords

    Reationship of cords of brachial


    plexus with the axillary artery

    Branches of the brachial plexus


    Divided into

    Supraclavicular branches
    Infraclavicular branches

    Supraclavicular branches
    arises from roots and
    trunk
    Infraclavicular branches
    form the cords

    SUPRACLAVICULAR BRANCHES

    From the roots:

    Dorsal scapular nerve(C5)


    A branch to join the phrenic nerve(C5)
    Long thoracic nerve(C5,C6,C7)
    Muscular branches to longus colli and scaleni

    From the trunk(upper trunk)

    Nerve to subclavius(C5,6)
    Suprascapular nerve(C5,6)

    Note:Middle&lower trunk does not give any branches

    Branches from roots:


    1. Long thoracic nerve (C5,6,7) Descend posterior to the mid axillary line
    Closely applied to the serratus anterior muscle
    Innervates the serratus anterior muscle

    2. Dorsal scapular nerve(C5)


    pierces the Scalenus.medius muscle
    innervates Rhomboidus major and minor muscles

    Branches from upper trunk:


    1. Nerve to subclavius: (C5,6)
    -supplies the subclavius muscle
    - contributes(C5) to the phrenic nerve as the accessory
    phrenic nerve

    2. Suprascapular nerve: (C5,6)


    -innervates supraspinatus and infraspinatus

    muscles of the

    scapula

    Note: No branches arise from middle & lower trunks

    Branches from the cord

    Lateral Cord : Lateral pectoral nerve(C5,6,7)


    Musculocutaneous nerve(C5,6,7)
    Lateral root of median nerve(C6,7)

    Medial Cord: Medial pectoral nerve(C8,T1)


    Medial cutaneous nerve of the forearm(C8,T1
    Medial cutaneous nerve of the Arm(C8,T1)
    Ulnar nerve(C7,C8,T1)
    Medial root of median nerve (C8,T1)

    Posterior cord: Upper sub scapular nerve (C5,C6)


    Lower subscapular nerve (C5,C6)
    Thoraco dorsal nerve (C6,C7,C8)
    Radial nerve (C5,C6,C7,C8,T1)
    Axillary nerve( C5,C6

    Branches from the lateral cord


    Lateral pectoral nerve: supplies

    Pectoralis .major& minor


    Musculocutaneous nerve: supplies the
    muscle of the anterior compartment of arm
    Lateral root of medial nerve:supplies the
    muscle of forearm combined with lateral root

    Branches from the medial cord

    Medial root of median nerve:supplies muscles of


    forearm along with the lateral root
    Medial cutaneous nerve of the arm:cutaneous to
    arm
    Medial cutaneous nerve of the forearm:cutaneous
    to forearm
    Medial pectoral nerve:supplies Pectoralis.major
    and P. minor
    Ulnar nerve:supplies the muscles of forearm

    Branches from the posterior cord

    Upper subscapular nerve:supplies subscapularis


    muscle
    Lower subscapular nerve:supplies subscapularis
    and Teres.Major
    Thoracodorsal nerve:supplies Lattisimus.dorsi
    Radial nerve:supplies the muscles of posterior
    compartment of arm,cutaneous to arm
    Axillary nerve:deltoid muscle&Teres.minor,cutaneous
    to the skin of shoulder

    Clinical anatomy
    Upper trunk injuries
    Lower trunk injuries
    Other nerve injuries arising from the plexus

    Upper brachial plexus

    Erb-Duchenne palsy

    Results from excessive displacement of the head to the opposite side and
    depression of the shoulder on the same side

    Difficult labour

    Motorcycle fall

    Malposition of the upper


    limb on the operation table

    Abrasions on the face


    and shoulder show
    how this motorcyclist
    pulled his entire
    plexus apart

    Upper brachial plexus

    Erb-Duchenne palsy

    The lesion produced is similar to that produced by a stab or bullet wound in


    the neck affecting the superior trunk of the brachial plexus
    Superior trunk

    Neck wound

    Affects C5 & C6 roots or the superior


    trunk
    suprascapular nerve, nerve to
    subclavius, musculocutaneous, and
    axillary nerves are affected

    Erbs point
    Point on the upper trunk
    Meeting point of six nerves
    C5,6 roots,
    anterior &posterior
    divisions
    Nerve to
    subclavius&suprascapular
    nerve

    Upper brachial plexus


    Erb-Duchenne palsy
    Abduction, lateral rotation, and
    flexion at the shoulder are
    affected
    the limb hangs by the side
    adducted and medially rotated by
    unopposed pectoralis major

    Affects C5 & C6 roots or the upper


    trunk
    suprascapular nerve, nerve to
    subclavius, musculocutaneous, and
    axillary
    Waiters
    tipnerves
    handare affected

    the forearm extended and


    pronated because the action of
    biceps is lost

    Erbs
    palsy

    Resulting from excessive displacement of head to


    the opposite side &depression of the shoulder on the
    same side
    Injury to C5 &C6 nerves
    Affecting muscles around the shoulder& elbow
    Clinical features:
    -arm is adducted & medially rotated
    -pronated forearm
    -extended elbow
    -hand turns backwards
    (waiters tip hand/policemans tip hand)

    Erbs palsy in new born

    Lower brachial plexus

    results from
    excessive abduction
    of the arm as in
    during labour

    or when a person
    falls from a height
    grasping something
    to save himself

    Cervical rib
    Note the transverse process of C7

    Klumpke palsy

    Lower brachial plexus

    Klumpkes palsy
    Affects C8&T1
    Claw hand

    Small muscles of the hand


    are affected due to paralysis
    of ulnar nerve
    Note wasting of dorsal interossei

    Klumpkes palsy:
    Resulting from excessive abduction of the arm as in
    grasping something to break a fall
    Injury to C7,C8 &T1 nerves
    Affects the muscles of forearm,wrist and hand
    Hand has clawed appearance due to hyper extension
    of metacarpo phalangeal joints and flexion of inter
    phalangeal joint (ulnar claw hand)
    Loss of sensation along the medial aspect of upper
    limb

    Ulnar claw hand

    Winging scapula:
    Injury to the long thoracic nerve
    causing paralysis of serratus
    anterior muscle
    Resulting from the blows on the
    posterior triangle of the neck
    Inability to protract & rotate the
    scapula during the abduction of the
    arm above the head
    Medial border and inferior angle of
    the scapula elevated

    Brachial plexus block:


    o

    Site:
    Interscalenei(bet
    scalenus.anterior& S.posterior)
    In the supraclavicular triangle

    Backpackers palsy:
    Seen in people who carry
    heavyloads at their back especially
    in hikers

    Acute brachial plexus neuritis:


    o
    o

    Disorder which is characterised by severe pain around the


    shoulder followed by muscle weakness
    Cause :Mostly unknown
    Followed by respiratory infection etc

    Horners Syndrome:
    Cause:
    o Damage to T1 root of the plexus ,since T1 carries the
    preganglionic sympathetic fibres for head and neck
    Features : Ptosis(drooping of the eyelid)
    Meosis
    Anhydrosis
    Flushing of the face

    Thank you

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