brachial plexus: odds and sods
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Brachial Plexus:Odds and Sods
Emily Matthews (e.k.matthews@warwick.ac.uk)Alex Clarke (alexander.clarke@warwick.ac.uk)
Content
• Mnemonic for nerve roots of main nerves
• Activity: Root values associated with key movements
• Question: Axillary nerve
Nerve roots of main nervesTHREE musketeers assassinate 5 rats, 5 mice, 2 unicorns
LABEL YOUR FINGERS
http://www.stritch.luc.edu/lumen/meded/grossanatomy/2013_2014/revisedbp14/revisedbp14_print.html
Nerve roots of main nervesTHREE musketeers assassinated 5 rats, 5 mice, 2 unicorns
Nerve roots of main nervesTHREE musketeers assassinated 5 rats, 5 mice, 2 unicorns
Nerve roots of main nervesTHREE musketeers assassinated 5 rats, 5 mice, 2 unicorns
FIVE RATS- FIVE MICE - Median
Nerve roots of main nervesTHREE musketeers assassinated 5 rats, 5 mice, 2 unicorns
Root values associated with key movementsQuestion 1
Joint Movement Root value
Shoulder
Elbow
Forearm
Digit
Hip
Knee
Root values associated with key movementsQuestion 2
Side Joint Movement Root value
Right Shoulder
Elbow
Hip
Knee
Left Shoulder
Elbow
Hip
Knee
Foot
Root values associated with key movementsAnswer 1
Joint Movement Root value
Shoulder Abduction C5
Elbow Extension C6, 7
Forearm Pronation C6
Digit Flexion C7-8
Hip Abduction L4, L5
Knee Extension L3, L4
Root values associated with key movementsAnswer 2
Side Joint Movement Root value
Right Shoulder Flexion C5
Elbow Flexion C5, 6
Hip Flexion L1, 2, 3
Knee Flexion L5, S1
Left Shoulder Extension C6, 7, 8
Elbow Flexion C5, 6
Hip Extension L5, S1
Knee Extension L3, 4
Foot Plantarflexion S1, S2
Root values associated with key movements
MAIN POINT:
Note how NOT all nerve roots of a named nerve are involved in movement
e.g. Biceps brachii and brachialis muscles are involved in elbow flexion.These muscles are in anterior compartment of the arm and innervated by musculocutaneous nerve. Nerve roots of musculocutaneous nerve: C5, C6, C7
Brachioradialis also involved in elbow flexion. Innervated by radial nerve. Radial nerve has nerve roots C5, 6, 7, 8 & T1
However, only neurons from C5, C6 innervate muscles involved in elbow flexion, so the nerve root value of elbow flexion is C5, C6
Root values associated with key movementsUPPER LIMB: From this year’s lectures slides:
LOWER LIMB: From last year’s lectures slides
QuestionBertha Jugs is diagnosed with breast cancer. Her surgeon performs a wide local excision and sentinel node biopsy.
(a) What is a sentinel node and what is the purpose of biopsying it?
A sentinel node is the first lymph node a carcinoma drains to
Sentinal node bx: radioactive (technetium 99) substance blue dye is injected into the nipple. Drains through the lymphatic system of the breast
All blue/radioactive lymph nodes are excised (radioactive nodes detected with Gieger counter)
If sentinel node clear of cancer then no need for further axillary node clearance.
Useful as only affected lymph nodes are removed, thus reducing need for axillary node clearance in most women which is associated with pain and lymphoedema http://health.kernan.org/patiented/articles/sentin
el_node_biopsy_000378.htm
QuestionAn axillary node clearance is required for Bertha.
(b) Name 5 main groups of axillary lymph nodes
CentralHumeralApicalPectoralSubscapular
CHAPS like breasts
QuestionThe surgeon’s credentials are questionable. He blunders about in the axilla and damages the axillary nerve.
(b) Describe the likely consequences of damaging the axillary nerve
Deltoid and teres minor affected:• Loss of shoulder contour id wasting)• Weakness of shoulder movement except adduction• Limb hang limp at side
loss of sensation over regimental badge region
n/a
MOTOR
SENSORY
REFLEX
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