brachial plexus & applied

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  • 1.Brachial plexus

2. Where Ventral Rami Come From Dorsal Root Dorsal Ramus of spinal nerve Ventral Ramus of spinal nerve spinal nerve Ventral Root 3. Parts of Brachial Plexus R = ROOTS (ventral rami) T = TRUNKS D = DIVISIONS C = CORDS B = BRANCHES 4. Relationship of cords of brachial plexus with axillary artery 5. PUT IT ALL TOGETHER... 6. BRANCHES OF SUPRACLAVICULAR PART OF BRACHIAL PLEXUSBranches of roots - Dorsal scapular nerve(C5)Long thoracic nerve (C5,C6,C7)muscular branches to longus colli &scaleniBranch to phrenic nerveBranches of upper- Nerve to subclavius (C5,C6) Trunk Suprascapular nerve (C5,C6) 7. BRANCHES OF INFRACLAVICULAR PART OF BRACHIAL PLEXUS Lateral cordMusculocutaneous nerve(C5,C6)Lateral pectoral nerve (C5,C6)Lateral root of median nerve (C5,C6) Medial cord Medial cutaneous nerve of arm (C8,T1) Medial cutaneous nerve of forearm(C8,T1) Medial root of median nerve(C8,T1) Medial pectoral nerve (C8,T1) Ulnar nerve(C7,C8,T1) Posterior cord Upper subscapular nerve(C5,C6) Lower subscapular nerve(C5,C6) Nerve to latissimus dorsi (C6,C7,C8) Axillary nerve(C5,C6) Radial nerve(C5,C6,C8,T1) 8. BRANCHES OF ROOTS DORSAL SCAPULAR NERVE Root value- C5 Supply Rhomboid major & minor muscle Posterior view 9. LONG THORACIC NERVERoot value- C5,C6,C7Supply Serratus anteriormuscle 10. BRANCHES OF UPPER TRUNKNERVE TO SUBCLAVIUS Root value C5,C6SUPRASCAPULAR NERVERoot value C5,C6 11. LATERAL PECTORAL NERVE MEDIAL PECTORAL NERVERoot value- C5,C6,C7Root value- C8,T1 12. MUSCULOCUTANEOUS NERVERoot value C5,C6,C7 13. MEDIAN NERVE 12-13 14. MEDIAL CUTANEOUS NERVE OF ARMRoot value- C8,T1MEDIAL CUTANEOUS NERVE OFFOREARMRoot value- C8,T1 15. ULNAR NERVERoot value-(C7),C8,T112-15 16. UPPER SUBSCAPULARRoot value-C5,C6LOWER SUBSCAPULARRoot value- C5,C6NERVE TO LATISSIMUS DORSIRoot value-C6,C7,C8 17. AXILLARY NERVE 18. RADIAL NERVE 19. DERMATOMES OF UPPER LIMB 20. APPLIED ANATOMY 21. TENDON REFLEXES Biceps brachii tendon reflexe (C5,C6) Triceps tendon reflex (C6,C7,C8) Brachioradialis tendon reflex(C5,C6,C7) 22. LONG THORACIC NERVECauses - carrying Heavy load on shoulder Sudden pressure on shoulder from aboveDeformity Winging of scapulaOverhead abduction not possible 23. ERBS PARALYSIS Erbs point Causes Nerve roots involved Muscles Paralysed Deformity Disability 24. LEFT SIDE PARALYSIS 25. Klumpkes paralysis-Site of injuryCause of injuryNerve roots involvedMuscles paralysedDeformityDisability 26. CLAW HAND HORNER SYNDROME 27. MUSCULOCUTANEOUS NERVE Cause Muscle paralysed Disability SUPRASCAPULAR NERVE Cause Muscle paralysed Disability 28. AXILLARY NERVE Causes crutch pressing upward into thearmpit, Downward shoulder dislocations fractures of the surgical neck ofthe humerus. Motor effects: Sensory effects: Deformity: 29. MEDIAN NERVE Cause-Site of injury-Muscles paralysed-DeformityDisability RIGHT SIDE 30. ULNAR NERVECauses-Axilla- crutch pressureArm- # of shaft of humerusElbow- # of medial epicondyleForearm- penetrating injuriesWrist- cut and stab woundsMuscles paralysed-DeformityDisability 31. RADIAL NERVECause-Site of injury-Muscles paralysed-DeformityDisability 32. DIAGNOSIS Relies mainly on clinical examination No specific lab. Studies CT myelography MRI Nerve conduction studies 33. TREATMENT Most injuries recover without any Rx Rx is done in very highly specializedcenters Surgical optionsa. nerve transfersb. nerve graftc. muscle transfersd. neurolysis of scar around the brachial plexus in incomplete lesions. 34. BRACHIAL PLEXUS BLOCKSupraclavicular approach Axillary approach 35. Roots join to form Trunks! (in neck)Ventral Rami Trunks C5 Upper Trunk C6 C7 Middle Trunk C8 T1Lower Trunk 36. Trunks Split to form Divisions! (in neck) TrunksDivisions Upper AnteriorPosterior Middle Anterior Posterior Lower AnteriorPosterior 37. Divisions Join to form Cords! (in axilla)TrunksDivisionsCordsUA LATERAL CORD PMAPMEDIAL CORDLA PPOSTERIOR CORD 38. Musculocutaneous Nerve Course Motor components Sensory: Skin along lateralsurface of forearm 39. Effects:Motor: paralysis of the supraspinatus, infraspinatus, subclavius, biceps brachii, part of brachialis, coracobrachialis; deltoid teres minor.Sensroy: sensory loss on the lateral side of the arm.Deformity:waiter tip postiona.limb will hang by the side,b.medially rotated by sternocostal part of the pectoralismajor;c. pronated forearm (biceps paralysis) 40. Motor effects:paralysis oftriceps Anconeus extensors of the wrist Extensors of fingers. Brachioradialis supinator muscle Deformity: Wrist and finger drop Sensory effects : small area of sensation loss at arm and forearm sensory loss over lateral part of the dorsum of the hand (lat. 3.5 fingers without distal phalynges) 41. Test for ulnar nerveCard testFroments signEgawas test 42. AXILLA CONTENT Axillary artery & its branches Axillary vein & its tributaries Infraclavicular part of brachial plexus Axillary lymph nodes Axillary fat 43. Carpal tunnel syndromeEpidemiologySigns &symptomsMotor changesSensory changesVasomotor changesTrophic changes 44. Tests doneTinel sign Phalens maneavure 45. Radial NerveInjury in axilla Causes of injuryMotor effects:paralysis of triceps,anconeus extensors of the wrist Extensors of fingers. Brachioradialis supinator muscle Deformity: Wrist and finger dropSensory effects -small area of sensation loss at arm andforearm sensory loss over lateral part of the dorsum of the hand (lat. 3.5 fingers without distal phalynges) 46. Injuries at Spiral Groove Caused by fracture shaft of humerus. Motor effects: paralysis of extensors of the wrist Extensors of fingers Deformity: Wrist and finger drop Sensory effects: anesthesia is present over the dorsalsurface of the hand (lat. 3.5 fingers)