brachial plexus & applied
Post on 07-May-2015
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Brachial plexus
Where Ventral Rami Come From
Dorsal Root
Ventral Root
spinal nerve
Dorsal Ramus of spinal nerve
Ventral Ramus of spinal nerve
Parts of Brachial Plexus
• R = ROOTS (ventral rami)• T = TRUNKS• D = DIVISIONS• C = CORDS• B = BRANCHES
Relationship of cords of brachial plexus with axillary artery
PUT IT ALL TOGETHER…...
Branches of roots - Dorsal scapular nerve(C5) Long thoracic nerve (C5,C6,C7) muscular branches to longus colli & scaleni Branch to phrenic nerve
Branches of upper- Nerve to subclavius (C5,C6)
Trunk Suprascapular nerve (C5,C6)
BRANCHES OF SUPRACLAVICULAR PART OF BRACHIAL PLEXUS
BRANCHES OF INFRACLAVICULAR PART OF BRACHIAL PLEXUS
• Lateral cord Musculocutaneous 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)
BRANCHES OF ROOTS
DORSAL SCAPULAR NERVE
• Root value- C5• Supply – Rhomboid major & minor muscle
Posterior view
LONG THORACIC NERVERoot value- C5,C6,C7Supply – Serratus anterior muscle
BRANCHES OF UPPER TRUNK
NERVE TO SUBCLAVIUS Root value – C5,C6
SUPRASCAPULAR NERVERoot value – C5,C6
LATERAL PECTORAL NERVE
Root value- C5,C6,C7
MEDIAL PECTORAL NERVE
Root value- C8,T1
MUSCULOCUTANEOUS NERVE
Root value – C5,C6,C7
12-13
MEDIAN NERVE
MEDIAL CUTANEOUS NERVE OF ARMRoot value- C8,T1
MEDIAL CUTANEOUS NERVE OF FOREARMRoot value- C8,T1
12-15
ULNAR NERVE
Root value-(C7),C8,T1
UPPER SUBSCAPULARRoot value-C5,C6
LOWER SUBSCAPULARRoot value- C5,C6
NERVE TO LATISSIMUS DORSIRoot value-C6,C7,C8
AXILLARY NERVE
RADIAL NERVE
DERMATOMES OF UPPER LIMB
APPLIED ANATOMY
TENDON REFLEXES
• Biceps brachii tendon reflexe (C5,C6)
• Triceps tendon reflex (C6,C7,C8)
• Brachioradialis tendon reflex(C5,C6,C7)
LONG THORACIC NERVE
Causes - carrying Heavy load on shoulder Sudden pressure on shoulder from above
Deformity – Winging of scapula Overhead abduction not possible
ERB’S PARALYSIS
• Erb’s point
• Causes
• Nerve roots involved
• Muscles Paralysed
• Deformity
• Disability
LEFT SIDE PARALYSIS
Klumpke’s paralysis-
Site of injury
Cause of injury
Nerve roots involved
Muscles paralysed
Deformity
Disability
CLAW HAND HORNER SYNDROME
MUSCULOCUTANEOUS NERVE
• Cause• Muscle paralysed• Disability
SUPRASCAPULAR NERVE
• Cause• Muscle paralysed• Disability
AXILLARY NERVE• Causes crutch pressing upward into the
armpit, Downward shoulder dislocations fractures of the surgical neck of
the humerus. • Motor effects:
• Sensory effects:
• Deformity:
MEDIAN NERVE –
Cause-
Site of injury-
Muscles paralysed-
Deformity
Disability
RIGHT SIDE
ULNAR NERVE
Causes-
Axilla- crutch pressureArm- # of shaft of humerusElbow- # of medial epicondyleForearm- penetrating injuriesWrist- cut and stab wounds
Muscles paralysed-
Deformity
Disability
RADIAL NERVE
Cause-
Site of injury-
Muscles paralysed-
Deformity
Disability
DIAGNOSIS
• Relies mainly on clinical examination• No specific lab. Studies• CT myelography• MRI• Nerve conduction studies
TREATMENT
• Most injuries recover without any Rx• Rx is done in very highly specialized centers• Surgical optionsa. nerve transfersb. nerve graftc. muscle transfersd. neurolysis of scar around the brachial plexus in incomplete lesions.
BRACHIAL PLEXUS BLOCK
Supraclavicular approach Axillary approach
Roots join to form Trunks! (in neck)
Ventral Rami Trunks
• C5 Upper Trunk• C6• C7 Middle Trunk• C8• T1 Lower Trunk
Trunks Split to form Divisions! (in neck)• Trunks Divisions
• Upper AnteriorPosterior
• Middle Anterior
Posterior
• Lower Anterior Posterior
Divisions Join to form Cords! (in axilla)
U A P
M A P
L A P POSTERIOR CORD
LATERAL CORD
MEDIAL CORD
Trunks Divisions Cords
Musculocutaneous Nerve
• Motor components
• Sensory: Skin along lateral surface of forearm
Course
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 pectoralis major; c. pronated forearm (biceps paralysis)
• Motor effects:paralysis of triceps 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)
Test for ulnar nerve Card test
Froment’s sign
Egawa’s test
AXILLA
CONTENT• Axillary artery & its
branches• Axillary vein & its tributaries• Infraclavicular part of
brachial plexus• Axillary lymph nodes• Axillary fat
Carpal tunnel syndrome
Epidemiology
Signs &symptoms
Motor changes
Sensory changes
Vasomotor changes
Trophic changes
Tests done
Tinel sign Phalen’s maneavure
Radial Nerve Injury in axilla• Causes of injury
Motor 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)
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 dorsal surface of the hand (lat. 3.5 fingers)
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