brachial plexus applied anatomy
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Transcript of brachial plexus applied anatomy
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Brachial plexus applied anatomy Dr sumer yadav
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Brachial plexus
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Where Ventral Rami Come From
Dorsal Root
Ventral Root
spinal nerve
Dorsal Ramus of spinal nerve
Ventral Ramusof spinal nerve
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Parts of Brachial Plexus
• R = ROOTS (ventral rami)
• T = TRUNKS
• D = DIVISIONS
• C = CORDS
• B = BRANCHES
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Relationship of cords of brachial plexus withaxillary artery
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PUT IT ALL TOGETHER…...
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Branches of roots - Dorsal scapular nerve(C5)
Long thoracic nerve (C5,C6,C7)
muscular branches to longus colli & scaleniBranch to phrenic nerve
Branches of upper- Nerve to subclavius (C5,C6)
Trunk Suprascapular nerve (C5,C6)
BRANCHES OF SUPRACLAVICULAR PART OFBRACHIAL PLEXUS
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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)
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BRANCHES OF ROOTS
DORSAL SCAPULAR NERVE
• Root value- C5
• Supply – Rhomboid major &
minor muscle
Posterior view
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LONG THORACIC NERVERoot value- C5,C6,C7Supply – Serratus anterior muscle
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BRANCHES OF UPPER TRUNK
NERVE TO SUBCLAVIUSRoot value – C5,C6
SUPRASCAPULAR NERVERoot value – C5,C6
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LATERAL PECTORAL NERVE
Root value- C5,C6,C7
MEDIAL PECTORAL NERVE
Root value- C8,T1
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MUSCULOCUTANEOUS NERVE
Root value – C5,C6,C7
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12-14
MEDIAN NERVE
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MEDIAL CUTANEOUS NERVE OF ARMRoot value- C8,T1
MEDIAL CUTANEOUS NERVE OFFOREARMRoot value- C8,T1
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12-16
ULNAR NERVE
Root value-(C7),C8,T1
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UPPER SUBSCAPULARRoot value-C5,C6
LOWER SUBSCAPULARRoot value- C5,C6
NERVE TO LATISSIMUS DORSIRoot value-C6,C7,C8
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AXILLARY NERVE
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RADIAL NERVE
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DERMATOMES OF UPPER LIMB
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APPLIED ANATOMY
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TENDON REFLEXES
• Biceps brachii tendon reflexe (C5,C6)
• Triceps tendon reflex (C6,C7,C8)
• Brachioradialis tendon reflex(C5,C6,C7)
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LONG THORACIC NERVE
Causes - carrying Heavy load on shoulderSudden pressure on shoulder from above
Deformity – Winging of scapulaOverhead abduction not possible
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ERB’S PARALYSIS
• Erb’s point
• Causes
• Nerve roots involved
• Muscles Paralysed
• Deformity
• Disability
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LEFT SIDE PARALYSIS
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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)
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Klumpke’s paralysis-
Site of injury
Cause of injury
Nerve roots involved
Muscles paralysed
Deformity
Disability
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CLAW HAND HORNER SYNDROME
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Klumpke’s Palsy
• Rare
• Involving lower root (C8 and T1)
• Affecting forearm and hand
• Characterize by paralysis and atrophy of the small hand muscles and flexor of the wrist.
• Claw hand
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MUSCULOCUTANEOUS NERVE
• Cause
• Muscle paralysed
• Disability
SUPRASCAPULAR NERVE
• Cause
• Muscle paralysed
• Disability
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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:
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MEDIAN NERVE –
Cause-
Site of injury-
Muscles paralysed-
Deformity
Disability
RIGHT SIDE
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Carpal tunnel syndrome
Epidemiology
Signs &symptoms
Motor changes
Sensory changes
Vasomotor changes
Trophic changes
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Carpal Tunnel Syndrome
• Compression median nerve at the carpal tunnel
• Patient will experience numbness, tingling, or burning sensation at the thumb, index, middle and radial half of the ring finger.
• If untreated – weakness or atrophy of the thenar muscles.
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• This posture occurs because of paralysis and atrophy of:
• Deltoid
• Biceps brachii
• Brachialis
• brachioradialis
Erb’s Duchenne Palsy
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Tests done
Tinel sign Phalen’s maneavure
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ULNAR NERVE
Causes-
Axilla- crutch pressureArm- # of shaft of humerusElbow- # of medial epicondyleForearm- penetrating injuriesWrist- cut and stab wounds
Muscles paralysed-
Deformity
Disability
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Claw Hand Deformities
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Test for ulnar nerve
Card test
Froment’s sign
Egawa’s test
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RADIAL NERVE
Cause-
Site of injury-
Muscles paralysed-
Deformity
Disability
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Radial NerveInjury 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 drop
Sensory 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)
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• 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)
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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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DIAGNOSIS
• Relies mainly on clinical examination
• No specific lab. Studies
• CT myelography
• MRI
• Nerve conduction studies
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Claw Hand Deformities
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TREATMENT
• Most injuries recover without any Rx
• Rx is done in very highly specialized
centers
• Surgical options
a. nerve transfers
b. nerve graft
c. muscle transfers
d. neurolysis of scar around the
brachial plexus in incomplete lesions.
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BRACHIAL PLEXUS BLOCK
Supraclavicular approach Axillary approach
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