Brachial plexus applied anatomy Dr sumer yadav

Brachial plexus

Where Ventral Rami Come From

Dorsal Root

Ventral Root

spinal nerve

Dorsal Ramus of spinal nerve

Ventral Ramusof spinal nerve

Parts of Brachial Plexus

• R = ROOTS (ventral rami)

• T = TRUNKS

• D = DIVISIONS

• C = CORDS

• B = BRANCHES

Relationship of cords of brachial plexus withaxillary artery

PUT IT ALL TOGETHER…...

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

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 SUBCLAVIUSRoot 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

12-14

MEDIAN NERVE

MEDIAL CUTANEOUS NERVE OF ARMRoot value- C8,T1

MEDIAL CUTANEOUS NERVE OFFOREARMRoot value- C8,T1

12-16

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 shoulderSudden pressure on shoulder from above

Deformity – Winging of scapulaOverhead abduction not possible

ERB’S PARALYSIS

• Erb’s point

• Causes

• Nerve roots involved

• Muscles Paralysed

• Deformity

• Disability

LEFT SIDE PARALYSIS

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)

Klumpke’s paralysis-

Site of injury

Cause of injury

Nerve roots involved

Muscles paralysed

Deformity

Disability

CLAW HAND HORNER SYNDROME

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

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

Carpal tunnel syndrome

Epidemiology

Signs &symptoms

Motor changes

Sensory changes

Vasomotor changes

Trophic changes

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.

• This posture occurs because of paralysis and atrophy of:

• Deltoid

• Biceps brachii

• Brachialis

• brachioradialis

Erb’s Duchenne Palsy

Tests done

Tinel sign Phalen’s maneavure

ULNAR NERVE

Causes-

Axilla- crutch pressureArm- # of shaft of humerusElbow- # of medial epicondyleForearm- penetrating injuriesWrist- cut and stab wounds

Muscles paralysed-

Deformity

Disability

Claw Hand Deformities

Test for ulnar nerve

Card test

Froment’s sign

Egawa’s test

RADIAL NERVE

Cause-

Site of injury-

Muscles paralysed-

Deformity

Disability

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)

• 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)

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)

DIAGNOSIS

• Relies mainly on clinical examination

• No specific lab. Studies

• CT myelography

• MRI

• Nerve conduction studies

Claw Hand Deformities

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.

BRACHIAL PLEXUS BLOCK

Supraclavicular approach Axillary approach