brachial plexus applied anatomy

brachial plexus anatomy, applied

1. Brachial plexus applied anatomy D r sumer yadav

2. Brachial plexus

3. Where Ventral Rami Come From Dorsal Root Ventral Root spinal nerve Dorsal Ramus of spinal nerve Ventral Ramus of spinal nerve

4. Parts of Brachial Plexus R = ROOTS (ventral rami ) T = TRUNKS D = DIVISIONS C = CORDS B = BRANCHES

5. Relationship of cords of brachial plexus with axillary artery

6. PUT IT ALL TOGETHER…...

7. 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

8. 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)

9. BRANCHES OF ROOTS DORSAL SCAPULAR NERVE Root value- C5 Supply – Rhomboid major & minor muscle Posterior view

10. LONG THORACIC NERVE Root value- C5,C6,C7 S upply – Serratus anterior muscle

11. BRANCHES OF UPPER TRUNK NERVE TO SUBCLAVIUS Root value – C5,C6 SUPRASCAPULAR NERVE Root value – C5,C6

12. LATERAL PECTORAL NERVE Root value- C5,C6,C7 MEDIAL PECTORAL NERVE Root value- C8,T1

13. MUSCULOCUTANEOUS NERVE Root value – C5,C6,C7

14. 12- 14 MEDIAN NERVE

15. MEDIAL CUTANEOUS NERVE OF ARM Root value- C8,T1 MEDIAL CUTANEOUS NERVE OF FOREARM Root value- C8,T1

16. 12- 16 U LNAR NERVE Root value-(C7),C8,T1

17. UPPER SUBSCAPULAR Root value-C5,C6 LOWER SUBSCAPULAR Root value- C5,C6 NERVE TO LATISSIMUS DORSI Root value-C6,C7,C8

18. AXILLARY NERVE

19. RADIAL NERVE

20. DERMATOMES OF UPPER LIMB

21. APPLIED ANATOMY

22. TENDON REFLEXES Biceps brachii tendon reflexe (C5,C6) Triceps tendon reflex (C6,C7,C8) Brachioradialis tendon reflex(C5,C6,C7)

23. LONG THORACIC NERVE Causes - carrying Heavy load on shoulder Sudden pressure on shoulder from above Deformity – Winging of scapula Overhead abduction not possible

24. ERB’S PARALYSIS Erb’s point Causes Nerve roots involved Muscles Paralysed Deformity Disability

25. LEFT SIDE PARALYSIS

26. 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 postion limb will hang by the side, medially rotated by sternocostal part of the pectoralis major; pronated forearm (biceps paralysis)

27. Klumpke’s paralysis- Site of injury Cause of injury Nerve roots involved Muscles paralysed Deformity Disability

28. CLAW HAND HORNER SYNDROME

29. 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

30. MUSCULOCUTANEOUS NERVE Cause Muscle paralysed Disability SUPRASCAPULAR NERVE Cause Muscle paralysed Disability

31. 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 :

32. MEDIAN NERVE – Cause- Site of injury- Muscles paralysed - Deformity Disability RIGHT SIDE

33. Carpal tunnel syndrome Epidemiology Signs &symptoms Motor changes Sensory changes Vasomotor changes Trophic changes

34. 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.

35. This posture occurs because of paralysis and atrophy of: Deltoid Biceps brachii Brachialis brachioradialis Erb’s Duchenne Palsy

36. Tests done Tinel sign Phalen’s maneavure

37. ULNAR NERVE Causes- Axilla - crutch pressure Arm- # of shaft of humerus Elbow- # of medial epicondyle Forearm - penetrating injuries Wrist- cut and stab wounds Muscles paralysed - Deformity Disability

38. Claw Hand Deformities

39. Test for ulnar nerve Card test Froment’s sign Egawa’s test

40. RADIAL NERVE Cause- Site of injury- Muscles paralysed - Deformity Disability

41. Radial Nerve Injury in axilla Causes of injur y 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 )

42. 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 )

43. 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)

44. DIAGNOSIS Relies mainly on clinical examination No specific lab. Studies CT myelography MRI Nerve conduction studies

45. Claw Hand Deformities

46. TREATMENT Most injuries recover without any Rx Rx is done in very highly specialized centers Surgical options nerve transfers nerve graft muscle transfers neurolysis of scar around the brachial plexus in incomplete lesions.

47. BRACHIAL PLEXUS BLOCK Supraclavicular approach Axillary approach