Brachial plexus by Dr. Rahul Singh Thakur

Brachial plexus

1. M.B.B.S {GMC, AMBEDKARNAGAR} ANATOMY DR . RAHUL SINGH THAKUR Brachial Plexus

2. DESCRIBE Brahcial Plexus in details. 10 MARKS ( 2011 SUPPLY , 2012 MAIN) SHORT NOTE ON Brachial Plexus. 2013 MAIN, 2014 MAIN, 2014 SUPPLY , 2015 MAIN, 2017 MAIN Enumerate Posterior cord of Brachial Plexus 2014 SUPPLY , 2015 MAIN, 2017 MAIN EVERY second terminal and PCT

3. Nerves Plexus  The principal plexuses are: Cervical plexus Brachial plexus Lumbar plexus Sacral plexus Cocygeal plexus

4. Brachial Plexus The anterior (ventral) rami of spinal nerves C5-C8 and T1 form the brachial plexus. Passes above the first rib posterior to the clavicle and then enter the axilla ( cervicoaxillary canal). The brachial plexus provide the entire nerve supply of the shoulder and upper limbs.

5.  Five important nerves arise from brachial plexus are: Axillary nerve Musculocutaneous nerve Radial nerve Median nerve Ulnar nerve Brachial Plexus

6. SOME BASIC TERMS GREY MATTER : COLLECTION OF CELL BODIES within CNS WHITE MATTER : BUNDLES OF AXONS CEPHALIC – UPWARDS CAUDIALLY – DOWNWARDS ASCENDING TRACT- UPWARDS DESCENDING TRACTS- DOWNWARDS R TO L FIBRES : COMMISURE FIBRE e.g corpus callosum Peduncle s : bundle of nerve fibre

7. Where Ventral Rami Come From Dorsal Root Ventral Root spinal n erve Dorsal Ramus of spinal nerve Ventral Ramus of spinal nerve

8. Branches of a Spinal Nerve Spinal nerves: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal. Each has dorsal and ventral ramus .

9. Parts of Brachial Plexus R oots T runks D ivisions C ords B ranches R eal T rainers D rink C old B eer

10. Relationship of cords of brachial plexus with axillary artery

11. Spe c ific Branches One can remember the specific branches of lateral, posterior and medial cord using the mnemonic LML , ULNAR , M4U respectively . LML – L ateral pectoral nerve , M usculocutaneous nerve , L ateral root of the median nerve .

12. ULNAR – U pper subscapular nerve , L ower subscapular nerve , N erve to latissmus dorsi (thoracodorsal nerve) , A xillary nerve , R adial nerve.

13. M4U – M edial pectoral nerve , M edial root of the median nerve , M edial cutaneous nerve of the arm , M edial cutaneous nerve of the forearm , U lnar nerve.

14. S u pr a s pi n a t u s , infraspinatus C6, C6 Suprascapular Superior trunk Subclavius C5, C6 Subclavian Superior trunk Serratus anterior C5, C6, C7 Long thoracic R oo t s Rhomboid minor, major and levator scapulae C 5 Dorsal scapular R oo t s Muscles R oo t N e r ve F r o m

15. Muscles R oo t N e r v e F r o m Subscapularis C5, C6 Upper subcsapular nerve Posterior cord Fibers to the median nerve C5. C6, C7 Lateral root of the median nerve Lateral cord C o r a co b ra c hi a l i s , brachialis, biceps brachii C5. C6, C7 Mu s c u l oc u t a n e o u s nerve Lateral cord Pectoralis major C5. C6, C7 Lateral pectoral nerve Lateral cord

16. Triceps brachii, supinator, anconeus, extensor muscles move the hand, brachioradialis C5-C8, T1 Radial nerve Posterior cord Anterior branch: Deltoid Posterior branch: Teres minor C5, C6 Axillary nerve Posterior cord Subscapularis C5, C6 Lower s u b s c a p u l a r Posterior cord Latissimus dorsi C6, C7, C8 T h o r a c o d o rs a l nerve Posterior cord Muscles R oo t N e r v e F r o m

17. Skin of medial and posterior aspects of forearm C8, T1 Medial cutaneous nerve of the forearm (medial antebrachial cutaneous) Medial cord Skin of medial and posterior aspect of distal third of arm C8, T1 Medial cutaneous nerve of the arm (medial brachial cutaneous) Medial cord Fibers to the median nerve C8, T1 Medial root of median nerve Medial cord Pectoralis major, Pectoralis minor C8, T1 Medial pectoral nerve Medial cord Muscles R oo t N e r v e F r o m

18. From Nerve Root Muscles Medial cord Ulnar nerve C8, T1 Flexor carpi ulnaris, flexor digitorum profundus, most of the small muscles of the hand

19. APPLIED ANATOMY

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

21. LEFT SIDE PARALYSIS

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

23. CLAW HAND HORNER SYNDROME

24. Klumpke’s palsy Results from a brachial plexus injury in which C8 and T1 nerves are injured . Affects, the intrinsic muscles of the hand and the flexors of the wrist and fingers. The classic presentation of klumpke's palsy is the “claw hand” where the forearm is supinated and the wrist and fingers are hyperextended with flexion at interphalangeal and metatarso phalangeal joints.

25. Erb’s palsy Erb's palsy ( Erb-Duchenne Palsy ) is a paralysis of the arm caused by injury to the upper trunk C5-C6. signs of Erb's Palsy include loss of sensation in the arm and paralysis and atrophy of the deltoid, biceps, and brachialis muscles. the arm hangs by the side and is rotated medially; the forearm is extended and pronated. commonly called "waiter's tip hand."

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