Mbbs anatomyBRACHIAL PLEXUX RICHA CLASS.pptx

First year mbbs brachial plexus

1. Departmental seminar DR. RICHA GURUDIWAN 1 st yr PG Student S.C.B. Med. College CUTTACK

2. BRACHIAL PLEXUS CHAIRPERSON- DR. CHINMAYI moHAPATRA SPEAKER -DR. RICHA GURUDIWAN

3. Spinal Nerves Spinal nerves attach to the spinal cord via roots Dorsal root Has only sensory neurons Attached to cord via rootlets Dorsal root ganglion Ventral root Has only motor neurons No ganglion - all cell bodies of motor neurons found in gray matter of spinal cord

4. 8 pairs of cervical nerves from C1 to C8 12 pairs of thoracic nerves from T1-T12 5 pairs of lumbar nerves from L1 to L5 5 pairs of sacral nerves from S1 to S5 1 pair of coccygeal nerves located at C zero (Co) Spinal Nerves

5. introduction It is formed by ventral rami of C5-C8 & T1. C5 & C6 – receive grey rami from middle cervical ganglion of sympathatic trunk C7 & C8 – receive grey rami from inferior cervical ganglion T1 – receives gray rami from 1 st thoracic ganglion PREFIXED TYPE of plexus– C5 + C4 POSTFIXED TYPE of plexus– T1 + T2

6. In the neck , the brachial plexus lies in the posterior triangle, being covered by the skin, Platysma , and deep fascia;where it is crossed by the supraclavicular nerves, the inferior belly of the Omohyoid , the external jugular vein, and the transverse cervical artery. When It emerges between the Scaleni anterior and medius ; its proximal part lies above the third part of the subclavian artery, while the lower trunk placed behind the artery. RELATIONS

7. the plexus next passes behind the clavicle , the Subclavius , and the transverse scapular vessels, and lies upon the first digitation of the Serratus anterior, and the Subscapularis . In the axilla it is placed lateral & posterior cords are lateral to the first portion of the axillary artery, the medial cord lies behind it. It surrounds the second part of the artery, one cord lying medial to it, one lateral to it, and one behind it; at the lower part of the axilla it gives off its terminal branches to the upper limb.

8. formation Brachial plexus is formed by ventral rami of lower 4 cervical nerves and the 1 st thoracic nerve. It consists of: ROOTS TRUNKS DIVISIONS CORDS BRANCHES ROOTS : 5 in no(C5,C6,C7,C8,T1) & lie between S. anterior and medius muscle TRUNKS : 3 in no( upper,middle,lower ) & appear in Post. triangle of neck DIVISIONS : 6 in no(anterior and posterior) &Lie behind clavicle CORDS : 3 in no( lateral,medial,posterior ) & located in axilla

9. BRANCHES SUPRACLAVICULAR BRANCHES From the ROOTS Dorsal scapular nerve/ nerve to rhomboids A branch to join phrenic nerve Long thoracic nerve Muscular branches to join longus coli and scaleni From the TRUNKS – Upper trunk Nerve to subclavius Suprascapular nerve

10. Branches of LATERAL CORD : 1)Lateral pectoral 2) musculo-cutaneous 3)Lateral root of Median nerve b)Branches of MEDIAL CORD : 1)Medial pectoral 2)Medial cutaneous nerve of forearm 3)Medial cutaneous nerve of arm 4) Ulnar nerve 5) Medial root of median nerve c)Branches of POSTERIOR CORD : 1)Upper subscapular 2)Lower subscapular 3) Thoracodorsal 4) Axillary nerve 5)Radial nerve INFRACLAVICULAR BRANCHES

11. NERVE SUPPLY From Nerve Roots Muscles Cutaneous Roots Nerves to scaleni and longus coli C5,C6,C7,C8 scaleni and longus coli Roots Branch to phrenic nerve C5 Roots dorsal scapular nerve C5 rhomboid muscles and levator scapulae - Roots long thoracic nerve C5, C6 , C7 serratus anterior - Upper trunk nerve to the subclavius C5,C6 subclavius muscle - Upper trunk suprascapular nerve C5, C6 supraspinatus and infraspinatus -

12. From lateral cord Lateral Cord lateral pectoral nerve C5, C6, C7 pectoralis major and pectoralis minor (by communicating with the medial pectoral nerve ) - Lateral Cord musculocutaneous nerve C5, C6, C7 coracobrachialis , brachialis and biceps brachii becomes the lateral cutaneous nerve of the forearm Lateral Cord lateral root of the median nerve C5, C6, C7 fibres to the median nerve -

13. POSTERIOR CORD BRANCHES Posterior Cord upper subscapular nerve C5, C6 subscapularis (upper part) - Posterior Cord thoracodorsal nerve (middle subscapular nerve) C6, C7, C8 latissimus dorsi - Posterior Cord lower subscapular nerve C5, C6 subscapularis (lower part ) and teres major -

14. POSTERIOR CORD BRANCHES Posterior Cord Axillary Nerve C5, C6 Anterior Branch: Deltoid And A Small Area Of Overlying Skin Posterior Branch: Teres Minor And Deltoid Muscles Posterior Branch Becomes Upper Lateral Cutaneous Nerve Of The Arm Posterior Cord Radial Nerve C5, C6, C7, C8, T1 Triceps Brachii , Supinator , Anconeus , The Extensor Muscles Of The Forearm , And Brachioradialis Skin Of The Posterior Arm As The Posterior & lower lat. Cutaneous Nerve Of The Arm and posterior cutaneous nerve of forearm.

15. MEDIAL CORD BRANCHES Medial cord Medial pectoral nerve C8, t1 Pectoralis major and pectoralis minor - Medial cord Medial root of the median nerve C8, t1 Fibres to the median nerve - Medial cord Medial cutaneous nerve of the arm C8, t1 - Front and medial skin of the arm

16. MEDIAL CORD BRANCHES Medial Cord Medial Cutaneous Nerve Of The Forearm C8, T1 - Medial Skin Of The Forearm Medial Cord Ulnar Nerve C8, T1 Flexor Carpi Ulnaris , The Medial 2 Bellies Of Flexor Digitorum Profundus , The Intrinsic Hand Muscles Except The Thenar Muscles And The Two Most Lateral Lumbricals The skin of the medial side of the hand medial one and a half fingers .

17. Musculocutaneous nerve

18. AXILLARY NERVE

19. Median nerve

20. The median nerve continues into the hand by passing deep to the flexor retinaculum . It innervates: Three thenar muscles associated with the thumb Lateral 2 lumbrical muscles associated with movement of the index and middle fingers; and Skin over the palmar surface of the lateral three and one-half digits and over the lateral side of the palm and middle of the wrist.

21. ULNAR NERVE

22. RADIAL NERVE

23. APPLIED ANATOMY 1)ERB-DUCHENE PARALYSIS (Upper Trunk paralysis) – most common during birth,occurs due to forecep use in delivery or due to extraction of head in breech presentation Occurs due to excessive stretching of upper trunk at ERB’S POINT; which is meeting point of 6 nerves-C5 & C6 roots, nerve to subclavius & suprascapular nerve, ant. & post. Divisions of U. trunk In this 6 muscles are paralysed-deltoid,suprasinatus,infraspinatus,biceps,brachialis & brachioradialis . It resembles PORTER’S TIP Hand in which arms hang by the side & is rotated medially; forearm is extended & pronated ; with flexed fingers &wrist

24. 2)KLUMPKE’S PARALYSIS (Lower Trunk paralysis) : occurs due to injury of C8 & T1 nerves and is caused by pressure of a cervical rib . It results in paralysis of intinsic muscles of the hand & flexors of the digits resulting in CLAW HAND & aneasthesia along inner side of the forearm,hand & little finger

25. 3) WINGING OF SCAPULA : Occurs due to injury of Long Thoracic nerve of BELL resulting in paralysis of serratous anterior. It is manifested by backward projection of scapula when arm is held forward due to UNOPPOSED action of rhomboids & levator scapulae. 4)WRIST DROP : Occurs in fracture of humerus in the region of spiral groove or by pressure of a crutch in the axilla . Hand become flaccid and flexed at the wrist.

26. 4)CARPAL TUNNEL SYNDROME : Occurs due to compression of median nerve in inflammatory condition or anterior dislocation of lunate.It leads to weakness and wasting of thenar muscle with loss of power of opposition and loss of palmar cutaneous sensation involving lateral three and half digits 5)CLAW HAND : Occurs due to ulnar nerve injury invoving medial two fingers which are extended in metacarpophalangeal joints and partially flexed at interphalangeal joints.

27. THANK YOU