BRACHIAL PLEXUS AND APPLIED

1. Brachial plexus

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

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

4. Relationship of cords of brachial plexus with
axillary artery

5. PUT IT ALL TOGETHER…...

6. BRANCHES OF SUPRACLAVICULAR PART OF
BRACHIAL PLEXUS
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)

7. 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)

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

9. LONG THORACIC NERVE
Root value- C5,C6,C7
Supply – Serratus anterior
muscle

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

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

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

13. MEDIAN NERVE
12-13

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

15. ULNAR NERVE
Root value-(C7),C8,T1
12-15

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

17. AXILLARY NERVE

18. RADIAL NERVE

19. DERMATOMES OF UPPER LIMB

20. APPLIED ANATOMY

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

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

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

26. LEFT SIDE PARALYSIS

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

28. CLAW HAND HORNER SYNDROME

29. MUSCULOCUTANEOUS NERVE
• Cause
• Muscle paralysed
• Disability
SUPRASCAPULAR NERVE
• Cause
• Muscle paralysed
• Disability

30. 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:

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

32. 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

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

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

35. 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.

36. BRACHIAL PLEXUS BLOCK
Supraclavicular approach Axillary approach

40. Roots join to form Trunks! (in neck)
Ventral Rami Trunks
• C5 Upper Trunk
• C6
• C7 Middle Trunk
• C8
• T1 Lower Trunk

41. Trunks Split to form Divisions! (in neck)
• Trunks Divisions
• Upper Anterior
Posterior
• Middle Anterior
Posterior
• Lower Anterior
Posterior

42. Divisions Join to form Cords! (in axilla)
Trunks Divisions Cords
U A LATERAL CORD
P
M A
P
MEDIAL CORD
L A
P POSTERIOR CORD

43. Musculocutaneous Nerve
Course
• Motor components
• Sensory: Skin along lateral
surface of forearm

44.  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
a. limb will hang by the side,
b. medially rotated by sternocostal part of the pectoralis
major;
c. pronated forearm (biceps paralysis)

45. • 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)

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

49. AXILLA
CONTENT
• Axillary artery & its
branches
• Axillary vein & its tributaries
• Infraclavicular part of
brachial plexus
• Axillary lymph nodes
• Axillary fat

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

51. Tests done
Tinel sign Phalen’s maneavure

52. Radial Nerve
Injury 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)

53. 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)